Antepartum haemorrhage (APH) is defined as vaginal bleeding after the 20th week (third trimester) of pregnancy. APH is associated with increased foetal and maternal morbidity and mortality. The foetal and maternal status will depend on the amount, duration, and cause of bleeding.

CAUSES OF ANTEPARTUM HAEMORRHAGE

The causes of APH are:

• nonplacental bleeding: From sites other than the placental surface, including cervical lesions, due to trauma, cancer of the cervix, cervical polyps; vaginal lesions, genital tears/lacerations, and infections; and vulvoperineal tears (rare).
• Placental causes:

• Placental abruption

  Placental abruption occurs when the placenta detaches from the endometrium. Detachment causes antepartum haemorrhaging at the location of abruption. Depending on the site of detachment, haemorrhaging may or may not be apparent. If abruption occurs behind the placenta where blood cannot escape through the cervix. 

• Placenta praevia : 
  This occurs when any part of the placenta implants in the lower part/segment of the uterus.
  Further clinical classification is feasible depending on the relationship to internal cervical as:
• PLACENTA PRAEVIA
  • Minor degree:
    • Type 1: Placenta in the lower uterine segment but not encroaching the internal os.
    • Type 2: Placenta partially encroaches internal os but not during
  • Major degree:
    • Type 3: Placenta partially encroaches the internal os and remains the same even during
    • Type 4: Placenta totally covers the internal os and this relationship does not change during
• Vasa praevia: This is a rare cause of antepartum haemorrhage in which the umbilical cord is inserted into placental membranes with blood vessels traversing and presenting over the internal cervical( insertion of the umbilical cord).

DIAGNOSIS AND INVESTIGATIONS

• Haemoglobin levels
• Urinalysis: Haematuria, proteinuria
• Bedside clotting time
• Bleeding time
• Platelet count
• Others: Ultrasound, which offers a high degree of diagnostic accuracy in antepartum haemorrhage