Antepartum bleeding

Question 1

What is the definition of APH and classification for minor, major and massive haemorrphage?

Answer 1

PV bleeding >20W gestation

Minor = <50mL that settles

Major = 50 - 1000 mL but no signs of shock

Massive = >1000 and/or clinical signs of shock

Question 2

What are the DDx for antepartum bleeding?

Answer 2

1. Abruption (30%)
2. Praevia (20%)

Cervical

1. Ectropion - most common local cause bleeding in pregnancy, pregnancy causes increase in ectropion
2. Don’t miss cervical malignancy

Other local causes
- vaginal tear/trauma, polyp, fibroid, infection

Rare

• Vasa pravia
• Uterine rupture

Question 3

What is the definition of placental abruption and how is it’s severity classified?

Answer 3

Separation of a normally implanted placenta prematurely - may be partial or complete

Mild - clinically well mother & foetus, no tenderness, <200mL revealed blood

Moderate - any of >200mL revealed loss, foetal or maternal compromise (haemodynamic, DIC), tense/tender uterus

Severe