Antepartum haemorrhage

In obstetrics, antepartum haemorrhage (APH), also antepartum hemorrhage, is bleeding from the vagina during pregnancy from twenty weeks gestational age to term.

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It should be considered a medical emergency (regardless of whether there is pain) and medical attention should be sought immediately, as if it is left untreated it can lead to death of the mother and/or fetus.

It can be associated with reduced fetal birth weight.^[1]

Bleeding without pain is most frequently bloody show, which is benign; however, it may also be placenta previa (in which both the mother and fetus are in danger). Painful APH is most frequency placental abruption.

Differential diagnosis of APH

• Bloody show (benign) - most common cause of APH
• Placental abruption - most common pathological cause
• Placenta previa - second most common pathological cause
• Vasa previa - often difficult to diagnose, frequently leads to fetal demise
• Uterine rupture
• Bleeding from the lower genital tract
  • Cervical bleeding - cervicitis, cervical neoplasm, cervical polyp
  • Bleeding from the vagina itself - trauma, neoplasm
• Bleeding that may be confused with vaginal bleeding
  • GI bleed - hemorrhoids, inflammatory bowel disease
  • Urinary tract bleed - urinary tract infection

References

1. ^ Lam CM, Wong SF, Chow KM, Ho LC (2000). "Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery". Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 20 (1): 27–31. doi:10.1080/01443610063417. PMID 15512459.

See also

• Obstetrical hemorrhage