Antepartum Haemorrhage

Question 1

What is APH?

Answer 1

Bleeding from the genital tract from 24wks gestation to onset of labour. Occurs in 2-5% of pregnancies

Question 2

Why is an APH only from 24wks?

Answer 2

Bleeding before 24wks is a threatened miscarriage where the pregnancy can continue

Question 3

What are the causes

Answer 3

Differentials for APH include

• uterine causes - Placenta praaevia, Placental abruption, indeterminate - marginal placental haemorrhage that can’t be explained on a scan
• cervical causes - show( mucous), polyp, erosion ectropion
• vaginal causes - trauma, infection

Question 4

Which is more concerning, painful or painless bleeding?

Answer 4

Painful bleeding - think placental abruption. More concern for baby

Question 5

Risk factors for having a placental abruption?

Answer 5

History of abruption 
Smoking and cocaine use
Hypertension 
Thrombophilia
Trauma

Question 6

What risks/ complications are associated with placental abruption?

Answer 6

For mum - hypovolaemic shock.
qIncreased risk of perinatal mortality - depending on gestational age.
IUGR
Feto-maternal haemorrhage - NB if mum Rh- and baby Rh+ needs anti D injection
Congenital malformations

Question 7

What is placental abruption

Answer 7

Separation of the placenta - either partially or completely from the uterus before delivery.
80% present with vaginal bleeding
20% are concealed with no external bleeding

Question 8

How does placental abruption manifest clinically?

Answer 8

• Vaginal bleeding, abdominal plain, rock hard abdomen, ± maternal shock
• 50% cases occur during labour so s&s would include breakthrough pain with epidural, continuous uterine contraction , fetal bradycardia (may be difficult to hear the fetal heart)

Question 9

What is the management of placental abruption?

Answer 9

Stabilise mother and deliver
Treat the haemorrhage shock
Treat DIC, treat renal failure