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
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.
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.
Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126(3):654–68.
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.
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.
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.
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.
Rasmussen S, Albrechtsen S, Dalaker K. Obstetric history and the risk of placenta previa. Acta Obstet Gynecol Scand. 2000;79(6):502–7.
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.
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.
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.
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.
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.
Cotton DB, Read JA, Paul RH, Quilligan EJ. The conservative aggressive management of placenta previa. Am J Obstet Gynecol. 1980;137(6):687.
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.
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.
Sakornbut E, Leeman L, Fontaine P. Late pregnancy bleeding. Am Fam Physician. 2007;75(8):1199–206.
Abbrescia K, Sheridan B. Complications of second and third trimester pregnancies. Emerg Med Clin North Am. 2003;21(3):695–710.
Leerentveld RA, Gilberts EC, Arnold MJ, Wladimiroff JW. Accuracy and safety of transvaginal sonographic placental localization. Obstet Gynecol. 1990;(76):759–62.
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.
Timor-Tritsch IE, Yunis R. Confirming the safety of transvaginal sonography in patients suspected of placenta previa. Obstet Gynecol. 1993;81(5Pt 1):742.
Sunna E, Ziadeh S. Transvaginal and transabdominal ultrasound for the diagnosis of placenta praevia. J Obstet Gynaecol. 1999;19(2):152.
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.
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.
Practice Bulletin No. 159: Management of preterm labor. Obstet Gynecol. 2016;127:29–38.
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.
Hladky K, Yankowitz J, Hansen WF. Placental abruption. Obstet Gynecol Surv. 2002;57:299–305.
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.
Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand. 2011;90(2):140–9.
Kyrklund-Blomberg NB, Gennser G, Cnattingius S. Placental abruption and perinatal death. Paediatr Perinat Epidemiol. 2001;15(3):290–7.
Abu-Heija A. Abruptio placentae: risk factors and perinatal outcome. J Obstet Gynaecol Res. 1998;24(2):141–4.
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.
Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006;108(4):1005–16.
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.
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.
Yeo L, Ananth C, et al. Glob. libr. women’s med., (ISSN: 1756–2228). 2008.
Ananth CV, Berkowitz GS, Savitz DA, et al. Placental abruption and adverse perinatal outcomes. JAMA. 1999;282:1646–51.
Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. J Ultrasound Med. 2002;21:837–40.
Witlin AG, Sibai BM. Perinatal and maternal outcome following abruptio placentae. Hypertens Pregnancy. 2001;20:195–203.
Kayani SI, Walkinshaw SA, Preston C. Pregnancy outcome in severe placental abruption. BJOG. 2003;110:679–83.
Oyalese KO, Turner M, Lees C, Campbell S. Vasa previa: an avoidable obstetric tragedy. Obstet Gynecol Surv. 1999;54:138–45.
Lubin B. Neonatal anaemia secondary to blood loss. Clin Haematol. 1978;7:19–34.
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.
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.
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.
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.
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.
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.
Al-Zirqi I, Daltveit AK, Forsen L, et al. Risk factors for complete uterine rupture. Am J Obstet Gynecol. 2017;216(2):165e1–165e8
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.
Rudd NL, Nimrod C, Holbrook KA, Byers PH. Pregnancy complications in type IV Ehlers-Danlos Syndrome. Lancet. 1983;1(8314–5):50.
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.
Ozdemir I, Yucel N, Yucel O. Rupture of the pregnant uterus: a 9-year review. Arch Gynecol Obstet. 2005;272(3):229.
Bujold E, Gauthier RJ. Neonatal morbidity associated with uterine rupture: what are the risk factors? Am J Obstet Gynecol. 2002;186(2):311–4.
Bujold E, Mehta SH, Bujold C, Gauthier RJ. Interdelivery interval and uterine rupture. Am J Obstet Gynecol. 2002;187(5):1199–202.
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.
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.
Johnson C, Oriol N. The role of epidural anesthesia in trial of labor. Reg Anesth. 1990;15(6):304–8.
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.
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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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