Research Concept · HypothesisPre-publication

Can the PPH treatment window be defined by oxygen-delivery risk, not blood-loss volume alone?

Postpartum hemorrhage is first a bleeding emergency. The immediate clinical priority is rapid recognition, hemorrhage control and evidence-based PPH treatment. The research question here is narrower: during severe blood loss, can we define the physiological window in which oxygen delivery is becoming inadequate before irreversible organ injury develops?

01 / Current clinical direction

PPH care is moving earlier.

WHO's 2025 consolidated PPH guidance emphasizes early recognition and rapid response. WHO also highlighted acting at 300 mL blood loss when abnormal vital signs are present, rather than waiting only for a traditional 500 mL threshold.

The same guidance keeps established emergency measures central: uterine massage, uterotonics, tranexamic acid, intravenous fluids, examination, escalation of care, surgery when required and blood transfusion when indicated.

02 / BHOC research hypothesis

The key window may be physiological, not simply volumetric.

Blood-loss volume helps identify the event, but a future oxygen-delivery therapeutic would require its own patient-selection logic. The relevant question is whether a measurable combination of bleeding severity, vital signs, perfusion and oxygenation signals can identify a high-risk interval in which oxygen-delivery support could be studied as a complement to hemorrhage control and definitive transfusion care.

This is a protocol-development question, not a proposal to replace blood components, surgery, uterotonics, TXA or patient blood management.

03 / Protocol concept to investigate

Define the treatment window before defining the product role.

1 / RecognizePPH and active bleeding early
2 / ControlStart guideline-based hemorrhage treatment immediately
3 / AssessIdentify worsening perfusion and oxygen-delivery risk
4 / InvestigateStudy BHOC only in a prospectively defined eligible window
5 / EscalateContinue definitive obstetric, surgical and transfusion care
04 / Questions to test

The research program begins with patient selection.

Which patient?Which combination of measured blood loss, hemodynamics, clinical deterioration and validated perfusion or oxygenation markers identifies the relevant treatment window?
Which timing?Should an investigational oxygen-delivery intervention be studied before blood arrives, during transfer, or only after specific failure criteria are met?
Which endpoint?Which endpoints best capture meaningful benefit: shock reversal, organ injury, transfusion requirement, ICU course, survival or a prespecified composite?
Evidence boundary: WHO guidelines do not evaluate BHOC or HBOC therapy. This page presents a research hypothesis only. Any future use in PPH would require product-specific preclinical evidence, safety data, prospective trials, obstetric specialist input and regulatory authorization.

Research Concept · Hypothesis · Author: · Published: · © Archil Jaliashvili