ANTEPARTUM HEMORRHAGE
Definition:
− It is bleeding per vagina after 28th week of pregnancy also known as third trimester bleeding
Etiology:
− Differentiation must be made between obstetric causes of bleeding (usually more hazardous)
and nonobstetric causes (usually less hazardous)
Obstetric causes
a) Placenta previa
b) Abruptio placenta
c) Vasa previa
d) Bloody show
e) Uterine rapture
f) Disseminated Intravascular Coagulopathy
Nonobstetric causes
a) Cervicitis
b) Cervical cancer or dysplasia
c) Cervical polyps
d) Cervical eversion
e) Cervical erosion
f) Vaginal laceration
g) Vaginitis
h) Vaginal varicosities
i) Vaginal trauma E.g. sexual, object
− Nonobstetric causes usually result in relatively little blood loss and little threat to mother or
fetus.
− An exception is invasive carcinoma of the cervix.
− Most serious hemorrhages (2-3% of pregnancies) lose more than 800mL of blood and are
due to premature separation of the placenta or placenta previa.
− Less common but still dangerous causes of bleeding are circumvallate placenta,
abnormalities of the blood clotting mechanism, and uterine rupture
− Bleeding from the peripheral portion of the intervillous space, or marginal sinus rupture, is a
debatable cause of bleeding
Definition:
− It is bleeding per vagina after 28th week of pregnancy also known as third trimester bleeding
Etiology:
− Differentiation must be made between obstetric causes of bleeding (usually more hazardous)
and nonobstetric causes (usually less hazardous)
Obstetric causes
a) Placenta previa
b) Abruptio placenta
c) Vasa previa
d) Bloody show
e) Uterine rapture
f) Disseminated Intravascular Coagulopathy
Nonobstetric causes
a) Cervicitis
b) Cervical cancer or dysplasia
c) Cervical polyps
d) Cervical eversion
e) Cervical erosion
f) Vaginal laceration
g) Vaginitis
h) Vaginal varicosities
i) Vaginal trauma E.g. sexual, object
− Nonobstetric causes usually result in relatively little blood loss and little threat to mother or
fetus.
− An exception is invasive carcinoma of the cervix.
− Most serious hemorrhages (2-3% of pregnancies) lose more than 800mL of blood and are
due to premature separation of the placenta or placenta previa.
− Less common but still dangerous causes of bleeding are circumvallate placenta,
abnormalities of the blood clotting mechanism, and uterine rupture
− Bleeding from the peripheral portion of the intervillous space, or marginal sinus rupture, is a
debatable cause of bleeding
