ANTEPARTUM HAEMORRHAGE

DEFINITION:
An antepartum haemorrhage (APH) is bleeding from the vagina that
occurs after the 20th week of pregnancy and before the birth of your
baby.
Causes:
The common causes of bleeding during pregnancy are:
1. cervical ectropion,
2. vaginal infection,
3. placental edge bleed,
4. placenta praevia
5. or placental abruption.
Cervical ectropion

 The cells on the surface of the cervix often change in pregnancy

and make the tissue more likely to bleed, particularly after sex.
This is called cervical ectropion.
  This condition does not affect the pregnancy at all. If there is
bleeding from the cervix it is important to ensure you are up to
date with your PAP smear and it is normal.
Infection
Cervical and vaginal infections can also cause a small amount of
vaginal bleeding (eg severe Thrush or Chlamydia) and you may be
very uncomfortable.
It is important to seek treatment from your doctor for these
conditions.
Placental edge bleed
 In the second half of your pregnancy, the lower-half of the uterus
begins to stretch and grow.
 This can lead to the edge of the placenta separating from the wall
of the uterus.
 In most cases bleeding will stop after a few hours, and your baby
will not be adversely affected.
 However it is important that you contact the hospital immediately
if mother notice any bleeding.
Placenta praevia
TYPES OF PLACENTA PREVIA:

Placenta praevia is diagnosed when the placenta grows in the lower

part of the uterus and is located near to or actually covering the cervix.
Placenta praevia is classified into four types:
 Type I: the placenta is located in the lower part of the uterus but
does not come close to the cervix. You can usually expect to birth
vaginally with this type
 Type II (or marginal) – the placenta touches but does not cover
the cervix
 Type III (or partial) – the placenta partially covers the cervix
 Type IV (or complete) – the placenta completely covers the cervix
Types II, III and IV are associated with a risk of heavy bleeding in labour
as the cervix dilates and, therefore caesarean birth is usually
recommended.
Causes of placenta praevia
The cause of placenta praevia is often unknown but these are some of
the factors that put women more at risk. :
 previous caesarean birth or uterine surgery
 previous placenta praevia
 age above 35 years
 multiple pregnancy twins or triplets etc.
 multiple previous pregnancies
 endometriosis
 closely spaced pregnancies
 placental abnormalities
 abnormalities in the baby
 smoking.

Diagnosis
 As part of the 18–20 weeks ultrasound scan (USS) the site of the
placenta is identified. Approximately one in five women will have
a low-lying placenta at this time.
 A repeat USS will be recommended between 32 and 36 weeks of
pregnancy depending on where the placenta is positioned at the
earlier scan. 
 By this time only 2 per cent of women will still have a low-lying
placenta.
  doctor will discuss ongoing management and care.
Most women with Type II, III & IV placenta praevia will need to give
birth by caesarean section.
Placental abruption

 Placental abruption occurs when part of the placenta separates

from the wall of the uterus prior to term. A large amount of
vaginal blood loss usually occurs.
 Some of the blood may however remain in the uterus and this can
lead to a blood clot forming behind the placenta.
 The amount of vaginal blood loss seen is therefore, not an
accurate measurement of the total amount of blood loss which
has occurred.
 If mother have any blood loss or abdominal pain it is important to
contact your midwife/obstetrician immediately.
 Some causes of vaginal bleeding are more serious than others so
it is important to find out the reason as soon as possible.
MANAGEMENT
 Patient may be admitted to hospital for observation and
assessment of the cause of your bleeding.
 mother will have an ultrasound scan and your baby may have a
cardiotocograph (CTG) which checks your baby's heart beat.
 Depending on how much bleeding has occurred, you may need to
have an intravenous (IV) drip inserted and may require IV fluids.
 In severe circumstances you may require a blood transfusion or
your baby may need to be born early.
 Initially you will be encouraged to rest in bed.
At this point in time, we recommend that you:
 change sanitary pads at least every four hours while you have any
blood loss (personal hygiene is very important to reduce the risk
of infection)
 do not use tampons
 wipe from front to back after going to the toilet
 do not go swimming
 do not have baths or use a spa—please shower
 do not have sexual intercourse
 do not use any vaginal medications/creams.