Antepartum Haemorrhage

1. INTRODUCTION

Antepartum haemorrhage (APH) is bleeding from the genital tract during pregnancy after 20 weeks and before delivery.

It is a serious obstetric complication affecting both mother and fetus.

2. DEFINITION

Bleeding from the birth canal after 20 weeks of gestation and before birth of the baby.

3. CAUSES

Major Causes

• Placenta previa

• Placenta lies low in uterus, covering cervix

Placental abruption (Abruptio placentae)

• Premature separation of normally placed placenta

Minor Causes

• Local cervical lesions (erosion, polyp, cancer)

• Trauma (coitus, examination)

• Vasa previa

• Unknown cause

  
  

4. Types of APH

1. Placenta Previa

• Placenta partially or completely covers cervical opening

Types:

Type I → Low-lying

Type II → Marginal

Type III → Partial

Type IV → Complete

2. Abruptio Placentae

• Early separation of placenta

Types:

• Revealed hemorrhage (visible bleeding)

• Concealed hemorrhage (hidden bleeding)

• Mixed type

  
  

5. CLINICAL MANIFESTATIONS

General Symptoms

• Vaginal bleeding (bright red or dark)

• Abdominal pain (in abruption)

• Weakness, dizziness

Placenta Previa

• Painless bleeding

• Bright red blood

• Soft, non-tender uterus

Placental Abruption

• Painful bleeding

• Dark blood

• Rigid, tender uterus

• Fetal distress common

  
  

6. RISK FACTORS

• Previous cesarean section

• Multiple pregnancy

• Hypertension

• Trauma

• Smoking

• Advanced maternal age

  
  

7. COMPLICATIONS

Maternal

• Shock

• Anemia

• Disseminated intravascular coagulation (DIC)

• Death (if severe)

Fetal

• Fetal distress

• Prematurity

• Intrauterine death

  
  

8. DIAGNOSIS

• History and physical examination

• Ultrasound (to locate placenta)

• Avoid vaginal examination in placenta previa

• Blood tests (Hb, clotting profile)

  
  

9. MANAGEMENT

A. Initial Management

• Admit to hospital

• Monitor vital signs

• IV fluids and blood transfusion

• Continuous fetal monitoring

B. Specific Management

Placenta Previa

• Mild bleeding → bed rest, observation

• Severe bleeding → cesarean section

Placental Abruption

• Mild → close monitoring

• Severe → immediate delivery (often emergency)

  
  

10. PREVENTION

• Regular antenatal checkups

• Control hypertension

• Avoid trauma and smoking

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Here’s a short “exam trick” version for Antepartum Haemorrhage — super quick points you can remember :

Definition: Bleeding after 20 weeks of pregnancy before delivery.

Main Causes: Placenta previa & placental abruption.

Placenta previa: Painless, bright red bleeding.

Abruption: Painful, dark bleeding + rigid uterus.

Types: Revealed, concealed, mixed bleeding.

Risk factors: Hypertension, trauma, previous C-section.

Symptoms: Vaginal bleeding ± shock.

Complications: Maternal shock, fetal distress/death.

Diagnosis: Ultrasound (avoid vaginal exam in previa).

Management: ABC + IV fluids + monitor + deliver if severe.

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Here’s a set of 07 MCQs on Antepartum Haemorrhage for practice :

1. APH is defined as bleeding after:

A. 12 weeks

B. 20 weeks

C. 24 weeks

D. 28 weeks

✅ Answer: B

2. Most common cause of APH is:

A. Trauma

B. Placenta previa

C. Infection

D. Fibroid

✅ Answer: B

3. Painless vaginal bleeding in late pregnancy suggests:

A. Abruptio placentae

B. Placenta previa

C. Uterine rupture

D. Infection

✅ Answer: B

4. Painful bleeding with a rigid uterus is seen in:

A. Placenta previa

B. Placental abruption

C. Cervical polyp

D. Vasa previa

✅ Answer: B

5. Which investigation is safest in APH?

A. Vaginal examination

B. Ultrasound

C. CT scan

D. MRI

✅ Answer: B

6. Which of the following is a risk factor for APH?

A. Hypotension

B. Hypertension

C. Anemia

D. Diabetes

✅ Answer: B

7. In placenta previa, the uterus is usually:

A. Rigid and tender

B. Soft and non-tender

C. Contracted

D. Enlarged

✅ Answer: B