Death saving throws are usually reserved for PCs and very important NPCs. In contrast, most creatures simply die when reduced to 0 HP.

If a creature is attuned to a periapt of wound closure, but does not get death saving throws, will this stop them from dying if they aren't instantly killed by massive damage?


The relevant rule on monsters and death saving throws says:

Most DMs have a monster die the instant it drops to 0 hit points, rather than having it fall unconscious and make death saving throws.

Mighty villains and special nonplayer characters are common exceptions; the DM might have them fall unconscious and follow the same rules as player characters.

So I suppose we would expect that, if an NPC were special enough to have a magic item, the DM would probably consider that NPC to be special enough to get death saves.

A different way to think of this: it's not that random monsters shouldn't get death saves, it's just that it's too much work for the DM to roll them, so most DMs will just call them dead to avoid bookkeeping. If a monster is wearing a periapt of wound closure, the DM would likely call them unconscious-but-stable to avoid bookkeeping.

In my own games, I assume defeated opponents are dead, unless one of the PCs expresses an interest in keeping them alive for interrogation, in which case I go back and roll the death saves to see if they're alive. That seems to work fine.

Ultimately it's up to the DM, though.


Yes. The Periapt should work to stabilize any creature that isn't killed outright by massive damage, just simply RAW.

I see the statement "Most DMs have a monster die the instant it drops to 0 hit points, rather than having it fall unconscious and make death saving throws." as being a convenience, or a suggestion, rather than a rule.

In my world, I consider all creatures to get the benefits of unconsciousness and death saves. I only actually roll them at the time if it matters, but I count them. If, in a fight, the party wins and just leaves the monsters for dead, I'll check afterward to see how many died, and how many wake up eventually and might hold a grudge in the future.

I would definitely count any of them that had a Periapt as surviving.



Periapt of Wound Closure description states

While you wear this pendant, you stabilize whenever you are dying at the start of your turn.

Providing a creature is killed on someone else's turn, at the start of its own turn it would be already dead, not dying. Even if a creature got its death saving throws, it still can be killed before its turn starts.


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