Antepartum Haemorrhage

Antepartum Haemorrhage (APH)
pronounced an-te-part-um hem-or-idj

Bleeding from the genital tract at any time after the 20th week of pregnancy until the baby is born (although some sources say after the 24th week of pregnancy) of greater than 500ml. A major obstetric haemorrhage is described as being greater than 1,000ml, or one which causes clinical shock in the woman. Women with an APH should always be admitted to hospital for assessment and management. The incidence of APH is 3-5% of all pregnancies, with risk increasing with parity. No definite cause is identified in 40% of women who present with APH. The most common cause of APH is placental abruption, with an incidence of 1 in 50 pregnancies.

Causes of minor blood loss could be cervical erosion, a show, or post-coitus, but are not considered to be a true APH.

In recent years, APH has become more prevalent. CEMACH (2004) have determined that this is due to risk factors becoming more common in recent years, for example:
· Increasing mean age of childbirth.
· An increasing number of women with complex medical disorders choosing to become pregnant.
· Increased number of multiple pregnancies, due to assisted reproduction.
· Increased caesarean section rates, leading to placenta praevia or accrete in subsequent pregnancies.

Severe APH may be caused by:
Placenta praevia.
Vasa praevia.
Placental abruption.
Uterine Rupture.

http://www.patient.co.uk/showdoc/40000210/
Medforth, J., Battersby, S., Evans, M., Marsh, B. and Walker, A. (2006) Oxford Handbook of Midwifery. Oxford: Oxford University Press.
Tiran, D. (2003) Baillière’s Midwives’ Dictionary. 10th ed. Edinburgh: Baillière Tindall.