LATE PREGNANCY BLEEDING (LPB):
ANTEPARTUM HEMORRHAGE (APH)
KENNEDY K.
1
, Session Objectives
At the end of this session, the students will be able to:
• Define late pregnancy bleeding (LPB)
• List the differential diagnosis of LPB
• Describe the prognosis and principles of
management of LPB
• Discuss in detail the main causes of LPB namely-
placental site bleeding;
– Placenta praevia
– Abruptio placentae
2
, Definition and incidence
Definition:
• Late pregnancy bleeding (LPB) or antepartum
haemmorhage (APH) refers to any vaginal bleeding
that occurs in the third trimester of pregnancy (at or
after 28 weeks of gestation)
Incidence:
• 3-10%
3
, Prevalence
• Haemorrhage is the leading direct cause of maternal
mortality accounting for 34 % of all maternal deaths in
Sub-Saharan Africa.
• APH complicates 2 to 6 percent of all pregnancies.
• Death may occur in about 10 hours after the onset of
APH.
• Anaemia in pregnancy is common in Africa and bleeding
in pre-existing anaemia increases the risk of death.
• Appropriate care in pregnancy and labour includes:
– Detection, correction and prevention of anaemia
– Care by skilled attendant
– Recognition and early management of complications
4
ANTEPARTUM HEMORRHAGE (APH)
KENNEDY K.
1
, Session Objectives
At the end of this session, the students will be able to:
• Define late pregnancy bleeding (LPB)
• List the differential diagnosis of LPB
• Describe the prognosis and principles of
management of LPB
• Discuss in detail the main causes of LPB namely-
placental site bleeding;
– Placenta praevia
– Abruptio placentae
2
, Definition and incidence
Definition:
• Late pregnancy bleeding (LPB) or antepartum
haemmorhage (APH) refers to any vaginal bleeding
that occurs in the third trimester of pregnancy (at or
after 28 weeks of gestation)
Incidence:
• 3-10%
3
, Prevalence
• Haemorrhage is the leading direct cause of maternal
mortality accounting for 34 % of all maternal deaths in
Sub-Saharan Africa.
• APH complicates 2 to 6 percent of all pregnancies.
• Death may occur in about 10 hours after the onset of
APH.
• Anaemia in pregnancy is common in Africa and bleeding
in pre-existing anaemia increases the risk of death.
• Appropriate care in pregnancy and labour includes:
– Detection, correction and prevention of anaemia
– Care by skilled attendant
– Recognition and early management of complications
4
