Chapter-08 Antepartum Hemorrhage

BOOK TITLE: Management of High-Risk Pregnancy—A Practical Approach

1. Trivedi SS
2. Nagpal Monika B
3. Goel Madhu
Publishing Year
Author Affiliations
1. Lady Hardinge Medical College and SSK Hospital, New Delhi, India, Lady Hardinge Medical College, New Delhi, Lady Hardinge Medical College and SSK Hospital, New Delhi, New Delhi, India, New Delhi
2. Lady Hardinge Medical College and SSK Hospital, New Delhi, India
3. Rockland Hospital, Qutub Institutional Area, New Delhi, India
Chapter keywords


Antepartum hemorrhage is defined as bleeding from or into the genital tract after the period of viability of pregnancy but before delivery of the baby and occurs in 3–5% of all pregnancies. Antepartum hemorrhage can be due to placental, extraplacental and indeterminate causes. When the placenta is implanted wholly or partially in the lower uterine segment of the uterus it is called placenta previa and it occurs in about one in two hundred deliveries. Diagnosis is confirmed by ultrasound. Expectant treatment is given if pregnancy is less than 38 weeks, fetus is live with no serious congenital malformation, bleeding is not excessive and patient is not in labor and is hemodynamically stable. Termination of pregnancy is indicated if pregnancy is more than 38 weeks, patient is in labor, bleeding is excessive or fetus is dead or malformed. Abruptio placentae is the premature separation of normally situated placenta and occurs in about 1% of deliveries. Bleeding in abruptio placentae is usually associated with pain. Uterus is tense and tender, fetal parts are not easily made out and fetal heart may be absent. Severe hemorrhage, shock, coagulation failure and renal failure may be present in severe cases. Prompt and adequate administration of fluid, blood and fresh frozen plasma, early delivery with careful monitoring of vital signs, coagulation profile and urine output is included in the management. Coagulation disorder, if present, must be corrected before surgical procedure. All women with antepartum hemorrhage are at high risk for postpartum hemorrhage and should be managed appropriately.

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