In obstetrics, antepartum haemorrhage (APH), also prepartum hemorrhage , is bleeding from the vagina during pregnancy from the 24th(22 weeks in malaysia.) week (sometimes defined as from the 20th week) gestational age to term.

It can be associated with reduced fetal birth weight.

It should be considered a medical emergency (regardless of whether there is pain) and medical attention should be sought immediately, as if it is left untreated it can lead to death of the mother and/or fetus.

Bleeding without pain is most frequently bloody show, which is benign; however, it may also be placenta previa (in which both the mother and fetus are in danger). Painful APH is most frequently placental abruption (which may also lead to adverse fetal and/or maternal outcomes).

As with other forms of hemorrhage, the patient may be at risk of hypovolemic shock, and volume restoration may be a priority.

• Obstetric

• * Placenta

• ** Maternal blood

• *** Bloody show (benign) - most common cause of APH

• *** Placental abruption - most common pathological cause

• *** Placenta previa - second most common pathological cause

• ** Fetal blood (can be distinguished with Apt test)

• *** Vasa previa - often difficult to diagnose, frequently leads to fetal demise

• * Uterus

• ** Uterine rupture

• Nonobstetric

• * Bleeding from the lower genital tract

• ** Cervical bleeding - cervicitis, cervical neoplasm, cervical polyp

• ** Bleeding from the vagina itself - trauma, neoplasm

• * Bleeding that may be confused with vaginal bleeding

• ** GI bleed - haemorrhoid s, inflammatory bowel disease

• ** Urinary tract bleed - urinary tract infection

• Obstetrical haemorrhage