Antepartum Haemorrhage (APH), cause and management

Bleeding from or into the Genital tract after the 28th week of pregnancy but before the birth of the baby.

Causes of Antepartum Haemorrhage

Placenta previa

When the placenta is implanted partially or completely over lower Uterine segment.

Etiology- The exact cause is unknown, but following theories may explain-

1. Dropping down theory- The fertilized ovum drops down and gets implanted in the lower segment.
2. Defective decidua, results in spreading of the chorionic villi over a wide area in the Uterine wall.
3. Persistence of chorionic activity in the decidua capsularis and it’s development which comes in contact with lower segment.
4. Big surface area of placenta

Types or Degrees-

• Type I- low lying
• Type II- Marginal
• Type III- Incomplete or partial central
• Type IV- Central or total

Clinical features-

◾ Symptoms- only symptom is bleeding, Bleeding has a sudden onset, painless, apparently causeless and recurrent.

◾Signs-

Abdominal examination- size of uterus propotionate to period of gestation, uterus feels relaxed, persistence of malpresentation, fetal heart sound is present.

Vulval inspection, is done to note whether bleeding is still occuring or has ceased.

Vaginal examination must not be done outside the operation theatre.

◾Diagnosis-

1. Placentography- Sonography (TAS, TVS, TPS), MRI
2. Clinical- By internal examination, direct visualization during caesarean section, examination of placenta following vaginal delivery.

◾Complications of placenta praevia-

Maternal-

1. During pregnancy- Malpresentation and premature labour.

2. During Labour-

• Early rupture of membranes
• Cord prolapse
• Slow dilatation of the cervix
• Intrapartum Haemorrhage
• Increased incidence of operative interference
• Postpartum Haemorrhage
• Retained Placenta

Fetal complications-

• Low birth weight baby
• Asphyxia
• Intrauterine death
• Birth injuries
• Congenital malformations

◾Management-

Abruptio Placentae

Form of Antepartum Haemorrhage in which bleeding occurs due to premature separation of normally situated placenta.

◾Varieties

◾Etiology- exact cause of separation unknown in majority cases.

Prevalence is more with

1. High birth order pregnancies
2. Advancing age of mother
3. Poor socio- economic condition
4. Malnutrition
5. Smoking