Débora jade Cavalcante Porto, Rodrigo Lima pithon
Postpartum hemorrhage (PPH) is one of the main challenges in reducing maternal mortality in Brazilian public maternity hospitals, being the leading cause of preventable deaths in the pregnancy-puerperium cycle. This article reviews prophylactic measures in the third stage of labor, along with the new protocol for early detection of PPH, based on updates recorded in the FEBRASGO Obstetrics Treatise (2025) and the consolidated guidelines of the World Health Organization (WHO, 2025). The study highlights the transition from sequential postpartum management to the E-motive strategy, which advocates simultaneous intervention through previously established protocols and packages of measures. The article also discusses the relevance of early PPH detection through the use of volumetric collectors and the application of the Shock Index as a marker of occult hemodynamic instability. The analysis focuses on active management, emphasizing the judicious use of uterotonics, the fundamental role of tranexamic acid as a first-line drug in postpartum hemorrhage (PPH), and rigorous clinical monitoring during the fourth Greenberg stage. It concludes that the systematic implementation of these protocols in public institutions is essential to transform maternal prognosis and ensure healthcare safety.