An antepartum hemorrhage is vaginal bleeding that happens during later pregnancy up to birth. Antepartum bleeding, also known as antepartum haemorrhage or prepartum hemorrhage, is genital bleeding during pregnancy after the 28th week of pregnancy up to delivery. It is commonly caused by difficulties with the placentas attachment to the uterus that lead to tissue tearing or rupture. Aph complicates 35% of pregnancies and is a leading cause of. Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Antepartum hemorrhage an overview sciencedirect topics. Avoiding delays in diagnosis and treatment will have a significant impact on sequelae and chance of survival. Winner of the standing ovation award for best powerpoint templates from presentations magazine. This greentop guideline is restricted in scope to the management of postpartum haemorrhage pph. Active man agement of the third stage of labor should be. Together with suggested overhead slides to be used with each module, these handouts are also included in a separate folder.
Even in the absence of antepartum hemorrhage, placenta previa carries a risk for postpartum hemorrhage, primarily caused by uterine atony, as the lower uterine segment does not have the same contractile ability as the fundus after delivery. This greentop guideline is restricted in scope to the. Of the 383 deaths from postpartum haemorrhage, there were 4 main groups of primary causes. A placenta praevia is the most likely cause of a massive antepartum haemorrhage that threatens the patients life. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Rare causes include vasa previa and uterine rupture. Pph remains an important cause of maternal morbidity in both developing and technologically advanced countries. Postpartum haemorrhage management, risks, and maternal. Primary postpartum haemorrhage refer to online version, destroy printed copies after use page 4 of 37 flow chart. Intrapartum can refer to both the woman and the fetus. Antepartum haemorrhage definition bleeding from the vagina any time after 24 weeks gestation until the birth of the baby blood loss greater than 300mls or any amount causing hypovolaemic shock incidence 35% of all pregnancies. Most deaths resulting from pph occur during the first 24 hours after.
Antepartum haemorrhage aph defined as bleeding from the genital tract in the second half of pregnancy, remains a major cause of perinatal mortality and maternal morbidity in. Timely recognition, appropriate resources, and appropriate response are critical for preventing death. Should antibiotics be offered after manual extraction of the placenta as part of the. From sites other than the placental surface, including cervical lesions, e. Antepartum haemorrhage are sometimes associated with subsequent postpartum haemorrhage. Who recommendations for the prevention and treatment of. Postpartum hemorrhage pph is an obstetric emergency. If antepartum, the consultant obstetrician may consider expediting delivery. Aph occurs in 25 per cent of pregnancies and half are of unknown cause. Postpartum hemorrhage can result in severe maternal morbidity such as hysterectomy, hypovolemic shock, disseminated intravascular coagulation, and sheehans syndrome. Obstetric haemorrhage encompasses both antepartum and postpartum bleeding. Common causes of antepartum hemorrhage are bloody show associated with labor, placental previa, and placental abruption.
Antepartum haemorrhage caused by cervical ectropion can be expected and is. Differentiate the clinical features of placenta previa, abruptio placenta and other possible causes. An antepartum haemorrhage with fetal distress or fetal death is almost always due to abruptio placentae. Antepartum hemorrhage is bleeding from genital tract which usually takes place after 24 wks. Postpartum haemorrhage pph is commonly defined as a blood loss of 500 ml or more within 24 hours after birth.
By contrast, postpartum haemorrhage continues to be a major cause of maternal death both in the developing as well as in the developed world1. Prevention and management of postpartum haemorrhage ranzcog. Definition loss of blood more than 500 ml from the genital tract post delivery of a baby who excessive pvb that cause haematocrit drop more than 10% that require immediate transfusion acog 3. Global burden of maternal haemorrhage in the year 2000. Antepartum haemorrhage pv bleeding 20 weeks 25% of pregnancies classification.
