APH (Antepartum Haemorrhage) and Placenta previa (PP) Diagnosis Symptoms

APH (Antepartum Haemorrhage) and Placenta previa (PP) APH (Antepartum Haemorrhage)

  • } It is defined as bleeding from or into the Genital tract.

APH (Antepartum haemorrhage)


APH (Antepartum Haemorrhage) and Placenta previa (PPT) Diagnosis Symptoms

Cause of APH

} I. Placenta previa (PP) is defined as the presence of placental tissue over or near the internal cervical os. } PP can be classified into four types based on the location of the placenta relative to the cervical os: to the internal os.

Placenta previa (PP)

Placenta previa (PP)

  • } Type-1/low-lying placenta,
    • ◦ placenta is located near (2 to 3 cm) but not directly adjacent
  • } Type-2/marginal previa,
    • ◦ the edge of the placenta lies adjacent to the internal os;
  • } Type-3/partial previa,
    • ◦ the margin of the placenta covers part but not all of the internal os;
  • } Type-4/complete or total previa,
    • ◦ the placenta covers the entire cervical os;
  • } 1. the incidence of PP is 1 in 200 to 1 in 390 pregnancies over 20 weeks’ gestational age).
    • ◦ varies with parity,
    • ◦ For nulliparous, the incidence is 0.2%, in grand multiparous, it may be as high as 5%
  • } 2.  The most important risk factor for PP is a previous cesarean section.
    • ◦ PP occurs in 1% of pregnancies after a cesarean section.
    • ◦ The incidence after four or more cs increases to 10%

APH Epidemiology

  • ◦ increasing maternal age after age 40),
  • ◦ multiple gestation, and previous uterine curettage
  • ◦ the placenta covers the cervical os in 5% of pregnancies when examined at midpregnancy.
  • ◦ The majority resolve as the uterus grows with gestational age.
  • ◦ The upper third of the cervix develops into the lower uterine segment, and the placenta “migrates” away from the internal os.
Other risk factors
  • } Unknown —
    • ◦ a.  Endometrial scarring.
    • ◦ b.  A reduction in uteroplacental oxygen promotes need for an increase in the placental surface area that favors previa formation.

APH Etiology

  • } Bleeding occur in association with the development of the lower uterine segment in the third trimester.
  • } Placental attachment is disrupted because this area gradually thins in preparation for labor.
  • } the thinned lower uterine segment is

Cause of bleeding

  • } unable to contract adequately to
  • } prevent blood flow from the open vessels.shearing action
  • } Vaginal examination or intercourse may also cause separation of the placenta from the uterine wall.
  • } 80% of affected patients present with painless vaginal bleeding
  • } Most commonly, the first episode is around 34 weeks of gestation;
  • } one-third of patients develop bleeding before 30 weeks
  • } Anaemia

Clinical Manifestations symptoms —

  • } Abnormal growth of the placenta into the uterus can result in one of the following 3 complications:
    • } i. Placenta Previa Accreta.
    • } ii. Placenta Previa Increta.
    • } iii. Placenta Previa Percreta.
  • } 1.  History.
    • ◦ PP presents with acute onset of painless vaginal bleeding.
    • ◦ A thorough history should be obtained from the patient, including obstetric and surgical history as well as documentation of previous ultrasound examinations.
    • ◦ Other causes of vaginal bleeding must also be ruled out, such as placental abruption.

APH Diagnosis

  • } Vaginal sonography –
    • ◦ is the gold standard for diagnosis of previa
    • ◦ Placental tissue has to be overlying or within 2 cm of the internal cervical os to make the diagnosis.
    • ◦ The diagnosis may be missed by transabdominal scan,
    • ◦ if the placenta lies in the posterior portion empty bladder may help in identifying anterior previas, and Trendelenburg positioning may be useful in diagnosing posterior previas.

Complete placenta previa. Sagittal mid-line view of the lower uterus performed tau the placenta (PL) completely covering the cx Marginal/partial placenta previa in 3RD trimester patient with bleeding. Tvu shows inferior edge of posterior pl (P) located at internal CX os

APH (Antepartum Haemorrhage)

  • } If PP is present, digital examination is contraindicated.
    • ◦ a.  A speculum examination can be used to evaluate the presence and quantity of vaginal bleeding, the amount of vaginal bleeding can be assessed without placing a speculum and potentially causing more bleeding.
    • ◦ b.  Maternal vital signs, abdominal exam, uterine tone, and fetal heart rate monitoring should be evaluated.


  • } 4. . The following laboratory studies should be done for a patient with PP with vaginal bleeding:
    • ◦ a.  Complete blood cell count
    • ◦ b.  Type and cross-match
    • ◦ c.  Prothrombin time and activated thromboplastin time
    • ◦ d.  Kleihauer test to assess for fetomaternal hemorrhage

Laboratory Studies

  • } Maternal—
    • ◦ Anaemia with shock or CHF
    • ◦ Malpresentation
    • ◦ Premature labour
    • ◦ Rarly rupture of membrain
    • ◦ Post partum haemorrhage
    • ◦ Sepsis
    • ◦ subinvolution
  • } Foetal complications include
    • ◦ Low birthweight baby
    • ◦ Asphyxia
    • ◦ IUD
    • ◦ Birth injury
    • ◦ Congenital malformation
  • } 1. Standard Management
    • ◦ a.  In the third trimester in a patient who is not bleeding, recommendations include
  • } ultrasound confirmation
    • ◦ pelvic rest (nothing in the vagina, including intercourse or pelvic exams),
    • ◦ explanation of warning signs and when to seek immediate medical attention,
    • ◦ avoidance of exercise and strenuous activity, and fetal growth ultrasounds every 3 to 4 weeks.
    • ◦ Fetal testing semiweekly


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