Antepartum haemorrhage (APH) is bleeding from the genital tract between 28 weeks of pregnancy and the onset of labor. Placenta previa and placenta abruption are major causes of APH. Placenta previa occurs when the placenta is implanted in the lower uterine segment or covers all or part of the cervical os. It can be diagnosed by ultrasound and treated with caesarean section. Complications of APH include maternal and fetal mortality due to factors like pre-existing anemia, transport difficulties, and inadequate medical care.

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ANTEPARTUM HAEMORRHAGE
(APH)
DR HENRY A.A.
UGBOMA (JP)

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Antepartum haemoharrage is bleeding
from the genital tract between the
28th week of pregnancy and the onset
of labour.
 Causes:
 Placenta previa and placenta abruption are the
major cause of (APH) but most common causes
are undetermined. Diseases of the lower genital
tract contribute to (APH).

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Complications:Complications:
• Maternal and fetal mortality may result
from APH due to:
• Pre-existing anaemia.
• Transport difficulties.
• Restricted medical facilities.
• Inadequate resuscitation of mother.
• Inexperience of junior medical staff.
• Delay in seeking assistance of more
experienced doctors.
• Delay in response by senior medical staff.

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Placenta praevia
 A condition where the placenta is implanted wholly or
in part in the lower uterine segment.
 There are four different grades of placenta praevia.
 The placenta reaches the lower uterine segment but
does not reach the internal cervical os.
 The placenta reaches the edge of the cervix but does
not cover it..
 The placenta covers the cervix but does not at full
cervical dilatation.
 The placenta covers the cervix and remains so at full
cervical dilatation.
 Placenta praevia can also be grouped as major or
minor degrees. The major degrees are 2B, 3 and 4
while the minor degrees are 1 and 2A. The ‘A’ and ‘B’
stands for anterior and posterior sites respectively.

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CausesCauses
• This is unclear. There are accepted
associations like:
• Older multiparous women.
• Multiple pregnancies.
• Previous caesarean sections, other
previous uterine damage, include
dilatation and curettage, spontaneous
abortion and evacuation of uterus for
retained products of conception.

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Clinical presentation:
 Presentation of APH.
 Fetal malposition in late pregnancy.
 Asymptomatic placenta praevia by routine
ultrasound examination.
 Bleeding in placenta praevia is usually painless and
unprovoked. In abdominal examination, the uterus is
soft and non tender. The fetal heart rate is usually
normal. There is unusually high head presenting or a
malpresentation. Vaginal examination is
contraindicated.

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Investigations:Investigations:
 FBCFBC
 UrinalysisUrinalysis
 Ultrasonography.Ultrasonography.
 MRI.MRI.

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TreatmentTreatment
 In minor degree placenta praevia, vaginalIn minor degree placenta praevia, vaginal
deliveries are allowed. In cases where bleeding isdeliveries are allowed. In cases where bleeding is
severe, emergency caesarean section is done.severe, emergency caesarean section is done.
 Delivery for major degree placenta praevia is byDelivery for major degree placenta praevia is by
caesarean section. Patient is admitted into thecaesarean section. Patient is admitted into the
ward. About 4-6 units of blood are grouped andward. About 4-6 units of blood are grouped and
cross matched for her.cross matched for her.
 Blood transfusion is given to these patients toBlood transfusion is given to these patients to
replace losses from intermittent bleeds untilreplace losses from intermittent bleeds until
delivery is carried out.delivery is carried out.

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 Thanks ……Thanks ……
Any questions?Any questions?

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 Thanks ……Thanks ……
Any questions?Any questions?