NeoHealth Publications

Postpartum hemorrhage: why should we now measure blood loss and act from 300 mL?

In early October 2025, WHO, FIGO and ICM published the first international guideline devoted entirely to postpartum hemorrhage. Three key ideas: measure instead of estimating, respond earlier, and treat with the full bundle from the outset. Our analysis.

The context

Postpartum hemorrhage (PPH) remains a cause of maternal death that international agencies now aim to eliminate. Its management suffered from two weaknesses: blood loss that was estimated rather than measured, and a diagnosis that waited for the classic 500 mL threshold. Treatments, for their part, were often given one after another as the situation worsened.

Launched at the FIGO 2025 congress in Cape Town, the new consolidated guideline from the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM) brings together 51 recommendations and replaces up to eight earlier documents.

The studies

The guideline draws in particular on two bodies of work:

• An individual participant data meta-analysis led by WHO and published in The Lancet in October 2025: 12 datasets, 312,151 women. It assessed how well different blood-loss thresholds, alone or combined with clinical signs, identified women at risk of death or severe morbidity.
• The E-MOTIVE trial, published in 2023, which evaluated this approach (early detection plus a care bundle): a cluster-randomized trial of 210,132 vaginal births in 80 hospitals in Kenya, Nigeria, South Africa and Tanzania.

The results

Diagnostic thresholds (meta-analysis):

• At 500 mL: sensitivity 75.7% (95% CI: 60.3–86.4), specificity 81.4% (70.7–88.8).
• At 300 mL alone: sensitivity 83.9%, but specificity of only 54.8%.
• Combined rule, 300 to 450 mL and at least one abnormal sign: sensitivity 86.9 to 87.9%, specificity 66.6 to 76.1%. Signs used: pulse > 100/min, systolic blood pressure < 100 mmHg, diastolic < 60 mmHg or shock index > 1.0.

Treatment (E-MOTIVE): the composite outcome of severe PPH, laparotomy or death fell from 4.3% to 1.6% (relative risk 0.40; 95% CI: 0.32–0.50).

The guideline draws three messages from this:

• Measure blood loss with a calibrated collection drape instead of estimating it.
• Act from 300 mL combined with an abnormal sign, without waiting for 500 mL.
• Trigger the MOTIVE bundle immediately: uterine massage, uterotonics, tranexamic acid, intravenous fluids, examination of the genital tract and escalation of care.

The guideline also endorses heat-stable carbetocin as an alternative to oxytocin for prevention, and intravenous iron when rapid correction is needed, including after PPH.

The limits — and local implementation

• Lowering the threshold gains sensitivity but loses specificity: some women will be treated who did not need it.
• The benefit of E-MOTIVE was obtained in hospitals in low- and middle-income countries; its magnitude in high-resource maternity units remains uncertain.
• The data mainly concern vaginal birth; cesarean delivery follows other care pathways.
• The I'M WOMAN trial, which is evaluating intramuscular tranexamic acid, had not been published at the time of this analysis.

In France, how these criteria fit with national protocols (CNGOF, HAS) and with the organization of each maternity unit remains to be determined: check local guidance. The same applies in the United Arab Emirates.

What it changes in practice

In concrete terms: a calibrated collection drape under every vaginal birth; vital signs checked as soon as blood loss reaches 300 mL; and, in the event of tachycardia or hypotension, treating it as PPH and launching the whole bundle at once — tranexamic acid included — rather than one drug after another. It is a change of culture as much as of protocol: moving from estimation to measurement, and from sequential escalation to simultaneous action.

This topic will be covered in depth at the NeoHealth Summit Dubai (8–12 November 2026, Grand Hyatt Dubai).

HPV: is a single vaccine dose enough, and can women screen themselves at home?

A large randomized trial supports single-dose vaccination, and self-sampling is entering US and English screening policy. Where do things stand in France and the UAE?

The context

Cervical cancer prevention rests on two pillars: vaccination against human papillomavirus (HPV) and screening. For vaccination, the number of doses weighs on campaigns, particularly catch-up campaigns; WHO opened the door to a single-dose schedule in 2022, without a large comparative randomized trial to support it. For screening, participation remains insufficient: in England, coverage stood at 68.8% against a target of 80%, and some women avoid the speculum examination.

The studies

ESCUDDO, published in December 2025, is the first large randomized trial to compare one and two doses directly, for both the bivalent and the nonavalent vaccines. In Costa Rica, 20,330 girls aged 12 to 16 were assigned to four equal groups. Primary endpoint: a new persistent HPV 16 or 18 infection between month 12 and month 60, with a non-inferiority margin set at 1.25 infections per 100.

Self-sampling, for its part, has advanced through a series of regulatory and public health decisions. For the first at-home device, the data reported by the manufacturer (SELF-CERV study) cover about 600 patients at 16 US sites, with a positive agreement of about 95%.

