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Abstract

Bleeding in late pregnancy often heralds serious and potentially life-threatening complications. Antepartum hemorrhage is defined as any vaginal bleeding in the second half of pregnancy but before birth, usually considered after 20 weeks’ gestation. Major causes include placenta previa, placental abruption, vasa previa, and uterine rupture. These complications are infrequently managed in the emergency department, but emergency physicians must be prepared to make a swift, accurate diagnosis and to lead resuscitative efforts until definitive obstetric management can be obtained. Prompt, coordinated interdisciplinary care can be lifesaving for both mother and fetus. Ultimate management depends on maternal stability and gestational age, and many patients will require emergent cesarean delivery.

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References

  1. Hull AD, Resnick R. Placenta previa, placenta accreta, abruptio placentae, and vasa previa. In: Creasy RK, Resnick R, Iams JD, et al editors. Maternal-fetal medicine: Priniciple and practice. 7th ed. Philadelphia, PA: Elsevier Saunders, p. 732–42.

    Google Scholar 

  2. Chilaka VN, Konje JC, Clarke S, Taylor DJ. Practice observed: is speculum examination on admission a necessary procedure in the management of all cases of antepartum haemorrhage? J Obstet Gynaecol. 2000;20:396–8.

    Article  CAS  PubMed  Google Scholar 

  3. Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126(3):654–68.

    Article  PubMed  Google Scholar 

  4. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med. 2003;13:175–90.

    Article  CAS  PubMed  Google Scholar 

  5. Mustafa SA, Brizot ML, Carvalho MH, Watanabe L, Kahhale S, Zugaib M. Transvaginal ultrasonography in predicting placenta previa at delivery: a longitudinal study. Ultrasound Obstet Gynecol. 2002;20:356–9.

    Article  CAS  PubMed  Google Scholar 

  6. Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol. 2011;205(3):262.

    Article  PubMed  Google Scholar 

  7. Ananth CV, Smulian JC, Vintzileos AM. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol. 1997;177(5):1071.

    Article  CAS  PubMed  Google Scholar 

  8. Rasmussen S, Albrechtsen S, Dalaker K. Obstetric history and the risk of placenta previa. Acta Obstet Gynecol Scand. 2000;79(6):502–7.

    Article  CAS  PubMed  Google Scholar 

  9. Macones GA, Sehdev HM, Parry S, Morgan MA, Berlin JA. The association between maternal cocaine use and placenta previa. Am J Obstet Gynecol. 1997;177(5):1097–100.

    Article  CAS  PubMed  Google Scholar 

  10. Iyasu S, Saftlas AK, Rowley DL, Koonin LM, Lawson HW, Atrash HK. The epidemiology of placenta previa in the United States, 1979 through 1987. Am J Obstet Gynecol. 1993;168(5):1424–9.

    Article  CAS  PubMed  Google Scholar 

  11. Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E. Critical analysis of risk factors and outcome of placenta previa. Arch Gynecol Obstet. 2011;284(1):47.

    Article  PubMed  Google Scholar 

  12. Ananth CV, Demissie K, Smulian JC, Vintzileos AM. 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. 2003;188(1):275.

    Article  PubMed  Google Scholar 

  13. Sheiner E, Shoham-Vardi I, Hallak M, Hershkowitz R, Katz M, Mazor M. Placenta previa: obstetric risk factors and pregnancy outcome. Matern Fetal Med. 2001;10:414–9.

    Article  CAS  Google Scholar 

  14. Cotton DB, Read JA, Paul RH, Quilligan EJ. The conservative aggressive management of placenta previa. Am J Obstet Gynecol. 1980;137(6):687.

    Article  CAS  PubMed  Google Scholar 

  15. Silver R, Depp R, Sabbagha RE, Dooley SL, Socol ML, Tamura RK. Placenta previa: aggressive expectant management. Am J Obstet Gynecol. 1984;150(1):15.

    Article  CAS  PubMed  Google Scholar 

  16. Dola CP, Garite TJ, Dowling DD, Friend D, Ahdoot D, Asrat T. Placenta previa: does its type affect pregnancy outcome? Am J Perinatol. 2003;20(7):353–60.

    Article  PubMed  Google Scholar 

  17. Sakornbut E, Leeman L, Fontaine P. Late pregnancy bleeding. Am Fam Physician. 2007;75(8):1199–206.

    PubMed  Google Scholar 

  18. Abbrescia K, Sheridan B. Complications of second and third trimester pregnancies. Emerg Med Clin North Am. 2003;21(3):695–710.

    Article  PubMed  Google Scholar 

  19. Leerentveld RA, Gilberts EC, Arnold MJ, Wladimiroff JW. Accuracy and safety of transvaginal sonographic placental localization. Obstet Gynecol. 1990;(76):759–62.

