Antepartum haemorrhage

Question 1

What is antepartum haemorrhage?

Answer 1

Vaginal bleeding from 24 weeks till time of delivery

It can be categorised into revealed or concealed APH based on whether the bleeding is visible or not

Question 2

How can APH be categorised?

Answer 2

It can be categorised into revealed or concealed APH based on whether the bleeding is visible or not

Question 3

How can the causes of APH be split up?

Answer 3

Placental (most worrying)

Maternal

Question 4

What is the main cause of APH?

Answer 4

Placenta praevia

Question 5

What placental causes of APH are there? (3)

Answer 5

Placental (most worrying)

• placental abruption
• placenta praevia (1%)
• vasa praevia

Question 6

What maternal causes of APH are there? (5)

Answer 6

Maternal
- Cervicitis
- Cervical ectropian
- Cervical carcinoma
- Vaginal trauma
- Vaginal infection

Question 7

What is important to ask when a women presents with antepartum bleeding?

Answer 7

• How much bleeding?
• Triggering factors
• Associated pain or contractions?
• Is baby moving?
• last cervical smear - date and normality

Question 8

What is important to examine when a women presents with antepartum bleeding?

Answer 8

HR, BP

Uterus soft or tender

Fetal heart auscultation or CTG

Speculum of cervix to check for placenta praevia