Nerve Blocks App
Anesthesia Assistant App
Ultrasound Pain App
Pain Medicine Assistant App
POCUS App
IV Access App
MSK Knee App
VetRA App
Nerve Block Manual
Regional Anesthesia Updates
Anesthesiology Manual
Anesthesiology Review
Anesthesia Updates 2025
Anesthesia Updates 2026
Pediatric Anesthesia Updates
Airway Management Updates
US Interventional Pain Manual
Pain Medicine Updates
Mastering Difficult IV Access
PACU Nursing Manual
RA Veterinary Manual
Books
About
Learning objectives
- Definition of antepartum bleeding (APB)
- Causes and consequences of APB
- General management of APB
Definition and mechanisms
- Antepartum bleeding (APB) is defined as bleeding from the genital tract after 24 weeks of gestation and before the birth of the baby
- A relatively frequent problem, occurring in 5% to 6% of pregnant women
- It remains a major cause of perinatal mortality and maternal morbidity
- Four degrees of APB:
- Spotting: stains, streaking, or spotting of blood
- Minor hemorrhage: < 50 mL
- Major hemorrhage: 50-1000mL without signs of circulatory shock
- Massive hemorrhage: > 1000mL with or without signs of circulatory shock
Causes
- Cervicitis
- Placenta abnormalities
- Abruptio placentae
- Placenta previa
- Placenta accreta /increta/percreta
- Uterine rupture
- Vasa previa
- Amniotic fluid embolism
Complications
| Maternal complications | Fetal complications |
|---|---|
| Perioperative anemia Infection Maternal shock Renal tubular necrosis Consumptive coagulopathy Postpartum hemorrhage Prolonged hospital stay Psychological sequelae Complications of blood transfusion | Fetal hypoxia Small for gestational age and fetal growth restriction Prematurity (iatrogenic and spontaneous) Fetal death |
Management
Suggested reading
- Walfish, M., Neuman, A., Wlody, D., 2009. Maternal haemorrhage. British Journal of Anaesthesia 103, i47–i56.
- Mercier FJ, Van de Velde M. Major obstetric hemorrhage. Anesthesiol Clin. 2008;26(1):53-vi.
- Antepartum haemorrhage Green–top Guideline No. 63 November 2011 royal College of obstreticans and gynaecologists. https://www.rcog.org.uk/media/pwdi1tef/gtg_63.pdf
Clinical updates
Bhowmik et al. (Cureus, 2024) describe a case series of obstetric emergencies from a remote secondary-care hospital, in which antepartum hemorrhage with severe anemia and hemodynamic instability was a leading indication for emergency cesarean section and laparotomy. The report highlights that rapid anesthetic decision-making, early resuscitation, blood product availability, and close multidisciplinary coordination are critical when APB presents without time for optimization, particularly in resource-limited settings. These cases reinforce practical anesthetic priorities in severe APB: maternal stabilization over diagnostic certainty, anticipation of massive hemorrhage, and flexible choice of anesthesia based on shock severity and urgency.
