Nursing Care and Patient Outcomes in Women Experiencing Postpartum Hemorrhage: A Comprehensive Review of Early Recognition, Emergency Response, Blood Loss Monitoring, and Maternal Safety in Clinical Practice

Abstract

Postpartum Haemorrhage (PPH) is a time-critical obstetric emergency that can cause severe anaemia, shock, organ injury, emergency surgery, psychological distress and maternal death. Its course may be rapid, and the first signs can be subtle; a woman may lose a clinically important volume of blood before hypotension becomes obvious. Nurses and midwives are central to prevention, early recognition, accurate blood-loss measurement, activation of emergency response systems, delivery of prescribed treatment, communication and recovery support. This narrative review synthesises current international guidance and selected clinical evidence relevant to nursing care of women with PPH. It discusses definitions and causes, risk assessment, the limitations of visual estimation, objective cumulative blood-loss measurement, haemodynamic surveillance, the first-response treatment bundle, transfusion and escalation, respectful communication and post-event follow-up. The 2025 World Health Organization guidance recommends routine objective measurement after birth and a practical recognition threshold based on at least 500 mL of measured blood loss or at least 300 mL accompanied by abnormal haemodynamic signs, whichever occurs first, with close attention in the first two hours. Treatment should not be delayed while waiting for a numerical threshold when bleeding or clinical deterioration is concerning. Evidence from the E-MOTIVE trial supports combining calibrated blood-collection methods with an organized treatment bundle and implementation support. Nursing priorities include calling for help early, assessing uterine tone and bleeding, monitoring vital signs and shock index, securing access and samples as directed, assisting with uterotonics and tranexamic acid according to protocol, preparing for escalation and maintaining clear records. Sustained improvement requires simulation, reliable equipment, multidisciplinary teamwork, audit and compassionate follow-up. These actions must be adapted to the woman’s condition, local resources and current institutional protocols.