Antepartum Hemorrhage (APH)

APH or Prepartum Hemorrhage bleeding from the vagina during pregnancy from twenty eight weeks of
gestational age to term.

Causes

 Placental abruption
 Placental Praevia
 Uterine Rupture
 Bleeding from the lower genital tract eg. Cervicitis, cervical carcinoma, cervical polyp, trauma

Comparison of presentation of abruption, Praevia and uterine rupture.

Abruption Praevia Uterine Rupture

Abd. Pain Present Absent Variable
Vaginal blood Old or fresh Fresh Fresh
DIC Common Rare Rare
Acute fetal distress Common Rare Common
uterus Tender Uterus Non-tender Uterus Tender Uterus

Immediate Measures

 Call for help, involve the senior staff on call

 Put in 2 large bore IV cannulas
 Keep patient flat and warm
 Send blood for grouping & cross-matching of FBC and coagulation profile. Ask for at least 2 units
of blood.
 Infuse rapidly 2 liters of normal saline (crystalloids) to re-expand the vascular bed until blood is
ready to be transfused.
 Give oxygen by musk10-15l/min
 Insert Foley catheter to empty the bladder and monitor urine output.
 Monitor vital signs such as pulse, BP, Respiration, Temperature and also SP02.
 In severe bleeding or fetal distress: Urgent delivery of baby irrespective of gestational age.

Management of APH

Management depends on

 Gestational age
 Severity of bleeding
 Viability of fetus

The management includes:

 Admit to Hospital for assessment and management.

 Take history of the client
  Examine the woman by assessing maternal and fetal well-being
 Many need resuscitation measures if shocked or severe bleeding.
 Check vital signs such as pulse, Respiration, Blood pressure, Temperature and SP02.
 Arrange for Ultrasound scan
 Blood volume should be replaced by crystalloids example normal saline or Ringers lactate
 If bleeding is light and stopped and the fetus alive and premature, then immediate delivery is
not necessary, rather give steroids such as inj. Dexamethasone to help promote fetal lung
maturity and consider expectant management until 37/38 weeks.
 If bleeding is heavy or continuous, arrange or do caesarean section delivery irrespective of foetal
maturity.

Maternal complications

 Malpresentation
 Premature labour
 Postpartum Haemorrahage
 Shock
 Retained placenta
 Hysterectomy
 Puerperal infection
 Fetus may die from hypoxia during heavy bleeding
 High rate of maternal mortality
 Prenatal mortality