Abstract
Antepartum haemorrhage is defined as bleeding from the genital tract from 24 weeks of gestation onwards. The incidence is around 2–5% of all pregnancies progressing beyond 24 weeks. Placenta praevia and placental abruption are of great clinical importance as causes of antepartum haemorrhage. Placenta praevia occurs when the placenta is totally or partly inserted in the lower uterine segment. The aetiology of placenta praevia may merely represent an accident of nature but is associated with advanced maternal age, multiparity and previous uterine damage such as in a previous caesarean section. Usually, the initial bleed is painless and mild, but it may be severe. Screening and diagnosis are normally by ultrasound. A dilemma exists as to whether hospitalisation should be offered to women with an asymptomatic placenta praevia. Caesarean section is the recommended mode of delivery for major placenta praevia. Haemorrhage arising from premature separation of a normally situated placenta is known as abruptio placentae. Risk factors include placental abruption in a previous pregnancy, pre-eclampsia, cigarette smoking, and trauma. The patient typically develops pain over the uterus, and this may not be associated with apparent bleeding at first. The diagnosis is mainly clinical and confirmed by the demonstration of a retroplacental clot after delivery. In the obvious case of abruption, early delivery is of crucial importance. If the baby is still alive and the gestation compatible with survival upon delivery, it is recommended that urgent caesarean section should be performed. However, if the fetus is dead, one should expedite vaginal delivery. Complications of antepartum haemorrhage include maternal shock, especially due to the increased risk of postpartum bleeding. There is a greater risk of premature delivery, fetal hypoxia and sudden fetal death.
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Rigby E (1775) An essay on the uterine haemorrhage which precedes the delivery of the full grown fetus, 6th edn. Burkes & Kinnebrook, London
Dunn PM (2000) Dr Edward Rigby of Norwich (1747–1821) and antepartum haemorrhage. Arch Dis Child Fetal Neonatal Ed 82:F169–F170
Stirrat GM (1997) Aids to obstetrics and gynaecology for MRCOG, 4th edn. Churchill Livingstone, Edinburgh
EPICure Study Steering Group (1997) Survival and morbidity of infants born at the limit of viability. Proc R Coll Paediatr Child Health Ann Meeting 1:31
Royal College of Obstetricians and Gynaecologists (2005) Placenta praevia and placenta praevia accreta: diagnosis and management (Guideline No. 27). RCOG, London
Chamberlain G, Steer P (1999) ABC of labour care: obstetric emergencies. BMJ 318:1342–1345
Neilson JP (1999) Antepartum haemorrhage. In: Edmonds DK (ed) Dewhurst’s textbook of obstetrics and gynaecology for postgraduates. Blackwell Science, Oxford, pp 134–144
Moses S (2006) Placental abruption (abruptio placentae). In: The family practice notebook. Accessed at: http://www.fpnotebook.com/OB13.htm on 01.07.2006.
Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC (1997) William’s obstetrics, 20th edn. Appleton & Lange, Stamford, CT
Enkin M, Keirse MJ, Renfrew M, Neilson J (1995) A guide to effective care in pregnancy and childbirth, 2nd edn. Oxford University Press, New York
Arulkumaran S, Symonds IM, Fowlie A (2004) Oxford handbook of obstetrics and gynaecology. Oxford University Press, Oxford
Confidential enquiry into maternal and child health (CEMACH 2004) (2004) Why mothers die 2000–2002. RCOG, London
Harrison KA, Rossiter CE (1985) Maternal mortality. BJOG 5(Suppl):100–115
Neilson JP (1994) Perinatal loss and appropriate fetal surveillance. In: Van Geijn HP, Copray FJ (eds) A critical appraisal of fetal surveillance. Elsevier Science, Amsterdam, pp 16–24
