12.1.6
Antepartum Hemorrhage
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 12, Sexual and Reproductive Health.
Clinical Description
Bleeding from the genital tract occurring from 28+0 weeks of pregnancy and prior to the birth of the baby.
Signs and Symptoms
- Sudden onset abdominal pain, with or without vaginal bleeding, woody hard uterus or prolonged contractions, fetal distress / fetal demise, +/- hemodynamic instability, +/- coagulopathy.
Non-pharmacological
Management at the Health Centre
- Initial: ABCDE approach
- If patient stable:
- Full history and physical examination including vital signs
- Insert 2 large bore cannula, start 1litre of Ringer's Lactate or normal saline
- Abdominal palpation for SFH, contractions, tenderness, signs of acute abdomen and FHR assessment
- Avoid digital vaginal examination; rather do a sterile speculum examination.
- Request blood and blood products as required.
- Ultrasound examination to rule out placenta previa (if available)
- Once placenta previa is ruled out, do a vaginal examination
- Explain the findings to the patient
- Plan for urgent delivery.
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