Bleeding in Late Pregnancy (Antepartum Haemorrhage)

Antepartum haemorrhage (APH) is defined as bleeding from or in the genital tract after 24 weeks of pregnancy and prior to the delivery of the baby (Box 1). APH complicates 2–5 per cent of pregnancies and is a leading cause of maternal mortality, morbidity, and perinatal mortality worldwide, especially in women who live in areas of conflict or in rural areas with a poor transport infrastructure. Twenty per cent of very preterm babies are born in association with APH, as the subsequent impaired placental perfusion and fetal hypoxia can cause severe neurological injury or even fetal death. Every woman who presents with an APH must therefore be appropriately triaged to prevent and minimise both maternal and fetal complications. Any bleeding in pregnancy is a cause of anxiety and stress for the mother and their carer. Box 1 Classification of the causes of APH Placental causes

Placenta praevia

Abruption of placenta

Non-placental causes Maternal

Local causes coincidental to the pregnancy

A bloody ‘show’ with the onset of labour

Fetal

Vasa praevia

Unexplained

Where the cause cannot be identified