Antepartum Hemorrhage: Definition, Classification, and Epidemiology

Introduction

Antepartum hemorrhage (APH) refers to bleeding from the genital tract occurring after 20 weeks of gestation and before the onset of labor. It is a significant obstetric complication associated with maternal and fetal morbidity and mortality.

Definition

APH is defined as vaginal bleeding during pregnancy, occurring after 20 weeks of gestation but before delivery. It can result from various causes, including placental abnormalities and uterine rupture.

Classification

• Placenta previa: Implantation of the placenta over or near the cervical os.
• Abruptio placentae: Premature separation of a normally implanted placenta.
• Vasa previa: Fetal blood vessels crossing the internal cervical os.
• Uterine rupture: A rare but life-threatening condition involving the tearing of the uterine wall.

Epidemiology

APH occurs in approximately 3-5% of pregnancies. Risk factors include advanced maternal age, multiparity, previous cesarean section, smoking, and hypertension. Placenta previa is more common in women with prior uterine surgeries, while abruptio placentae is strongly associated with hypertensive disorders and trauma.

Clinical Presentation

• Painless vaginal bleeding (suggestive of placenta previa).
• Painful vaginal bleeding with uterine tenderness (suggestive of abruptio placentae).
• Fetal distress or abnormal fetal heart rate patterns.

Diagnosis

Diagnosis involves clinical assessment, ultrasonography, and laboratory investigations. Transvaginal ultrasound is the gold standard for diagnosing placenta previa, while abruptio placentae is primarily diagnosed based on clinical findings.

Management

• Hospitalization for monitoring and stabilization.
• Blood transfusion if necessary.
• Delivery planning based on gestational age and severity of bleeding.
• Cesarean section for placenta previa or severe abruptio placentae.

Conclusion

Antepartum hemorrhage is a critical obstetric emergency requiring prompt diagnosis and management. Understanding its classification and epidemiology helps in early identification and intervention, improving maternal and fetal outcomes.