Antepartum haemorrhage

The incidence of antepartum haemorrhage (APH) is reported as 3.5% of all pregnancies. It is an important cause of maternal and perinatal mortality. There has been a decline in maternal mortality due to APH due to placenta praevia, but the decline has been marginal in cases of placental abruption. No definite cause can be identified in at least half of cases of APH. The diagnosis of placental abruption is based on clinical presentation and on the examination of the delivered placenta. Major complications resulting from placental abruption require critical care in 5–7% of cases. Mid-pregnancy ultrasound scan is an effective screening tool for the detection of placenta praevia. Ultrasound-based criteria have been developed for managing cases of placenta praevia. The incidence of placenta accreta responsible for APH has increased 10-fold, mainly due to a rise in caesarean section rate. Extraplacental causes of APH can be diagnosed on careful speculum examination.