How is it Diagnosed?
Antepartum Hemorrhage (APH) refers to vaginal bleeding occurring after 20 weeks of
gestation and before the onset of labor. Diagnosis aims to determine the cause and
severity of bleeding to ensure maternal and fetal safety.
Clinical history plays a crucial role. Important details include gestational age, amount
and character of bleeding (fresh or clotted), associated pain, trauma, or previous
obstetric history (placenta previa or cesarean section). A physical examination focuses
on general condition, vitals (to assess for shock), uterine tone, and fetal heart rate.
Per speculum examination may be performed to rule out local causes of bleeding such
as cervical polyp or vaginal infection. However, digital vaginal examination is
contraindicated until placenta previa is excluded, as it may exacerbate bleeding.
Ultrasonography is the cornerstone diagnostic tool. Transabdominal or transvaginal
ultrasound identifies placental location and assesses for placenta previa or abruption.
Placenta previa presents with painless bleeding and a low-lying placenta, while
abruption placentae presents with painful bleeding and possibly retroplacental clots or
hematomas.
Other tests include complete blood count (to assess anemia), coagulation profile, and
blood grouping and cross-matching. Non-stress testing or biophysical profile helps
evaluate fetal well-being.
Prompt diagnosis of APH allows appropriate obstetric management. Depending on
severity, gestational age, and fetal status, it may necessitate hospitalization,
corticosteroids for fetal lung maturity, or emergency delivery.