Attached.

ANTEPARTUM HAEMORRHAGE
Specific Learning Outcomes
• To internalize the potential danger of APH
• To state the causes of APH
• To describe diagnosis, symptoms and management of
APH

1

Definition - Bleeding from the birth canal after the 20th week
or 28th week of pregnancy

Epidemiology
• Affects 3-5% of all pregnancies
• Three times more common in multiparous than in
primiparous women
• Very common cause of maternal Death
• May lead to post-partum haemorrhage

Aetiology
No definite cause in about 40% of cases
Types
Simple
• Local causes
▪ Vaginal Trauma
▪ Cervical Erosion or tumour
▪ Cervicitis
• Blood Dyscrasia
▪ Thrombocytopenia
▪ Anticoagulants

2

Complicated
• Placenta Praevia
• Abruptio Placentae
• Vasa praevia (bleeding from fetal vessels in fetal
membranes)
• Uterine rupture
Placenta accreta:
• Complicates approximately 10% of all cases of placenta
praevia but
• Is rare in the absence of placenta praevia

Placenta Praevia
Definition - Placenta which has implanted partially or wholly
in the lower uterine segment

Types
Old Classification
• Grade 1 – Just enters lower segment
• Grade 2 – Enters LUS but does not reach os
• Grade 3 – Partially covers os but not completely
• Grade 4 – Completely covers os

3

Types (New classification)
Minor – Enters LUS but does not cover os
Major – Covers internal os completely
Aetiology
• Unclear
• Any damage to endometrium or myometrium
• Scar tissue impedes migration away from os
• Multiple pregnancy- large surface area
• Smoking- vasoconstriction
• Cocaine Use – Vasoconstriction-hypertrophy
• Endo/myometrial damage
▪ Previous c/s
▪ Spontaneous abortion
▪ Uterine damage
• Other Factors
▪ Previous Placenta praevia
▪ Maternal age – reduced uterine blood flow needs
greater surface area
▪ Parity - 3 previous deliveries 2.6 fold
✓ Vessels at site of previous placenta reduced
flow discourage implantation
Associated Complications
4

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