Antepartum haemorrhage

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For patient information on Placenta previa, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Antepartum hemorrhage; APH

In obstetrics, antepartum haemorrhage is bleeding from the vagina during pregnancy from twenty weeks gestational age to term.

It should be considered a medical emergency (regardless of whether there is pain) and medical attention should be sought immediately, as if it is left untreated it can lead to death of the mother and/or fetus.

Bleeding without pain is most frequently bloody show, which is benign; however, it may also be placenta previa (in which both the mother and fetus are in danger). Painful APH is most frequently placental abruption.

• Bloody show (benign) – most common cause of APH
• Placental abruption – most common pathological cause
• Placenta previa – second most common pathological cause
• Vasa previa – often difficult to diagnose, frequently leads to fetal demise
• Uterine rupture
• Bleeding from the lower genital tract
  • Cervical bleeding – cervicitis, cervical neoplasm, cervical polyp
  • Bleeding from the vagina itself – trauma, neoplasm
• Bleeding that may be confused with vaginal bleeding
  • GI bleed – hemorrhoids, inflammatory bowel disease
  • Urinary tract bleed – urinary tract infection

• Obstetrical hemorrhage

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