The results

Vaccine: one dose does as well as two.

• Difference (one dose minus two doses): −0.13 infections per 100 with the bivalent vaccine (95% CI: −0.45 to 0.15) and +0.21 with the nonavalent vaccine (−0.09 to 0.51), well within the 1.25 margin: non-inferiority is demonstrated.
• Vaccine efficacy ≥ 97% in all four groups.

Screening: self-sampling enters public policy.

• United States. On 9 May 2025, the FDA authorized the first at-home self-sampling device (Teal Wand), by prescription, for ages 25 to 65. The American Cancer Society (ACS, 4 December 2025) considers self-sampling acceptable, with clinician collection still preferred; after a negative self-collected sample, it suggests rescreening at 3 years (5 years after a clinician-collected sample). The federal HRSA guidelines (5 January 2026) state that self-collection “should be offered” for ages 30 to 65, with high-risk HPV testing as the preferred modality, and insurer coverage from 2027.
• England. For tests performed since 1 July 2025, HPV-negative people aged 25 to 49 are recalled every 5 years instead of every 3. Since August 2026, the NHS has been rolling out self-sampling kits to about 4 million people aged 30 to 65 who have not attended screening.

The limits — and the situation in France and the UAE

• ESCUDDO measures infection, not precancerous lesions (CIN2+), over 5 years: durability beyond that has not yet been demonstrated. The results apply neither to immunocompromised people nor to catch-up vaccination in adults.
• A self-collected sample does not allow “reflex” cytology: a positive result requires a fast-track pathway to clinician collection.
• Intervals after a negative self-collected sample differ: 3 years for the ACS, 5 years for the HRSA and the USPSTF, whose update is still only a draft (December 2024).

In the UAE, the Abu Dhabi Department of Health's 2025 standard provides for primary HPV testing every 5 years from age 25 to 65; we found no self-sampling policy from the DHA (Dubai) or the federal ministry (MOHAP). A pilot project at Latifa Hospital in Dubai (100 women) showed strong agreement between self-sampling and clinician collection (feasibility study only). The country aims to have 90% of girls aged 13–14 vaccinated by 2030. In France, the vaccination schedule and the place of self-sampling are governed by the recommendations of the national health authorities (HAS, INCa): check local guidance.

What it changes in practice

On the vaccination side, a single-dose schedule in adolescent girls now rests on randomized evidence, which strengthens catch-up and elimination campaigns; the applicable schedule, however, remains that of each country. On the screening side, self-sampling is an entry point to offer women who are overdue for screening or who avoid the speculum examination, provided that rapid follow-up of positive results has been organized beforehand.

This topic will be covered in depth at the NeoHealth Summit Dubai (8–12 November 2026, Grand Hyatt Dubai).

The FDA removes the cardiovascular, breast cancer and dementia boxed warning from menopausal hormone therapy: should MHT be rehabilitated?

In the United States, the most visible warning on menopausal hormone therapy (MHT) labels no longer mentions cardiovascular disease, breast cancer or dementia. A bold decision, contested on method — and strictly American. Our analysis.

The context

MHT has long had a reputation as a dangerous treatment; supporters of the change speak of two decades of undertreatment of symptomatic women. In the United States, a boxed warning at the top of the labeling cited cardiovascular disease, breast cancer and probable dementia, and the labeling recommended “the lowest dose for the shortest duration.” Meanwhile, age-stratified reanalyses of the WHI (Women's Health Initiative) study fueled the “timing hypothesis”: when treatment is started would matter.

The decision

On 10 November 2025, the FDA asked all MHT manufacturers to change their labeling:

• Remove from the boxed warning cardiovascular disease, breast cancer and probable dementia.
• Delete the phrase “lowest dose, shortest duration.”
• Add that MHT may be considered for moderate to severe vasomotor symptoms in women under 60 or within 10 years of menopause, along with WHI data in women aged 50–59.
• Retain the boxed warning on endometrial cancer for systemic estrogen-alone products; the cardiovascular and breast warnings remain in the body of the label.
• Condense the safety information for vaginal estrogens.

The decision is based on a literature review (WHI reanalyses, observational data), not on a new trial.

The early effects

On 12 February 2026, the FDA approved the first six revised labels; 29 companies submitted changes, across four product categories (systemic estrogen plus progestogen, systemic estrogen alone, progestogens for women with a uterus, vaginal estrogens). The FDA reports increased demand for transdermal estradiol patches since the change.

