Antepartum Hemorrhage

Any Bleeding from genital tract after 24 to 28 weeks of pregnancy and Before delivery of the fetus

4% of all pregnancy

Causes:

Placental causes ( 50-70%) (obstetric causes)

_Placental previa

-Placental abruption

-Velamentous insertion of cord

-Marginal sinus rupture

-Circumvellate placenta

-Rarely rupture uterus

Excessive show

Non Obstetric Causes

_Cervical polyp

-Cervical ectopy (erosion)

_Carcinoma cervix

_Vaginal/ vulval Varicositis

_Cervicitis/vaginitis

Indeterminate Bleeding

Abruptio Placentae / accidental hemorrhage

Types:

Revealed / External hemorrhage

Concealed hemorrhage- carries worse risk , increased risk of consumptive coagulopathy / extent of hemorrhage not appreciated

Mixed

Total / partial

Incidence : 0.5%

Etiology

Advancing Maternal age

Race- more common among african american as compared to asians

main etiology is Hypertension such as chronic HTN : pre eclampsia

Uterine over distention e.g multiple pregnancy

Trauma

Cigarette smoking / cocaine

acquired thrombophilias

previous abruption

Pathophysiology:

Vascular injury

Rise in Uterine venous pressure

also separation of placenta

Clinical feature

Symptoms:

Bleeding (may be altered / fresh blood

Abdominal pain- Continuos pain

Too frequent contraction

Back pain