Current strategies for the diagnosis and management of postpartum hemorrhage: a focused review of four Cochrane Systematic Reviews from 2024 and 2025

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, particularly in low-resource settings. Despite international initiatives, significant variability persists in how PPH is diagnosed and managed. This integrative review synthesizes findings from four recent Cochrane systematic reviews published in 2024 and 2025, aiming to inform clinical practice and highlight research gaps. The included reviews examined: (1) diagnostic accuracy of tools during vaginal birth, (2) implementation strategies for WHO guidelines, (3) transfusion of blood and blood products, and (4) intraoperative cell salvage during cesarean delivery. Calibrated blood loss tools combined with clinical observation demonstrated superior performance compared to visual estimation, with pooled sensitivity of 93% and specificity of 95%. Multicomponent strategies modestly improved adherence to WHO-recommended practices, yet had limited impact on maternal mortality and ICU admissions. Evidence regarding transfusion thresholds, fibrinogen concentrate, and cryoprecipitate was of low certainty and inconclusive. Intraoperative cell salvage showed potential benefits, including a reduction in total blood loss (mean difference –113.6 mL) and a modest increase in postpartum hemoglobin (mean difference +6.14 g/L), although the overall quality of evidence remains low. This review underscores the value of objective measurement tools and structured implementation efforts in improving PPH care. However, transfusion and salvage practices require further validation in high-quality randomized trials. Greater attention is needed to address context-specific challenges, particularly in settings with limited resources.