Palmer L, Blair E, Petterson B, Burton P (1995) Antenatal antecedents of moderate and severe cerebral palsy. Paediatr Perinat Epidemiol 9:171–184
Hagan R, Benninger H, Chiffings D, Evans S, French N (1996) Very preterm birth—a regional study: Part 1. Maternal and obstetric factors. Br J Obstet Gynaecol 103:230–238
Obed JY, Adewole IF (1997) Antepartum haemorrhage: the influence of first trimester uterine bleeding. West Afr J Med 16:24–26
Rose GL, Chapman MG (1986) Aetiological factors in placenta praevia—a case controlled study. Br J Obstet Gynaecol 93:586–588
Ananth CV, Demissie K, Smulian JC, Vintzileos AM (2003) Placenta previa in singleton and twin births in the United States, 1989 through 1998: a comparison of risk factor profiles and associated conditions. Am J Obstet Gynecol 188:275–281
Faiz AS, Ananth CV (2003) Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 13:175–190
Ananth CV, Wilcox AJ, Savitz DA, Bowes WA Jr, Luther ER (1996) Effect of maternal age and parity on the risk of uteroplacental bleeding disorders in pregnancy. Obstet Gynecol 88:511–516
Karegard M, Gennser G (1986) Incidence and recurrence rate of abruptio placentae in Sweden. Obstet Gynecol 67:523–528
Kramer MS, Usher RH, Pollack R, Boyd M, Usher S (1997) Etiologic determinants of abruptio placentae. Obstet Gynecol 89:221–226
Abdella TN, Sibai BM, Hays JM Jr, Anderson GD (1984) Relationship of hypertensive disease to abruptio placentae. Obstet Gynecol 63:365–370
Purdie DW, Young JL, Guthrie KA, Picton CE (1983) Fetal growth achievement and elevated maternal serum alpha-fetoprotein. Br J Obstet Gynaecol 90:433–436
Redman CW (1989) Hypertension in pregnancy. In: Turnbull AC, Chamberlain G (eds) Obstetrics. Churchill Livingstone, Edinburgh, pp 515–541
Handwerker SM, Selick AM (1995) Placental abruption after insertion of catheter tip intrauterine pressure transducers: a report of four cases. J Reprod Med 40:845–849
Pearlman MD, Tintinallli JE, Lorenz RP (1990) A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol 162:1502–1507
Miller JM Jr, Boudreaux MC, Regan FA (1995) A case-control study of cocaine use in pregnancy. Am J Obstet Gynecol 172:180–185
Hulse GK, Milne E, English DR, Holman CD (1998) Assessing the relationship between maternal opiate use and antepartum haemorrhage. Addiction 93:1553–1558
Gonen R, Hannah ME, Milligan JE (1989) Does prolonged preterm premature rupture of the membranes predispose to abruptio placentae? Obstet Gynecol 74:347–350
Rice JP, Kay HH, Mahony BS (1989) The clinical significance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol 160:1212–1216
Donald I, Abdulla U (1967) Ultrasonics in obstetrics and gynaecology. Br J Radiol 40:604–611
Neilson JP (2003) Interventions for suspected placenta praevia. Cochrane Database Syst Rev 2:CD001998
Tan NH, Abu M, Woo JL, Tahir HM (1995) The role of transvaginal sonography in the diagnosis of placenta praevia. Aust NZ J Obstet Gynaecol 35:42–45
Smith RS, Lauria MR, Comstock CH, Treadwell MC, Kirk JS, Lee W, Bottoms SF (1997) Transvaginal ultrasonography for all placentas that appear to be low-lying or over the internal cervical os. Ultrasound Obstet Gynecol 9:22–24
Oyelese KO, Holden D, Awadh A, Coates S, Campbell S (1999) Placenta praevia: the case for transvaginal sonography. Cont Rev Obstet Gynecol 11:257–261
Oyelese Y, Smulian JC (2006) Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 107:927–941
Timor-Tritsch IE, Yunis RA (1993) Confirming the safety of transvaginal sonography in patients suspected of placenta previa. Obstet Gynecol 81:742–744
Hertzberg BS, Bowie JD, Carroll BA, Kliewer MA, Weber TM (1992) Diagnosis of placenta previa during the third trimester: role of transperineal sonography. AJR Am J Roentgenol 159:83–87
