Antepartum Hemorrhage

In labor, there are several different types of bleeding that a woman can experience. Each type has its risk factors and way of presenting itself. If you suspect your labor will be painful, and you feel like something is poking into your abdomen or even the liver. In this article, we will discuss antepartum hemorrhage and many more. 

Antepartum hemorrhage is one of the hemorrhagic types. It is a serious problem typically occurring in the last trimester of pregnancy. It’s also the leading cause of pregnancy-related deaths but is preventable and treatable. Continue reading the article. 

What Is An Antepartum Hemorrhage?

Antepartum hemorrhage is bleeding that occurs during pregnancy. This condition can be life-threatening if not treated properly and early. Antepartum hemorrhage occurs when there has been an abrupt internal loss of blood through the uterus and fallopian tubes or another organ in the pelvis, such as the stomach or spleen.

Bleeding can be caused by several conditions, including:

• Placenta accreta (a condition in which the placenta grows abnormally through the wall of your uterus)
• Abnormal bleeding after childbirth
• Pregnancy-induced hypertension (high blood pressure during pregnancy)

Epidemiology

Every pregnancy has a risk of hemorrhaging. However, bleeding is most common in the first trimester when the mother’s hormones change, and the placenta isn’t fully developed. It can be severe and sometimes life-threatening if it occurs during this time. 

Hemorrhaging may also occur when other factors, such as blood clotting disorders or certain infections, a present which can cause excessive blood loss.

• Antepartum hemorrhage is a common complication of pregnancy.
• The National Institute of Child Health and Human Development reports that about 1 in 100 women will suffer from an antepartum hemorrhage during their lifetime.
• In the United States alone, about 3-5 pregnancies lead to antepartum hemorrhage each year—and it’s estimated that between 40 and 50 percent of these women die as a result.

Placental Abruption

Placental abruption is a severe complication of pregnancy that can cause bleeding, preterm birth, and fetal death.

• The placenta separates from the uterus before delivery. This occurs in about one in five pregnancies, but it’s unclear why some women experience this while others don’t. If you’re pregnant with twins or triplets, there’s an increased risk of placental abruption because your baby has two or three hearts instead of just one, as most people have.
• Placental abruption can lead to excessive bleeding into your vagina following delivery—leading to severe pain that may require stitches or surgery to stop (spontaneous vaginal bleeding). It will also make it harder for you and your partner to breathe when he holds his breath during sex (if he doesn’t know about this condition beforehand).

Placenta Previa

Placenta previa is a condition in which the placenta is near or over the cervix. This can cause bleeding during pregnancy or delivery. If left untreated, placenta previa can lead to postpartum hemorrhage (PPH), which occurs when blood leaks out of your uterus after giving birth.

If you have placenta previa and are planning on having babies in the future, you should talk with your doctor about what steps you should take to reduce your risk for PPH. For example, your doctor might recommend that they monitor any signs of PPH closely, so they can intervene quickly if needed.

Vasa Previa

Vasa Previa is a condition where the umbilical vessels are located in the lower segment of the uterus. These vessels can rupture, causing severe bleeding into your uterus. In some cases, this bleeding may lead to death or congenital disabilities if not treated quickly.

If you have vasa previa, your baby may be born with low birth weight and may have trouble breathing after delivery.

Causes

• Placenta previa occurs when the placenta covers or partially covers your cervix, blocking the path of blood flow from your uterus to your baby. This can cause postpartum hemorrhage if it’s not treated immediately.
• Vasovasostomy: If you had a previous cesarean section, that could put pressure on your bladder and force some blood loss into it during delivery (vasovasostomy).
• Uterine atony: The uterus may be stretched out due to constriction caused by pregnancy and labor; this also causes bleeding after delivery.
• Blood clotting disorder: Blood clots form because of an inherited condition called thrombophilia (another way of saying “blood clotting disorder”). These clots can break off inside the body and travel through veins or arteries to cause significant damage throughout different organs in men AND women alike (including heart attack).

