Antepartum haemorrhage

For patient information on Placental abruption, click here

For patient information on Placenta previa, click here

Overview
In obstetrics, antepartum haemorrhage (APH), also antepartum hemorrhage, is bleeding from the vagina during pregnancy from twenty weeks gestational age to term.

It should be considered a medical emergency (regardless of whether there is pain) and medical attention should be sought immediately, as if it is left untreated it can lead to death of the mother and/or fetus.

Bleeding without pain is most frequently bloody show, which is benign; however, it may also be placenta previa (in which both the mother and fetus are in danger). Painful APH is most frequency placental abruption.

Differential diagnosis of APH

 * Bloody show (benign) - most common cause of APH
 * Placental abruption - most common pathological cause
 * Placenta previa - second most common pathological cause
 * Vasa previa - often difficult to diagnose, frequently leads to fetal demise
 * Uterine rupture
 * Bleeding from the lower genital tract
 * Cervical bleeding - cervicitis, cervical neoplasm, cervical polyp
 * Bleeding from the vagina itself - trauma, neoplasm
 * Bleeding that may be confused with vaginal bleeding
 * GI bleed - hemorrhoids, inflammatory bowel disease
 * Urinary tract bleed - urinary tract infection