Antepartum Hemorrhage: Clinical Presentation and Symptoms

Introduction

Antepartum hemorrhage (APH) is defined as bleeding from the genital tract occurring after 20 weeks of gestation but before delivery. It is a significant complication of pregnancy that requires prompt diagnosis and management to prevent maternal and fetal morbidity.

Causes of Antepartum Hemorrhage

APH can be categorized based on its etiology:

• Placenta previa – Abnormal implantation of the placenta covering the cervical os.
• Abruptio placentae – Premature separation of a normally implanted placenta.
• Vasa previa – Fetal vessels crossing the cervical os, vulnerable to rupture.
• Other causes – Uterine rupture, cervical or vaginal lesions, and coagulopathies.

Clinical Presentation

The symptoms of APH depend on the underlying cause:

• **Painless vaginal bleeding:** Suggestive of placenta previa.
• **Painful vaginal bleeding with uterine tenderness:** Indicative of abruptio placentae.
• **Fetal distress or absent fetal heart tones:** May occur in cases of significant blood loss.

Diagnosis

Diagnosis of APH involves a thorough clinical assessment, including:

• Ultrasound evaluation for placenta previa.
• Fetal heart rate monitoring.
• Coagulation profile to assess clotting abnormalities.

Management

The management of APH depends on severity, gestational age, and etiology:

• Hospitalization for monitoring and stabilization.
• Administration of corticosteroids for fetal lung maturity if preterm delivery is anticipated.
• Immediate cesarean delivery for cases of severe hemorrhage or fetal distress.

Conclusion

Antepartum hemorrhage remains a critical condition requiring timely intervention. Early recognition and appropriate management significantly improve maternal and fetal outcomes.