Antepartum Haemorrhage - Symptom, Causes, Treatment of Antepartum Haemorrhage

Antepartum Haemorrhage is the bleeding from the vagina during the second half of pregnancy, before labour commences, or it can also be defined as the bleeding from the vagina after 24 weeks gestation up until labour. Before 24 weeks, bleeding heralds threatened or inevitable abortion due to pre-mature separation of the placenta from the wall of the uterus.

APH occurs in 2% of pregnancies and is an important cause of foetal and maternal death - 30% of maternal deaths are caused by APH, of which 50% are associated with avoidable factors. If the placenta is implanted in the normal position in the upper part of the uterus, bleeding caused by premature separation is called accidental haemorrhage which can result from pregnancy induced hypertention (high blood pressure) or occur for no apparent reason. If bleeding is slight there is no danger to the mother, but even a small amount can reduce the supply of oxygen and nutrients to the foetus.

Diagnosis of Antepartum Haemorrhage

• Bloody show (benign) - most common cause of APH
• Placental abruption - most common pathological cause
• Placenta previa - second most common pathological cause
• Vasa previa - often difficult to diagnose, frequently leads to fetal demise
• Uterine rupture
• Bleeding from the lower genital tract
  -- Cervical bleeding - cervicitis, cervical neoplasm, cervical polyp
  -- Bleeding from the vagina itself - trauma, neoplasm
• Bleeding that may be confused with vaginal bleeding
  -- GI bleed - hemorrhoids, inflammatory bowel disease
  -- Urinary tract bleed - urinary tract infection

Types of antepartum haemorrhage

An antepartum haemorrhage may fall into one of three main categories:

Placenta praevia is a condition in which the placenta, instead of being attached to the upper part of the uterus, is attached to the lower part in the region of the lower uterine segment or the cervix. Accidental haemorrhage is often associated with pain low in the abdomen.

Accidental antepartum haemorrhage (abruptio placentae) is a comparatively rare codlt1on In which the placenta is normally Implanted In the upper part of the uterus but detaches from it prematurely and usually results in vaginal bleeding.

Incidental antepartum haetnorrhage is haemorrhage which occurs from the genital tract but not from the site of the placenta or its implantation. Such haemorrhage may result from injury, infection, ulcers on the neck of the womb, polyps or, I1lOstcommonly, the onset of labour.

Pregnancy and Antepartum Haemorrhage

If you have any bleeding during pregnancy, contact your doctor or go to hospital immediately. An ultrasound examination will show whether the bleeding is accidental or due to placenta praevia. Bleeding which occurs during the last 2 months of pregnancy is especially significant and the woman is nearly always admitted to hospital until a diagnosis of placenta praevia has been proved, or disproved by ultra-sonic scan. If an accidental haemorrhage is slight and stops soon, you will usually be able to go home, provided your blood pressure is normal and there is no continuing risk to the foetus. If placenta praevia is found you may be advised to stay in hospital, as the bleeding is likely to recur and may be severe enough for you to need a blood transfusion. The aim is to maintain the pregnancy until about 37 weeks.

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