Antepartum Hemorrhage: Understanding Etiology and Risk Factors

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 potentially life-threatening condition that requires timely diagnosis and intervention.

Etiology of Antepartum Hemorrhage

Placenta Previa

Placenta previa occurs when the placenta abnormally implants over or near the cervical os, leading to painless vaginal bleeding in the third trimester.

Abruptio Placentae

Placental abruption refers to premature separation of the placenta from the uterine wall, often resulting in painful vaginal bleeding, uterine tenderness, and fetal distress.

Vasa Previa

Vasa previa is a rare but serious condition where fetal blood vessels traverse the membranes over the internal cervical os, making them prone to rupture.

Risk Factors

• Previous history of placenta previa or placental abruption
• Multiple gestations
• Maternal smoking and substance abuse
• Advanced maternal age
• Hypertensive disorders of pregnancy
• Previous cesarean section or uterine surgery

Clinical Presentation and Management

Patients with APH may present with varying degrees of bleeding, ranging from mild spotting to profuse hemorrhage. The primary approach includes prompt maternal stabilization, fetal monitoring, and appropriate obstetric management tailored to the underlying etiology.