and Paula Briggs2
(1)
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
(2)
Sexual and Reproductive Health, Southport and Ormskirk Hospital, Southport, UK
Definition
This is defined as vaginal bleeding after 20 weeks gestation.
Incidence
It occurs in 2–5 % of pregnancies. Together with postpartum haemorrhage, it is one of the commonest causes of maternal death, although fortunately these are very uncommon in the Western world (less than four per million births).
Aetilogy and Pathogenesis
There are three causes of APH:
Placenta praevea – including vasa praevia (when there is a blood vessel in the membranes which crosses the internal os)
Retroplacental haemorrhage (known as placental abruption or accidental haemorrhage)
Incidental causes from the cervix, vagina or vulva
Recurrent APH occurs when there is more than one episode of bleeding.
Predisposing factors for abruption are a previous pregnancy with abruption, pre-eclampsia, intrauterine growth restriction (IUGR), multiparity, advanced maternal age, low BMI, pregnancy after assisted reproductive technology (ART), polyhydramnios, premature rupture of membranes, abdominal trauma, smoking, and drug use. There is a suggestion that thrombophilias may also be associated with an increased risk of abruption.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
