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Antepartum Hemorrhage


Learning Objectives

  • Evaluate patients with antepartum hemorrhage.

  • List differential diagnoses for antepartum bleeding.

  • Manage antepartum hemorrhage safely and promptly.

  • Counsel patients on recurrence risks for antepartum hemorrhage.

Antepartum hemorrhage is defined as any bleeding from the genital tract after the 20th week of pregnancy and before the onset of labor. Antepartum hemorrhage complicates 2%–5% of all pregnancies . It is associated with increased rates of perinatal morbidity and mortality and contributes significantly to healthcare costs.

Causes of Antepartum Hemorrhage

  • Placenta previa

  • Placental abruption

  • Uterine rupture

  • Vasa previa

  • Cervical lesions (such as polyps, ectropion, or malignancy)

  • Infection

  • Trauma

  • Unknownk

Complications

  • Maternal hypovolemic shock

  • Premature birth

Types of Antepartum Hemorrhage

Placental Abruption ( Fig. 14.1 )

Placental abruption, or abruptio placentae, occurs when the placenta separates from the lining of the uterus prior to delivery. Patients typically present with bleeding in setting of abdominal pain. There are two types of placental abruption:

  • Revealed placental abruption causes overt vaginal bleeding

  • Concealed placental abruption occurs when there is no vaginal bleeding because the blood gets trapped inside the uterus behind the placenta

Fig. 14.1, Placental abruption. This occurs when the placenta separates from the uterine wall. It typically presents with painful vaginal bleeding.

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