Antepartum haemorrhage

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Bleeding from birth canal after 24 weeks.


3-5% of pregnant women have some form of bleeding. 3x more common in multiparous women (had a baby before) than primiparous.


There are lots of potential causes for bleeding during pregnancy. (Well, bleeding from the vagina. Obviously being pregnant doesn't decrease your risk of getting paper cuts.)

  • No cause - OK, so this is a bit of cop out but it's true in 40% of cases.
  • Placenta praevia - the placenta is in the lower segment of the uterus, possibly covering the cervical os. This is graded I-IV depending on how far down it is.
  • Placental abruption - this is the cause in 20% of cases and occurs in 1 in 200 pregnancies. Essentially, the placenta separates from the uterus and the blood collects between uterus and placenta.
  • Uterine rupture - well, the uterus ruptures. This is only mentioned because it's incredibly serious.
  • There are other causes such as infection, vasa praevia (bleeding from the foetal blood vessels) and inherited bleeding problems but these are either not serious or rarer.

Management of acute bleeding

  • As always, firstly do ABC and resuscitate if shocked.
  • Foetal distress or severe bleeding require urgent delivery, regardless of the gestation.
  • Bloods: FBC, group and save, cross-match
  • USS
  • Foetal monitoring