The word antepartum means “occurring before birth.” Antepartum hemorrhage has been defined by many medical boards across the world and varies significantly based on their research and evidence. Broadly, it is defined as “bleeding from or into the genital tract, occurring from 24 weeks of pregnancy and before the birth of a baby”.
Bleeding of any sort is a major cause of concern for any pregnant woman. Antepartum hemorrhage, in most cases, can occur without any warning; hence it becomes extremely overwhelming to cope with such an emergency. It complicates around 2-5% of pregnancies worldwide and can contribute to a significant amount of maternal and perinatal morbidity and mortality. Through this article, we would like to discuss the major causes of antepartum bleeding, their complications, and how you can identify and treat them early.
What are the types of antepartum hemorrhage?
Depending upon the quantity of blood lost, antepartum hemorrhage can be divided into minor hemorrhage (less than 50 ml), major hemorrhage (50-100 ml), and massive hemorrhage (more than 1000 ml).
What can cause antepartum hemorrhage?
Bleeding during pregnancy can either be caused by placenta praevia (low-lying placenta) or placental abruption. Other minor causes include vasa praevia (bleeding from placental blood vessels), cervix diseases, or bleeding of undetermined origin. Let’s look at the major causes of bleeding!
- Placenta Previa
Usually, the placenta should lie in the upper part of the uterus during pregnancy, especially by 20 weeks. If it lies partially or wholly in the lower part of the uterus, the condition is called placenta praevia. This is especially dangerous and can cause bleeding whenever the uterus contracts and the cervix dilates and also during the digital examination of the vagina. Depending upon the position of the placenta and the risk of bleeding, it can be graded into four types. The low-lying placenta is more common in women who have had multiple births, multiple pregnancies, previous caesarian sections, and previous uterine damage. It can be diagnosed by ultrasound scan, or it can present as painless vaginal bleeding.
- Placental Abruption
The placenta that is normally situated can sometimes separate from the uterus. This is called placental abruption. Initially, a small portion of the placenta separates, causing bleeding. This collection of blood can cause further separation and hemorrhage. This can be concealed where the blood stays between the uterus and placenta, or it can escape and pass out through the vagina. Some associated factors causing abruption include high blood pressure, abdominal trauma, fibroid, multiparty, multiple pregnancies, previous abruption, and cocaine use. It presents with abdominal pain, bleeding, shock, pain on palpating the uterus, decreased fetal heart sound and decreased urine.
What complications can antenatal hemorrhage lead to?
In the mother, it can lead to premature delivery, incorrect position of the baby at the time of labor, bleeding after delivery, sepsis, shock, and retained placenta. Complications in fetuses include preterm babies, low birth weight, intrauterine death, congenital defects, and suffocation after birth.
An insight from mamahood
In case of bleeding, consult your physician immediately for a detailed checkup. Do not delay seeking medical attention in such cases to avoid deterioration of the condition. Your gynecologist will take a thorough history examination and scan to confirm the diagnosis. You might need emergency delivery to reduce complications. You should ensure timely antenatal visits, anemia correction, and precautions to avoid abdominal trauma. Also, treat hypertension during pregnancy aggressively.