Risk Factors of Antepartum Hemorrhage 

• Advanced maternal age: The risk of an antepartum hemorrhage increases significantly.
• Previous cesarean delivery: The rate of antepartum hemorrhage increases with the number of prior cesarean deliveries.
• Multiparity: A woman who has given birth to more than three children is at increased risk for bleeding during pregnancy and may also be at higher risk for postpartum hemorrhage (PPH).
• Previous PPH: PPH before pregnancy can lead to a higher incidence in subsequent pregnancies among women who have suffered from it previously. A history of hemoperitoneum or other types of uterine rupture is also associated with an increased risk for this complication during pregnancy as well as after delivery.

Symptoms

• Bleeding from the vagina
• Abdominal pain
• Vaginal discharge (mucus, blood)
• Fever and chills. This can also be accompanied by back pain or nausea, common symptoms of an underlying infection.

When to Seek Medical Care?

If you’re having a problem, seek medical care immediately.

Call your doctor or nurse if you are bleeding more than you think is normal and the bleeding has not been resolved after one hour of giving birth. Your blood pressure may be low, and you might need to be taken to the hospital immediately.

If contractions or cramping disturb your sleep at night, call an ambulance immediately if it does not stop within 15 minutes of calling 911 or for help from someone else in your home (such as a neighbor). A cesarean delivery can be done when all other methods have failed to stop this type of bleeding from occurring again during pregnancy. 

However, this procedure should only be considered once all other options have been ruled out first. There is still some risk involved with the surgery, even with modern anesthesia techniques available today!

Examinations and Tests

• Blood pressure, pulse rate, breathing, and respiratory rate
• Temperature
• Skin color and temperature

Treatment Options

Treatment options for an antepartum hemorrhage include:

• Treat the cause. This can be anything from a difficult delivery to uterine fibroids, which may cause bleeding. You should also see your doctor if you have any of these risk factors for postpartum hemorrhage:
• Previous C-section
• Previous uterine rupture or placenta accreta (premature separation after delivery)
• History of multiple pregnancies or prolonged labor

Acute management checklist

• Check the patient’s vital signs.
• Assess the bleeding. If there is no obvious source of bleeding, determine if it is profuse or intermittent.
• Check for signs of shock (elevated temperature/heart rate). If present, prepare for immediate delivery if possible; otherwise, maintain fetal monitoring and proceed with surgery as soon as possible.

Complications

Some complications of postpartum hemorrhage may include:

• Bleeding. This can be severe if enough blood loss occurs in the first few days after delivery, or it may be milder if the woman has been given hormone therapy during pregnancy. The extent of bleeding depends on both factors.
• Shock (hypotension). Blood volume is reduced rapidly after delivery because most blood is removed from the uterus as part of childbirth and replaced with fluid from intravenous fluids or breast milk (which may contain hormones). 

Once this process stops in about 24 hours, your body absorbs much more oxygen than usual because you’re now breathing normally again. However, if there’s too little fluid around for proper lung function due to shock or dehydration caused by excessive vomiting during labor or delivery, problems develop near term! 

These range from mild symptoms like headache and fatigue to more serious ones such as low urine output due to dehydration-related causes (elevated white count). It may occur indirectly because they’ve lost more liquid through excessive vomiting/diarrhea for another reason. 

These dangerous conditions need immediate attention before further damage occurs, so please call us immediately if anyone experiences these kinds of any kind whatsoever – even if they don’t show signs yet.”

Prognosis

Most cases of antepartum hemorrhage are managed successfully. The mortality rate is high in severe cases, and the risk of death from antepartum hemorrhage is higher in pregnant women with twins.

Antepartum hemorrhage is a major cause of death related to pregnancy. It is characterized by heavy bleeding in the second half of pregnancy, and it occurs most often in women who have had previous pregnancies.

The condition can be lethal if not treated quickly, so you must take steps to protect yourself from complications if you suffer from antepartum hemorrhage.

Advice for Managing the After-Abortion Side Effects

Now that you are aware of some of the symptoms you could feel following an abortion, here are some suggestions for taking care of yourself or a loved one. Although they are most intense during the surgery, some of these symptoms last after the abortion.

