From guesstimates to game changers: Introducing objective measurement of blood loss for timely postpartum hemorrhage detection in Nigeria, Zambia, and Kenya.

Accurate, timely diagnosis of postpartum hemorrhage (PPH) is critical for effective management. However, in low-resource settings, reliance on visual estimation leads to missed diagnoses in up to 50% of cases, underscoring the need for more objective and reliable methods. Evidence suggests that the use of tools for objective measurement of blood loss, such as calibrated drapes, can improve early detection and prompt treatment of PPH. This article shares learning from the Accelerating Measurable Progress and Leveraging Investments for Postpartum Hemorrhage Impact (AMPLI-PPHI) project's experience introducing calibrated drapes for PPH detection in coordination with governments of Nigeria and Zambia and supporting county government-led rollout in Kenya. Early implementation revealed key lessons including the importance of engagement of ministries of health and key stakeholders in decision-making on the type of calibrated tool to use. Care must be taken to prepare healthcare providers, communities, government authorities, and other stakeholders about the potential increase in reported PPH cases due to more accurate measurement and diagnosis. Persistent challenges remain concerning safe waste disposal and ensuring monitoring of blood loss and vital signs, including documentation of checks every 15 min in the first hour, as recommended by 2025 WHO-FIGO-ICM guidelines. Additionally, context-specific considerations may be required for scale-up of objective measurement of postpartum blood loss, such as understanding the cultural dynamics related to blood measurement and afterbirth practices, and ensuring the workforce is sufficient in numbers and capacity to provide close monitoring and measurement of blood loss necessary for early PPH detection.