Antepartum haemorrhage

Published on 09/03/2015 by admin

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Last modified 09/03/2015

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Chapter 32 Antepartum haemorrhage

Definition. Antepartum haemorrhage is bleeding from the genital tract in the period from 20 weeks gestation to the birth of the baby.

Incidence. It occurs in 3% of pregnancies of >28 weeks gestation and 5% of pregnancies of >20 weeks gestation.

Aetiology

• placenta praevia

• placental abruption

• marginal bleed

• vasa praevia

• uterine rupture

• local causes: cervix, vagina

The source is almost entirely maternal in origin.

Placenta praevia

Incidence. Incidence is about 1%, rising with frequency of previous caesarean section.

Presentation. The placenta is attached to the lower segment of the uterus and/or covering the cervix. The presentation is usually that of a painless antepartum haemorrhage with a high presenting part. The absence of contractions and pain makes diagnosis more likely.

Routine second-trimester ultrasound will diagnose low-lying and placenta praevia.

Classification

• complete or grade 4 placenta praevia where placenta completely centrally covers the os

• marginal or grade 3 placenta praevia where the os is covered by the placenta edge

• marginal or grade 1 and 2 where the placenta is near but does not cover the os

The diagnosis is usually made in the third trimester. At the second trimester morphology assessment, a low-grade placenta praevia will be termed a ‘low lying placenta’ for complete assessment in the third trimester. Diagnosis of normal placental site is >5 cm from the cervical os.

Risk factors

• increased number of caesarean sections

• increased parity

Management

If asymptomatic and diagnosed at morphology scan, management is confirmation of diagnosis in the third trimester and planning elective caesarean section.

• It may involve resuscitation of the mother, fetal assessment and delivery (dependent on the amount of bleeding, continuation of bleeding and fetal maturity).

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