Antepartum Hemorrhage

Antepartum haemorrhage (APH) defined as bleeding from the genital tract in the second half of pregnancy, remains a major cause of perinatal mortality and maternal morbidity in the developed world.
  • Vaginal bleeding
  • Abdominal pain.
  • Back pain.
  • Uterine tenderness.
  • Uterine contractions
  • Firmness in the uterus or abdomen.
  • Maternal complications of APH are malpresentation, premature labour, postpartum hemorrhage, shock, retained placenta.

Placenta praevia refers to when the placenta of a growing foetus is attached abnormally low within the uterus. Intermittent antepartum haemorrhaging occurs in 72% of women living with placenta praevia. The severity of a patient's placenta praevia depends on the location of placental attachment; Abnormal placentation, Placental abruption. Use of aspirin before 16 weeks of pregnancy to prevent pre-eclampsia also appears effective at preventing antepartum bleeding. In regard to treatment, it should be considered a medical emergency (regardless of whether there is pain), as if it is left untreated it can lead to death of the mother or baby.

These risk factors include previous APH, previous cesarean section, advanced maternal age (age greater than 35), urban/rural residence, previous termination of pregnancy (curettage), pregnancy-induced hypertension (PIH), multi-parity, and multiple pregnancy.

How is it diagnosed?

Bleeding, which may be accompanied by pain (suggestive of abruption) or be painless (suggesting praevia).

How is it treated?

In the patient who has APH due to placenta previa, magnesium sulfate may be used as a tocolytic to allow the administration of betamethasone to mature the fetal lung and to allow the obstetrician to better time delivery. In patients with preeclampsia, magnesium therapy should be continued to prevent seizures.

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