Obstetrics

Antepartum Haemorrhage

Bleeding from or into the genital tract from 24+0 weeks until birth, where the visible loss understates the true loss and two patients are bleeding at once.

Definition

Antepartum haemorrhage is bleeding from or into the genital tract from 24+0 weeks of pregnancy until the birth of the baby. Bleeding before 24+0 weeks is not APH and is assessed as early pregnancy bleeding or threatened miscarriage. RCOG grades APH as spotting, minor, major or massive, and recurrent APH means episodes on more than one occasion.

First principles

Two patients bleed, and the mother is patient one

Fetal oxygenation depends entirely on maternal perfusion, so restoring the maternal circulation is also the fetal treatment. RCOG is explicit: in persisting major or massive haemorrhage the mother is the priority and is stabilised before the fetal condition is established. The same rule holds at the edge of viability, whatever the gestation.

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