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Antepartum Hemorrhage


Any Bleeding from genital tract after 24 to 28 weeks of pregnancy and Before delivery of the fetus

4% of all pregnancy

Causes:

Placental causes ( 50-70%) (obstetric causes)

_Placental previa
-Placental abruption
-Velamentous insertion of cord
-Marginal sinus rupture
-Circumvellate placenta
-Rarely rupture uterus

Excessive show

Non Obstetric Causes

_Cervical polyp
-Cervical ectopy (erosion)
_Carcinoma cervix
_Vaginal/ vulval Varicositis
_Cervicitis/vaginitis

Indeterminate Bleeding

Abruptio Placentae / accidental hemorrhage

Types:

Revealed / External hemorrhage

Concealed hemorrhage- carries worse risk , increased risk of consumptive coagulopathy / extent of hemorrhage not appreciated

Mixed

Total / partial
Incidence : 0.5%

Etiology

Advancing Maternal age

Race- more common among african american as compared to asians

main etiology is Hypertension such as chronic HTN : pre eclampsia

Uterine over distention e.g multiple pregnancy

Trauma

Cigarette smoking / cocaine

acquired thrombophilias

previous abruption

Pathophysiology:

Vascular injury

Rise in Uterine venous pressure
also separation of placenta

Clinical feature

Symptoms:

Bleeding (may be altered / fresh blood
Abdominal pain- Continuos pain
Too frequent contraction
Back pain