    Google Scholar 

  20. Smith RS, Lauria MR, Comstock CH, Treadwell MC, Kirk JS, Lee W, Bottoms SF. Transvaginal ultrasonography for all placentas that appear to be low-lying or over the internal cervical os. Ultrasound Obstet Gynecol. 1997;9(1):22.

    Article  PubMed  Google Scholar 

  21. Timor-Tritsch IE, Yunis R. Confirming the safety of transvaginal sonography in patients suspected of placenta previa. Obstet Gynecol. 1993;81(5Pt 1):742.

    CAS  PubMed  Google Scholar 

  22. Sunna E, Ziadeh S. Transvaginal and transabdominal ultrasound for the diagnosis of placenta praevia. J Obstet Gynaecol. 1999;19(2):152.

    Article  CAS  PubMed  Google Scholar 

  23. Sherman SJ, Carlson DE, Platt LD, Medearis AL. Transvaginal ultrasound: does it help in the diagnosis of placenta previa? Ultrasound Obstet Gynecol. 1992;2(4):256.

    Article  CAS  PubMed  Google Scholar 

  24. Oyelese KO, Holden D, Awadh A, Coates S, Campbell S. Placenta praevia: the case for transvaginal sonography. Contemp Rev Obstet Gynaecol. 1999;11:257–61.

    Google Scholar 

  25. Practice Bulletin No. 159: Management of preterm labor. Obstet Gynecol. 2016;127:29–38.

    Google Scholar 

  26. Bose DA, Assel BG, Hill JB, Chauhan SP. Maintenance tocolytics for preterm symptomatic placenta previa: a review. Am J Perinatol. 2011;28(1):45–50.

    Article  PubMed  Google Scholar 

  27. Hladky K, Yankowitz J, Hansen WF. Placental abruption. Obstet Gynecol Surv. 2002;57:299–305.

    Article  PubMed  Google Scholar 

  28. Rasmussen S, Irgens LM, Bergsjo P, Dalaker K. The occurrence of placental abruption in Norway 1967–1991. Acta Obstet Gynecol Scand. 1996;75:222–8.

    Article  CAS  PubMed  Google Scholar 

  29. Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand. 2011;90(2):140–9.

    Article  PubMed  Google Scholar 

  30. Kyrklund-Blomberg NB, Gennser G, Cnattingius S. Placental abruption and perinatal death. Paediatr Perinat Epidemiol. 2001;15(3):290–7.

    Article  CAS  PubMed  Google Scholar 

  31. Abu-Heija A. Abruptio placentae: risk factors and perinatal outcome. J Obstet Gynaecol Res. 1998;24(2):141–4.

    Article  CAS  PubMed  Google Scholar 

  32. Ananth CV, Smulian JC, Demissie K, Vintzileos AM, Knuppel RA. Placental abruption among singleton and twin births in the United States: risk factor profiles. Am J Epidemiol. 2001;153(8):771.

    Article  CAS  PubMed  Google Scholar 

  33. Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006;108(4):1005–16.

    Article  PubMed  Google Scholar 

  34. Mbah AK, Alio AP, Fombo DW, Bruder K, Dagne G, Salihu HM. Association between cocaine abuse in pregnancy and placenta-associated syndromes using propensity score matching approach. Early Hum Dev. 2012;88(6):333–7.

    Article  CAS  PubMed  Google Scholar 

  35. Tikkanen M, Nuutila M, Hiilesmaa V, et al. Clinical presentation and risk factors of placental abruption. Acta Obstet Gynecol Scand. 2006;85(6):700–5.

    Article  PubMed  Google Scholar 

  36. Yeo L, Ananth C, et al. Glob. libr. women’s med., (ISSN: 1756–2228). 2008.

    Google Scholar 

  37. Ananth CV, Berkowitz GS, Savitz DA, et al. Placental abruption and adverse perinatal outcomes. JAMA. 1999;282:1646–51.

    Article  CAS  PubMed  Google Scholar 

  38. Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. J Ultrasound Med. 2002;21:837–40.

    Article  PubMed  Google Scholar 

  39. Witlin AG, Sibai BM. Perinatal and maternal outcome following abruptio placentae. Hypertens Pregnancy. 2001;20:195–203.

    Article  CAS  PubMed  Google Scholar 

  40. Kayani SI, Walkinshaw SA, Preston C. Pregnancy outcome in severe placental abruption. BJOG. 2003;110:679–83.

    Article  PubMed  Google Scholar 

  41. Oyalese KO, Turner M, Lees C, Campbell S. Vasa previa: an avoidable obstetric tragedy. Obstet Gynecol Surv. 1999;54:138–45.