Antepartum haemorrhage aph complicates 25% of pregnancies and is defined in some literature as any bleeding from the genital tract after the 20 th week of pregnancy and before labour. The causes of obstetric haemorrhage differ, depending on whether the haemorrhage occurs antepartum, intra or postpartum. Prevention and management of postpartum haemorrhage. Antepartum and postpartum hemorrhage prediction and management. Antepartum hemorrhage aph affects 5% to 20% of pregnancies, defined as genital tract bleeding after 20 or 24 weeks. Who guidelines for the management of postpartum haemorrhage. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that. It occurs in 25% of pregnancies and is an important cause of fetal and maternal death. Francois and others published antepartum and postpartum hemorrhage find, read. Antepartum hemorrhage often presents greater threat to the life of the fetus. Antepartum haemorrhage excluding placenta praevia introduction obstetric haemorrhage both antepartum and postpartum is one of the leading causes of maternalperinatal morbidity and mortality in the developed world. The time period spanning childbirth, from the onset of labor through delivery of the placenta. Obstetric haemorrhage management guideline royal berkshire. Of the deaths 99% are in low and middle income countries.
Definition aph is defined as any bleeding from the genital tract after the 20th week of gestation but before the onset of labour. Antepartum hemorrhage is a serious complication of pregnancy occurring within the third trimester. Cumulative blood loss of greater than or equal to ml, or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process includes intrapartum loss regardless of the route of delivery. Predisposing risk factors for obstetric haemorrhage. Diagnosis and management of postpartum haemorrhage the bmj. Thirty percent of maternal deaths are caused by antepartum haemorrhage of which 50% are associated with avoidable factors. Some of the causes of aph might also cause intrapartum bleeding for example. As adjectives the difference between antepartum and postpartum is that antepartum is describing the period before childbirth.
Pph is the leading cause of maternal mortality in lowincome countries and the primary cause of nearly one quarter of all maternal deaths globally. Essential antenatal, perinatal and postpartum care 2 required resources and visual aids the handouts required to accompany sessions have been included with each module. The most important causes of aph are placenta praevia and placental abruption, although these are not the most common. Antepartum hemorrhage knowledge for medical students and. Primary postpartum haemorrhage pph is loss of blood estimated to be 500 ml, from the genital tract, within 24 hours of delivery the most common obstetric haemorrhage. Severe antepartum haemorrhage aph occurs in 35% of pregnancies. The woman trial world maternal antifibrinolytic trial. Systemic antifibrinolytic agents are widely used in surgery to prevent clot breakdown fibrinolysis in. It is one of the top five causes of maternal mortality in both high and low per capita income countries, although the absolute risk of death from pph is much lower in highincome countries. This greentop guideline is restricted in scope to the management of aph. Postpartum haemorrhage pph is a major cause of maternal morbidity and mortality, accounting for about onethird of all pregnancyrelated deaths in africa and asia.
The evidencebased management of postpartum haemorrhage pdf. Maternal haemorrhage is the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding. Who guidelines for the management of postpartum haemorrhage and retained placenta 2 establish the cause of the haemorrhage, and possibly obtain the assistance of other care providers, such as an obstetrician, anaesthetist or radiologist. Definition antepartum hemorrhage aph is defined as vaginal bleeding from 22nd week to term. Antepartum and postpartum hemorrhage prediction and. Obstetric haemorrhage clinical guideline royal cornwall. Blood loss is often underestimated, so it is vital to observe for maternal shock and fetal compromise. Obstetric haemorrhage remains a major cause of maternal mortality in the uk and is now the third leading. A monograph of the management of postpartum haemorrhage. Ongoing research is being conducted in hopes of preventing the occurrence of postpartum hemorrhage and providing more efficient ways to treat the issue that so many. Antepartum haemorrhage is defined as bleeding from the vagina after 24weeks. Describe an appropriate management plan based on the probable cause. Prevention and management of postpartum haemorrhage green. Women with pph in a pregnancy are at increased risk of pph in a subsequent pregnancy.
Massive haemorrhage protocol mhp queensland clinical guidelines. Antepartum haemorrhage aph is bleeding from the genital tract after 20 weeks gestation and before labour. Depending on the underlying cause, it can be painless, or accompanied by pain and discomfort. Death from hemorrhage still remains a leading cause of maternal mortality. Active man agement of the third stage of labor should be used routinely to reduce its incidence.
Women who have an antepartum haemorrhage aph are at significant risk of a postpartum haemorrhage pph. It is associated with significant maternal and fetal morbidity and mortality. Hemorrhage was a direct cause of more than 18 percent of 3201 pregnancyrelated maternal deaths. Secondary pph is defined as abnormal bleeding from the genital tract. Antepartum hemorrhage often presents greater threat to the life of. Postpartum hemorrhage pph is a leading cause of death and morbidity relating to pregnancy. Postpartum haemorrhage free download as powerpoint presentation.