The limits — a contested US decision

• The method: the decision followed an expert panel convened in July 2025, not a formal FDA advisory committee, which critics consider a procedural flaw. Researcher JoAnn Manson believes the evidence of overall benefit is not as “conclusive or definitive” as the FDA commissioner claimed.
• Breast cancer: the signal associated with combined estrogen-progestogen therapy persists and still appears in the label; there is a risk of overcorrection.
• Geography: this labeling is US-only. We found no equivalent change by the EMA (European Union) or the MHRA (United Kingdom), a divergence that creates confusion for international patients and is very real in Dubai, where practitioners trained in the US, Europe or the UK work side by side. For French, European, British and Emirati labeling, check local guidance.

What if MHT is not an option?

Elinzanetant, an NK1 and NK3 receptor antagonist, is a non-hormonal option for hot flashes. According to secondary sources, the FDA approved it in October 2025 for vasomotor symptoms of menopause; the European authorization (17 November 2025) also covers those caused by adjuvant endocrine therapy for breast cancer, an indication absent from the US label. In the OASIS 4 trial (474 women on adjuvant endocrine therapy, about 11.4 moderate to severe episodes per day at baseline), hot flash frequency fell by 3.5 per day more than with placebo at 4 weeks, and by 3.4 at 12 weeks, over and above a large placebo effect. On the other hand: more adverse events (69.8% vs 62.0%; headache, fatigue and somnolence, hence bedtime dosing) and more serious adverse events (2.5% vs 0.6%), limited long-term data, and a drug class under liver-safety scrutiny (boxed warning added by the FDA to fezolinetant in December 2024). Registration in the UAE has not been verified.

What it changes in practice

For a healthy woman bothered by vasomotor symptoms who is under 60 or within 10 years of menopause, the US label now aligns with the position of professional societies: MHT is an option to consider. But the decision creates no new data and does not replace individualized counseling, particularly on breast cancer risk with combined estrogen-progestogen therapy. In France, practice continues to rely on CNGOF and HAS recommendations. For women who cannot or do not wish to take hormones, a non-hormonal alternative exists, with a moderate benefit.

This topic will be covered in depth at the NeoHealth Summit Dubai (8–12 November 2026, Grand Hyatt Dubai).

A blood test to screen for several cancers at once: what does the NHS-Galleri trial tell us?

A simple blood draw to detect many cancers before symptoms appear: the idea is appealing. Yet the first large randomized trial did not meet its primary endpoint — which did not stop an FDA advisory committee from voting in favor of the test. Our analysis.

The context

Multi-cancer early detection tests look for signals suggestive of several cancers at once in a blood sample. The promise: to find cancers earlier, at a stage when they are more amenable to treatment. But a screening test is not judged by the number of cancers it finds. It is judged by its ability to reduce advanced cancers and, above all, mortality, without exposing too many healthy people to unnecessary tests or superfluous treatment.

The study

NHS-Galleri is a randomized trial conducted within the NHS in 142,250 participants, with three screening rounds. Presented at the 2026 ASCO Annual Meeting, it was published on 22 September 2026 in the New England Journal of Medicine and in Nature Medicine. Its primary endpoint was not mortality but the incidence of stage III–IV cancers: if the test is useful, it should “shift” diagnoses toward earlier stages (a so-called stage shift).

The results

• Primary endpoint not met: no reduction in stage III–IV cancers (incidence rate ratio 1.03; 95% CI: 0.92–1.14; p = 0.63).
• Stage IV: rate ratio 0.86 (0.74–1.00). The upper bound of the interval touches 1: this is a signal to be confirmed, from a secondary endpoint, not proof.
• Positive predictive value, that is, the proportion of positive tests that truly correspond to a cancer: 58.0%, 50.4% and then 45.8% over the three rounds. In other words, roughly one positive test in two corresponds to a cancer.

The day after publication, on 23 September 2026, an FDA advisory committee nonetheless voted in favor of the test: 10 to 0 on safety, 6 to 4 on effectiveness, and 7 to 2 for a favorable benefit–risk balance. At the time of this analysis, the FDA decision was pending.

The limits — intermediate endpoint and overdiagnosis

• An intermediate endpoint: stage shift is only a surrogate for mortality. Here, even this surrogate is not improved, and no mortality benefit has been demonstrated.
• Overdiagnosis: any screening can detect cancers that would never have threatened the person, leading to unnecessary tests, treatment and anxiety.
• False positives: nearly one positive result in two does not correspond to a cancer, yet still leads to investigations.
• Industry funding of the trial, to be kept in mind when reading the results.

The contrast between a missed primary endpoint and a favorable committee vote illustrates a principle worth remembering: moving an indicator is not the same as improving patient outcomes. The decline in positive predictive value between the first round and subsequent ones is also among the methodological points that deserve close scrutiny.

What it changes in practice

For now, a multi-cancer test does not replace recommended screening and has not shown a mortality benefit. When someone is considering this test or has already received a result, the physician's role is to explain that a positive result corresponds to a cancer only about half the time, and that a negative result does not exempt them from usual screening. In France as in the UAE, check local status and availability for this type of test; the FDA decision is still awaited.

