Antenatal haemorrhage is a term sometimes used by laypeople to describe antepartum haemorrhage (APH), which is bleeding inside or from your vagina that happens after 24 weeks of pregnancy but before you give birth to your baby. The main symptom is vaginal bleeding. The cause of antepartum haemorrhage is not always known, but it’s important that the most common of the serious causes—placental abruption (which usually involves both bleeding and pain), placenta praevia (usually bleeding without pain), and trauma—are swiftly investigated and identified so that mum can be properly monitored and treated. Rarer serious causes can include the rupture of the womb, which causes lots of blood loss from mum, and ruptured vasa praevia, which can be very dangerous for the baby. APH is associated with cerebral palsy in premature babies. Not all causes of antepartum haemorrhage are serious, but you should always seek medical help if you experience vaginal bleeding in pregnancy.

What is the difference between antenatal bleeding and antepartum haemorrhage?

The word haemorrhage can be distressing, but it simply means bleeding from a damaged blood vessel. The words “antenatal” and “antepartum” both mean “before birth,” but antepartum tends to be used to indicate that birth is close, whereas antenatal can be used to describe anything that happens in pregnancy before birth. Any vaginal bleeding that you experience in pregnancy should be checked out, whether your due date is imminent or months away.

How do I prevent antepartum haemorrhage?

Antepartum haemorrhage is not your fault, but there are certain things that put you at higher risk of the causes. For example, placenta praevia is more likely if you:

Are pregnant over 40 years of age
Have had one or more caesarean sections
Have had an abortion
Are carrying more than one baby
Conceived by an assisted method, such as IVF
Have a history of something that disrupts the lining of your uterus, such as endometriosis, uterine scarring, or submucosal fibroids.

A placental abruption is a greater risk if you:

Are pregnant over 40 years of age, though most placental abruption happens in low-risk pregnancies.
Have a history of placental abruption
Smoke, do drugs, or drink in pregnancy
Have pre-eclampsia
Conceived by an assisted method, such as IVF
Have a low body mass index

You can avoid smoking, drugs, and alcohol in pregnancy and should seek help if you feel you cannot. You can’t always avoid pre-eclampsia, though staying active and maintaining a healthy diet are positive steps. If you have a low body mass index, you can work with your doctor, a registered dietitian, or a mental health expert to safely gain weight both before and during pregnancy. You may also be able to prevent antenatal haemorrhage that happens as a result of trauma through certain activities, such as cycling and horseback riding. Sex is a very common cause of vaginal bleeding in pregnancy, but post-sex bleeding is not usually dangerous. Sex in pregnancy is usually considered very safe, right up until you are in labour. Some couples even use it to attempt natural induction, though there is limited evidence for this. You shouldn’t attempt sex while bleeding or if you have been bleeding and not yet been checked out. Physical accidents and domestic violence can cause both placental abruption and antepartum haemorrhage through trauma, and it’s important to seek medical help, as well as help from the appropriate authorities, as soon as possible if you are pregnant and at risk or know a pregnant person is at risk.

How is antepartum haemorrhage managed and treated?

The management and treatment of antepartum haemorrhage depends on the cause. If you have placenta praevia, you may simply be more closely monitored, while a placental abruption could lead to a recommendation for emergency delivery by Caesarean section. Your doctor should discuss any options with you thoroughly, and your consent will always be required. We really don’t mean this article to stress you out unnecessarily. Most women in developed countries will go on to get proper monitoring and care and have healthy births. The most important thing is that you get any antepartum haemorrhage checked without delay.

For more advice on taking care of yourself in pregnancy, labour, and birth, check out Unii’s Antenatal Classes, with prenatal video episodes taught by senior NHS midwives, an award-winning obstetrician and gynaecologist, and six other leading healthcare experts. Only at unii.com.

What is Antenatal Haemorrhage? Symptoms and Management