ANTEPARTUM HEMORRHAGE

Genital tract bleeding in late pregnancy
(APH) antepartum hemorrhage

Antepartum haemorrhage is defined as bleeding from the genital tract after the 24th week of pregnancy and before the onset of labour.

Incidence
5% of all pregnancies.

Causes
MATERNAL
• Placenta praevia: 30%.
• Abruptio placentae: 35%.
• Local cause in the vagina and cervix: 5%.
• Blood dyscrasias: <1%.
• Preterm labour
• Uterine rupture
• Idiopathic 30%.
FETAL
Vasa praevia: <1%.

1- Placenta praevia
A placenta which encroaches on the lower segment of the uterus.

The lower segment can be defined as that part of the uterine wall which:
• Does not contract in labour but is stretched in
response to contractions.
• Used to be the isthmus before pregnancy.
• Underlies the loose fold of peritoneum that reflects from the bladder.
• Is covered by a full bladder anteriorly.
• Is within 8 cm of the internal cervical os at term.

Classification of P.P:
According to the grades of severity of a placenta praevia
Grade 1, 2 ,3 ,4 .

2- Placental abruption
This is bleeding from the placental bed of a normally sited placenta. It may occur as an antepartum or an intrapartum event.

Classification
1- MAJOR
This is clinically obvious and may result in the death of the fetus. It is also life-threatening to the mother and usually involves separation of more than one-third of the placenta.
2- MINOR
Premature separation of small areas of the placenta may result in placental infarcts. Several small abruptions may precede a large abruption.

? Much of the bleeding that occurs from an abruption is not discharged through the vagina and is known as concealed haemorrhage.
? Bleeding which is clinically obvious is revealed haemorrhage.
? Most times it is obviously mixed.