Antepartum Hemorrhage (APH)
Antepartum hemorrhage is defined as bleeding from or into the genital tract occurring from 24+0 weeks of gestation until the birth of the baby. It is a significant obstetric emergency requiring prompt evaluation.
Key Causes
- Placenta Praevia: Placenta implanted in the lower uterine segment, potentially over the cervical os. Classically presents with painless, bright red vaginal bleeding.
- Placental Abruption: Premature separation of a normally situated placenta from the uterine wall. Often presents with painful bleeding, uterine tenderness, and fetal distress.
- Vasa Praevia: Fetal blood vessels traverse the fetal membranes over the cervical os. This is a rare, life-threatening condition for the fetus.
- Local Causes: Cervical ectropion, cervicitis, polyps, or lower genital tract trauma.
Management Principles
| Step | Action |
|---|---|
| Immediate | Call for help, assess ABCs, establish two large-bore IV lines, and monitor maternal/fetal status. |
| Resuscitation | Fluid replacement and oxygen therapy as needed. Emergency delivery if maternal/fetal compromise is present. |
| Investigation | Ultrasound for placental localization; CTG for fetal monitoring. |
High-Yield Exam Pearl:
- Contraindication: Digital vaginal examination is strictly contraindicated in cases of undiagnosed antepartum bleeding until placenta praevia has been ruled out by ultrasound.
- Rh Status: Always check the patient’s Rhesus status and administer Anti-D immunoglobulin if the mother is Rh-negative and not sensitized.