Antepartum Haemorrhage & Placental Disorders
Prioritise stabilisation and distinguish placental causes of bleeding in later pregnancy.
Quick revision ↓ Medical Dictionary
01First response
Bleeding in later pregnancy requires assessment of maternal stability and fetal condition. Visible blood loss may underestimate severity, particularly with concealed bleeding. Call for appropriate obstetric help, establish monitoring and prepare investigations and resuscitation according to the situation. History and localisation of the placenta follow alongside emergency care rather than delaying it.
02Placenta praevia
A low-lying placenta or placenta covering the cervical opening can cause bleeding, often without pain. Avoid digital vaginal examination until placenta praevia has been excluded through the appropriate assessment. Transvaginal ultrasound performed by trained staff can safely clarify placental position. Recurrent bleeding and placental location influence the individual birth plan.
03Placental abruption
Pain, uterine tenderness or increased tone with bleeding raises concern for abruption, but presentations vary and bleeding may be concealed. Maternal shock can be disproportionate to visible loss. A normal ultrasound does not exclude abruption. Assessment is primarily clinical, with attention to fetal compromise, coagulopathy and timely delivery decisions after stabilisation.
04Accreta spectrum
Abnormally adherent or invasive placentation is more likely in some patients with uterine scars and a low placenta. Antenatal recognition allows specialist planning, blood-product preparation and discussion of possible major surgery. Suspected accreta needs an experienced multidisciplinary team. Attempting routine placental removal without recognising the risk can precipitate severe haemorrhage.
05Vasa praevia and planning
Unprotected fetal vessels near the cervical opening can rupture when membranes break, threatening the fetus rapidly. Bleeding with fetal compromise after membrane rupture requires emergency assessment. For diagnosed placental disorders, explain warning signs, access to urgent care and planned place of birth. A written plan must be available to the receiving maternity team.
High-Yield Revision
- Visible blood loss can underestimate severity.
- Exclude praevia before digital vaginal examination.
- Normal ultrasound does not exclude abruption.
Common Pitfalls
- Delaying stabilisation to obtain a complete history.
- Assuming all painless bleeding is harmless.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.