    Article  Google Scholar 

  42. Lubin B. Neonatal anaemia secondary to blood loss. Clin Haematol. 1978;7:19–34.

    CAS  PubMed  Google Scholar 

  43. Society of Maternal-Fetal (SMFM) Publications Committee, Sinkey RG, Odibo AO, Dashe JS. #37: Diagnosis and management of vasa previa. Am J Obstet Gynecol. 2015;213(5):615.

    Google Scholar 

  44. Hasegawa J, Nakamura M, Sekizawa A, Matsuoka R, Ichizuka K, Okai T. Prediction of risk for vasa previa at 9-13 weeks’ gestation. J Obstet Gynaecol Res. 2011;37(10):1346–51.

    Article  PubMed  Google Scholar 

  45. Kruitwagen RF, Nijhuis JG. Ruptured vasa praevia complicated by a sinusoidal fetal heart rate pattern: a case report. Eur J Obstet Gynecol Reprod Biol. 1991;39:147–50.

    Article  CAS  PubMed  Google Scholar 

  46. Odunsi K, Bullough CH, Henzel J, Polanska A. Evaluation of chemical tests for fetal bleeding from vasa previa. Int J Gynaecol Obstet. 1996;55(3):207.

    Article  CAS  PubMed  Google Scholar 

  47. Gibbins KJ, Weber T, Holmgren CM, Porter TF, Varner MW, Manuck TA. Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus. Am J Obstet Gynecol. 2015;213(3):382.

    Article  PubMed  Google Scholar 

  48. Zwart JJ, Richters JM, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J. Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG. 2009;116(8):1069.

    Article  CAS  PubMed  Google Scholar 

  49. Al-Zirqi I, Daltveit AK, Forsen L, et al. Risk factors for complete uterine rupture. Am J Obstet Gynecol. 2017;216(2):165e1–165e8

    Google Scholar 

  50. Rageth JC, Juzi C, Grossenbacher H. Delivery after previous cesarean: a risk evaluation. Swiss Working Group of Obstetric and Gynecologic Institutions. Obstet Gynecol. 1999;93(3):332–7.

    CAS  PubMed  Google Scholar 

  51. Rudd NL, Nimrod C, Holbrook KA, Byers PH. Pregnancy complications in type IV Ehlers-Danlos Syndrome. Lancet. 1983;1(8314–5):50.

    Article  CAS  PubMed  Google Scholar 

  52. National Institutes of Health Consensus Development Conference Panel. National Institutes of Health Consensus Development conference statement: vaginal birth after cesarean: new insights March 8–10, 2010. Obstet Gynecol. 2010;115(6):127.

    Google Scholar 

  53. Ozdemir I, Yucel N, Yucel O. Rupture of the pregnant uterus: a 9-year review. Arch Gynecol Obstet. 2005;272(3):229.

    Article  PubMed  Google Scholar 

  54. Bujold E, Gauthier RJ. Neonatal morbidity associated with uterine rupture: what are the risk factors? Am J Obstet Gynecol. 2002;186(2):311–4.

    Article  PubMed  Google Scholar 

  55. Bujold E, Mehta SH, Bujold C, Gauthier RJ. Interdelivery interval and uterine rupture. Am J Obstet Gynecol. 2002;187(5):1199–202.

    Article  PubMed  Google Scholar 

  56. Leung AS, Leung EK, Paul RH. Uterine rupture after previous cesarean delivery: maternal and fetal consequences. Am J Obstet Gynecol. 1993;169(4):945–50.

    Article  CAS  PubMed  Google Scholar 

  57. Rodriguez MH, Masaki DI, Phelan JP, Diaz FG. Uterine rupture: are intrauterine pressure catheters useful in the diagnosis? Am J Obstet Gynecol. 1989;161(3):666–9.

    Article  CAS  PubMed  Google Scholar 

  58. Johnson C, Oriol N. The role of epidural anesthesia in trial of labor. Reg Anesth. 1990;15(6):304–8.

    CAS  PubMed  Google Scholar 

  59. Blanchette H, Blanchette M, McCabe J, Vincent S. Is vaginal birth after cesarean safe? Experience at a community hospital. Am J Obstet Gynecol. 2001;184(7):1478–87.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Maria Dynin M.D. .

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Dynin, M., Lane, D.R. (2017). Bleeding in Late Pregnancy. In: Borhart, J. (eds) Emergency Department Management of Obstetric Complications. Springer, Cham. https://doi.org/10.1007/978-3-319-54410-6_5

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  • DOI: https://doi.org/10.1007/978-3-319-54410-6_5

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