Get Cozy

During and after an abortion, the majority of patients prefer to wear loose, comfortable clothing and warm socks. Considering that the abortion pill is known to cause shivering, a big, cozy blanket might be helpful. A heating pad or hot water bottle is one of the best cramp treatments. It’s a good idea to keep an ice pack and a heating pad on hand and alternate between the two as needed because the abortion pill may trigger cold sweats and hot flashes in some people.

Drink a lot of fluids

To make sure you get enough liquids, keep a water bottle on hand and refill it frequently. Herbal beverages that calm an upset stomach, such as chamomile, ginger, or peppermint, are helpful for treating nausea. Do you not enjoy tea? Ginger ale is a tasty substitute. You might also try biting into a piece of raw ginger or sucking on ginger candy.

Eat healthy snacks

Generally speaking, it makes sense to have a variety of light snacks on hand. When deciding what to eat, choose salty or sweet snacks over fatty or spicy foods.

Use heat pad

A back and shoulder massage is a great way to unwind tight muscles and encourage blood flow. It makes sense if you’re not in the mood for a massage right now.

A quick massage of the abdomen may help reduce pain and cramps. In addition, Peppermint’s cooling effect may help to reduce nausea, and lavender oil’s scent has been shown to calm nerves and ease motion sickness.

Talk about your feelings.

Remember to give yourself time and space to analyze your emotions; all of them are appropriate reactions. Self-care may include discussing your abortion with a dependable friend or relative. Do not be afraid to share your feelings with a friend, family member, or spouse if you trust them.

Conclusion

Antepartum hemorrhage is blood loss from a woman’s placenta during pregnancy. This can be caused by several conditions, such as placenta previa and vasa previa, which are more common than other causes. Antepartum hemorrhage is often preventable with proper care and treatment options.

(Written By Dr. Ebad Khan)

Reference 

• Giordano, R., Cacciatore, A., Cignini, P., Vigna, R., & Romano, M. (2010). Antepartum hemorrhage. Journal of prenatal medicine, 4(1), 12–16.
• Giordano, R., Cacciatore, A., Cignini, P., Vigna, R., & Romano, M. (2010). Antepartum hemorrhage. Journal of prenatal medicine, 4(1), 12–16.
• Fan, D., Wu, S., Liu, L., Xia, Q., Wang, W., Guo, X., & Liu, Z. (2017). Prevalence of antepartum hemorrhage in women with placenta previa: a systematic review and meta-analysis. Scientific reports, 7, 40320. https://doi.org/10.1038/srep40320.
• Long, S. Y., Yang, Q., Chi, R., Luo, L., Xiong, X., & Chen, Z. Q. (2021). Maternal and Neonatal Outcomes Resulting from Antepartum Hemorrhage in Women with Placenta Previa and Its Associated Risk Factors: A Single-Center Retrospective Study. Therapeutics and clinical risk management, 17, 31–38. https://doi.org/10.2147/TCRM. S288461.
• Lam, C. M., Wong, S. F., Chow, K. M., & Ho, L. C. (2000). Women with placenta praevia and antepartum hemorrhage have a worse outcome than those who do not bleed before delivery. Journal of obstetrics and gynecology: the journal of the Institute of Obstetrics and Gynaecology, 20(1), 27–31. https://doi.org/10.1080/01443610063417.
• Ajayi, R. A., Soothill, P. W., Campbell, S., & Nicolaides, K. H. (1992). Antenatal testing to predict outcome in pregnancies with unexplained antepartum hemorrhage. British journal of obstetrics and gynecology, 99(2), 122–125. https://doi.org/10.1111/j.1471-0528.1992.tb14468.x.
• Kong, C. W., & To, W. W. K. (2020). Risk factors for severe postpartum hemorrhage during cesarean section for placenta praevia. Journal of obstetrics and gynecology: the journal of the Institute of Obstetrics and Gynaecology, 40(4), 479–484. https://doi.org/10.1080/01443615.2019.1631769.