Antepartum Hemorrhage – What is It, Top Causes and Complications

If the bleeding isn’t too severe, close monitoring may be all that’s needed. Hospitalization for the mother is usually required. There is a high probability that a cesarean section will be necessary to deliver the baby early in certain situations.

Top Causes of Antepartum Hemorrhage

Antepartum hemorrhage or bleeding during pregnancy can occur due to some issues. Here are a few of them discussed in detail. 

1. Constant Shift of Cervix Cells

During pregnancy, the cervix’s surface cells often shift, making the tissue more prone to bleeding, especially after intercourse. Cervical ectropion describes this condition. There will be no harm to the pregnancy from this situation. But it is always better to inform your doctor if you observe any kind of bloody show during the third trimester or after 20 weeks of gestation. 

2. Any Infection

Besides causing discomfort, cervical and vaginal infections may lead to minor vaginal bleeding. If you are experiencing any of these symptoms, visit a doctor immediately.

3. Placental Edge Bleed

The lower uterine segment stretches and enlarges throughout the second part of pregnancy. Because of this, the placenta’s border may get detached from the uterine wall. Your baby will likely be unharmed if you wait a few hours for the bleeding to stop. If you see bleeding, however, you must seek medical attention immediately.

4. Placenta Praevia

The placenta praevia is diagnosed when the placenta develops close to or covers the cervix during pregnancy. The four kinds of placenta praevia are as follows

• Type I is where the placenta rests in the uterine lower tract, far from the opening of the cervix. 
• Type II or marginal, where the placenta comes close to the cervix without completely covering it.
• Type III or partial, where the placenta partially covers the cervix.
• Type IV or complete, where the placenta covers the cervix entirely.

[Read : Placenta Previa]

Symptoms of Antepartum Hemorrhage

Antepartum hemorrhage is not always harmful, but it definitely calls for your doctor’s attention. Since pregnancy is a delicate time, you must be alert and keep a watch on the symptoms of bleeding and contractions, especially after 20 weeks of gestation. 

Here are a few symptoms of antepartum hemorrhage

• Vaginal bleeding, sometimes painful (indicating an abruption) or painless (indicating previa).
• Uterine contractions
• Fetal malpresentation
• Decreased fetal movements
• Reduced fetal heart rate

[Read : Placental Abruption]

Diagnosis of Antepartum Haemorrhage

If you experience any of the above symptoms or if you notice slightest of the bleeding during pregnancy, it is important that you inform your health care provider immediately. They may consider conducting further tests to rule out any complications.

Here are a few methods through which your doctors may diagnose antepartum hemorrhage

• Complete Blood Test
• Clotting and Bleeding Time
• Ultrasonography
• Transvaginal Ultrasound is done if it is not a placenta previa case
• Cardiotocography is done for fetal heart rate monitoring
• Liver and Renal Test is done if bleeding is over 50 ml

[Read : Transvaginal Scan During Early Pregnancy]

Treatment Options For Antepartum Hemorrhage

Depending on the condition of the mother, blood loss, and fetal stability, doctors may analyze and plan the treatment accordingly. Listed below are some treatment options for antepartum hemorrhage

• Controlling bleeding before delivery
• After receiving therapy, they may be dismissed if they are experiencing minor spotting or bleeding has stopped completely.
• Doctors may administer medicines for six days if delivery is anticipated before the full term.
• Conservative care is the norm until the mother’s condition stabilizes, usually between 24 and 26 weeks.
• Treatment for placenta previa

When the pregnancy is fewer than 37 weeks, placenta previa might develop. If both mother and fetus are stable and no severe bleeding occurs, doctors will likely suggest bed rest and thorough monitoring of vital signs. Fetus movement recording methods are investigated, including ultrasonography, and routine cardiotocography. Schedule your birth after 37 weeks if everything is going well. Normal birth is possible in types 1 and 2 of anterior placenta previa. If labor is progressing without bleeding, you may also have a vaginal birth.

Complications Associated With Antepartum Hemorrhage

The complications associated with antepartum hemorrhage include the following

Complications For the Mother

• Too much blood loss
• More likely to get infections
• Shock
• Disruption of renal tubular cells
• Unmanageable postpartum hemorrhage
• Unstable mental state
• Problems during blood transmission

Complications For the Fetus

• The fetus’s oxygen level drops
• Fetus growth retardation
• Premature birth
• Fetal demise

The health of the mother and the fetus must be considered before any therapy is administered, and every precaution must be made to avoid excessive bleeding. Safer treatment options can only be provided with adequate planning and implementation of a multidisciplinary strategy. Preventing such issues requires a complete and accurate case history. Timely care requires the proximity of the finest possible critical care unit and blood banks.

FAQ’s

1. How Many Types of Antepartum Hemorrhage Are There?

Bleeding during pregnancy during and after the period of 20 weeks gestation is called antepartum hemorrhage. There are four types of antepartum hemorrhage

• Spotting: Signs of blood, such as stains, streaks, or spots
• Minor Haemorrhage: Less than 50mL of blood loss
• Major Haemorrhage: Loss of 50-1000mL of blood with no signs of circulatory shock
• Massive Haemorrhage: Blood loss of 1000mL with or without symptoms of circulatory shock

Read Also: Postpartum Hemorrhage: Symptoms, Treatment And Prevention