Taipale P, Hiilesmaa V, Ylostalo P (1998) Transvaginal ultrasonography at 18–23 weeks in predicting placenta previa at delivery. Ultrasound Obstet Gynecol 12:422–425
Lauria MR, Smith RS, Treadwell MC, Comstock CH, Kirk JS, Lee W, Bottoms SF (1996) The use of second-trimester transvaginal sonography to predict placenta previa. Ultrasound Obstet Gynecol 8:337–340
Bhide A, Thilaganathan B (2004) Recent advances in the management of placenta previa. Curr Opin Obstet Gynecol 16:447–451
Benirschke K, Kaufmann P (2000) Pathology of the human placenta, 4th edn. Springer, Berlin Heidelberg New York
Kayem G, Grange G, Schmitz T (2006) Clinical aspects and management of morbidly adherent placenta. Eur Clin Obstet Gynaecol (in press). DOI 10.1007/s11296-006-0043-8
Powell MC, Buckley J, Price H, Worthington BS, Symonds EM (1986) Magnetic resonance imaging and placenta previa. Am J Obstet Gynecol 154:565–569
Nyberg DA, Cyr DR, Mack LA, Wilson DA, Shuman WP (1987) Sonographic spectrum of placental abruption. AJR Am J Roentgenol 148:161–164
Bewley S, Cooper D, Campbell S (1991) Doppler investigation of uteroplacental blood flow resistance in the second trimester: a screening study for pre-eclampsia and intrauterine growth retardation. Br J Obstet Gynaecol 98:871–879
Oosterhof H, Aarnoudse JG (1991) Placental abruption preceded by abnormal flow velocity waveforms in the uterine arteries. Case report. Br J Obstet Gynaecol 98:225–226
Lam CM, Wong SF, Chow KM, Ho LC (2000) Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery. J Obstet Gynaecol 20:27–31
Lam CM, Wong SF (2002) Risk factors for preterm delivery in women with placenta praevia and antepartum haemorrhage: retrospective study. Hong Kong Med J 8:163–166
Love CD, Fernando KJ, Sargent L, Hughes RG (2004) Major placenta praevia should not preclude out-patient management. Eur J Obstet Gynecol Reprod Biol 117:24–29
Corr P (2001) Arterial embolization for haemorrhage in the obstetric patient. Best Pract Res Clin Obstet Gynaecol 15:557–561
Mitty HA, Sterling KM, Alvarez M, Gendler R (1993) Obstetric hemorrhage: prophylactic and emergency arterial catheterization and embolotherapy. Radiology 188:183–187
Portal P (1685) The compleat practice of men and women midwives: or the true manner of assisting a woman in child-bearing. (English translation). J Johnson, London
Baskett TF (2002) Edward Rigby (1747–1821) of Norwich and his essay on the uterine haemorrhage. J R Soc Med 95:618–622
Baskett TF (2001) Of violent floodings in pregnancy: evolution of the management of placenta praevia. In: Sturdee D, Olah K, Keene D (eds) Yearbook of obstetrics & gynaecology. RCOG, London, pp 1–14
Amy JJ (2006) Management of severe postpartum haemorrhage: an updated protocol. Eur Clin Obstet Gynaecol 2 (in press). DOI 10.1007/s11296-006-0047-4
Hong JY, Jee YS, Yoon HJ, Kim SM (2003) Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome. Int J Obstet Anesth 12:12–16
Frederiksen MC, Glassenberg R, Stika CS (1999) Placenta previa: a 22-year analysis. Am J Obstet Gynecol 180:1432–1437
Dinsmoor MJ, Hogg BB (1995) Autologous blood donation with placenta previa: is it feasible? Am J Perinatol 12:382–384
Rasmussen S, Irgens LM, Bergsjo P, Dalaker K (1996) Perinatal mortality and case fatality after placental abruption in Norway 1967–1991. Acta Obstet Gynecol Scand 75:229–234
Basu HK (1969) Fibrinolysis and abruptio placentae. J Obstet Gynaecol Br Commonw 76:481–496
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Calleja-Agius, J., Custo, R., Brincat, M.P. et al. Placental abruption and placenta praevia. Eur Clinics Obstet Gynaecol 2, 121–127 (2006). https://doi.org/10.1007/s11296-006-0046-5
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DOI: https://doi.org/10.1007/s11296-006-0046-5