Antepartum Hemorrhage (APH)

Antepartum Hemorrhage or Prepartum Hemorrhage is 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 example. Cervicitis, cervical carcinoma, cervical polyp,
trauma

Comparison of presentation of abruption, Praevia and uterine rupture.

Abruption Praevia Uterine Rupture

Abdominal 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 Non-tender Uterus

Management of Antepartum Hamorrhage

Management depends on

 Gestational age
 Severity of bleeding
 Viability of fetus

Immediate management includes:

 Call for help. Involve the senior staff on call

 Assess 2 large bore IV cannulas
 Send blood for grouping & cross-matching, 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 mask 8-10L/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.
 Notify NICU
 Counsel the woman and the family about what to expect in terms of baby’s condition and care.
Inpatient management includes

 Admit to Hospital for assessment and management.

 Take history of the client
 Examine the woman by assessing maternal and fetal well-being
 May need resuscitation measures if shocked or severe bleeding.
 Check vital signs such as pulse, Respiration, Blood pressure, Temperature.
 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 consider expectant management until 37/38 weeks.
 Give steroids example inj. Dexamethasone to help promote fetal lungs maturity incase the
pregnancy does not go to term and labour sets in.
 If bleeding is heavy or continuous, arrange or do caesarean section delivery irrespective of fetal
maturity.

Risk factors associated with Antepartum Haemorrhage

 Maternal age/advanced age

 Previous history of caesarean section
 Previous history of abortion
 Previous placenta praevia

Complications

1. Malpresentation
2. Premature labour
3. Postpartum Haemorrahage
4. Shock
5. Hysterectomy
6. Puerperal infection
7. Fetus may die from hypoxia during heavy bleeding
8. High rate of maternal mortality
9. Perinatal mortality