Antepartum Haemorrhage

Bleeding from genital tract after 24 weeks and before birth

Differential diagnosis

• Abruptio placentae

  • abdominal pain - greatest in concealed bleed
  • vaginal bleeding
  • tense and tender uterus (Couvelaire uterus)
  • difficult to detect foetal heart or feel uterine contractions
  • evidence of hypovolaemia
  • dead foetus

• Placenta praevia

  • recurrent painless bleeding

  • usually begins around 32nd week but may be from late 2nd trimester

Incidental causes

• cervical carcinoma

• cervical ectopy

• cervical polyp

• varicosities of cervix, vagina, vulva

• diagnostic error - bleeding from urethra, or haemorrhoids

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