This topic will be covered in depth at the NeoHealth Summit Dubai (8–12 November 2026, Grand Hyatt Dubai).

Exercise as a treatment for colon cancer? What does the CHALLENGE trial tell us?

For the first time, a randomized trial shows that a structured exercise program improves survival after cancer. Reason enough to “prescribe” physical activity like a drug — without making it a cure-all. Our analysis.

The context

The benefits of physical activity are often invoked after cancer, but no randomized trial had yet shown that an exercise program improves survival. Without evidence at that level, exercise remained advice rather than a prescription. At a time when so-called “longevity” supplements are being promoted, the CHALLENGE trial, published in 2025, provides evidence of an altogether different order.

The study

CHALLENGE enrolled 889 patients with stage II or III colon cancer who had completed chemotherapy, randomly assigned to a control group or to a structured, supported exercise program for three years. The goal: to add about 2.5 hours of moderate-intensity activity per week. Patients were followed for a median of 7.9 years.

The results

• Disease-free survival: HR 0.72 (95% CI: 0.55–0.94), a relative reduction of about 28% in the risk of an event. At 5 years, 80.3% of patients in the exercise group were alive and disease-free, vs 73.9% in the control group.
• Overall survival: at 8 years, 90.3% vs 83.2%; risk of death reduced by about 37% (HR 0.63; 0.43–0.94).
• Safety: more musculoskeletal adverse events (18.5% vs 11.5%).

How should these figures be read? An HR (hazard ratio) below 1 means a lower risk in the exercise group; here, neither confidence interval reaches 1, which makes the results statistically significant. In absolute terms, the difference is about 6 percentage points in disease-free survival at 5 years and 7 points in overall survival at 8 years. Above all, these are “hard” endpoints (recurrence, death), not intermediate markers: that is what gives the trial its strength.

The limits

• One trial, one cancer: nothing yet allows these results to be automatically extrapolated to other tumors.
• No blinding: participants knew which group they were in, which is hard to avoid for an exercise intervention.
• Resource-intensive support: the program relied on sustained follow-up for three years, which will need to be reproduced in routine practice.
• More musculoskeletal events, to be anticipated through appropriate assessment and progression.

How this translates to France and the UAE (program organization, reimbursement) remains to be established: check local guidance and availability.

What it changes in practice

After stage II–III colon cancer, once chemotherapy is complete, supported exercise deserves to be prescribed like a drug: with a quantified goal, progression and follow-up. Sports physicians have a full role to play: assessing, adapting the program and preventing musculoskeletal complications. For patients, the message is simple: physical activity is part of care after chemotherapy, and it is built up gradually, preferably with support, as in the trial. The movement goes beyond oncology: in 2026, the European Society of Cardiology (ESC) published its first guideline dedicated to cardiac rehabilitation, which extends its indications to atrial fibrillation, valve replacement, congenital heart disease and cardiac damage related to cancer treatment. Faced with the promises of “anti-aging” supplements, supervised exercise, by contrast, has randomized evidence of a survival benefit.

This topic will be covered in depth at the NeoHealth Summit Dubai (8–12 November 2026, Grand Hyatt Dubai).

Inducing labor at 39 weeks in low-risk women: what does the ARRIVE trial tell us?

Long discouraged in France for fear of increasing cesarean deliveries, elective induction at 39 weeks has been reassessed since a large US trial. Our analysis.

The context

In France, clinicians have long been very reluctant to perform so-called “elective” induction (without a medical indication), for fear that it would increase the use of cesarean delivery. The US ARRIVE trial, published in 2018, challenged this received wisdom.

The study

ARRIVE is a large randomized trial: more than 6,000 low-risk women pregnant for the first time (nulliparous), randomly assigned to two groups — routine induction at around 39 weeks of gestation, or waiting for spontaneous labor (“expectant” management).

The results

• Fewer cesarean deliveries in the induction group (about 18.6% vs 22.2%).
• Less pregnancy-related hypertension (preeclampsia and gestational hypertension).
• No excess risk for the baby: the neonatal benefit was slight and not significant, but above all, induction did not increase complications.

The limits — and the view from France

The US population is not directly comparable to the French population (more obesity and hypertension). In the United States, interventionist practice rose markedly after the trial, to the point of being suspected of contributing to prematurity. That is why a French team launched its own study: French ARRIVE, modeled on the US trial and initiated in March 2021 by Professor Loïc Sentilhes and Dr Hugo Madar (Bordeaux University Hospital), to verify the safety of earlier induction in French patients.

What it changes in practice

The message is not “induce everyone at 39 weeks,” but rather: for a well-informed low-risk woman, induction at 39 weeks becomes a reasonable option, to be discussed through shared decision-making. In France, the results of French ARRIVE are awaited before settling on recommendations suited to French patients.