Bleeding from the genital tract after 24 weeks gestation and before the end of the second stage of labour

Aetiology

• Most common causes are placental abruption and placenta praevia
• Other causes:
  • Local causes - ectropion, polyp, infection, carcinoma
  • Uterine problem - rupture
  • Vasa praevia
  • Indeterminate

Quantifying APH

Placental abruption

• Separation of a normally implanted placenta from the wall of the uterus - partially or totally before the birth of the foetus
• Clinical diagnosis

Aetiology

Risk factors:

• Unknown - 70% occur in low risk pregnancies
• Pre-eclapsia/hypertension
• Trauma (blunt, forceful)
• Smoking, cocaine, amphetamine
• Medical thrombophilias, renal disease, diabetes
• Polyhydramnios
• Multiple pregnancy
• Preterm
• Abnormal placenta