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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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