Antepartum haemorrhage

Antepartum haemorrhage (APH) is a medical condition that occurs during pregnancy, specifically in the third trimester. It is characterized by vaginal bleeding after the 20th week of gestation but before the onset of labour. APH is a significant cause of maternal and fetal morbidity and mortality worldwide.

Causes

The primary causes of antepartum haemorrhage include placenta praevia, placental abruption, and vasa praevia. Other less common causes include cervical ectropion, cervical polyps, and cervical cancer.

Placenta Praevia

Placenta praevia is a condition where the placenta implants in the lower segment of the uterus and covers the cervix either partially or completely. This condition can lead to painless, bright red vaginal bleeding.

Placental Abruption

Placental abruption is the premature separation of the placenta from the uterus. It can cause painful, dark red vaginal bleeding.

Vasa Praevia

Vasa praevia is a rare condition where fetal blood vessels cross the internal os of the cervix. Rupture of these vessels can lead to fetal blood loss and death.

Diagnosis

Diagnosis of APH is based on clinical history, physical examination, and ultrasound scanning. It is important to differentiate between the causes of APH as the management differs significantly.

Management

Management of APH depends on the cause, gestational age, and the condition of the mother and fetus. It may involve conservative management, medical treatment, or surgical intervention including caesarean section.

Prognosis

The prognosis of APH depends on the cause, the gestational age at which bleeding occurs, and the promptness and appropriateness of management. With early detection and proper management, the prognosis can be improved.

See Also

• Postpartum haemorrhage
• Pregnancy complications
• Obstetric ultrasonography