Vaginal bleeding

Vaginal bleeding, or antepartum haemorrhage as it is called if it occurs after the 24th week of pregnancy up to delivery of the child, should always be investigated promptly, particularlay to exclude the possibility of a placental abruption (usually associated with pain) or placenta praevia. If the mother is Rhesus negative, Anti – D should be administered, to minimise the risk of Rhesus iso-immunisation. New evidence suggests that universal prophylaxis against Rhesus iso-immunisation for all women can further reduce the risks of iso-immunisation.

Management

It is important not to assume the origin of vaginal bleeding so a careful history and examination is essential. A speculum examination can confirm that the cervix is healthy and not the source of the bleeding. A careful history will determine if there is associated pain, which is very important in deciding how best to manage the bleeding.

If the bleed is substantial admission to hospital, intravenous lines and blood may all be required. With minor bleeding bed rest in the first instance is recommended, slowly returning to a normal life as the bleeding resolves. If there is a placenta praevia or abruption close medical care will be recommended until the delivery.

If the mother is Rhesus negative, Anti – D should be administered, to minimise the risk of Rhesus iso-immunisation. New evidence suggests that universal prophylaxis against Rhesus iso-immunisation for all women can further reduce the risks of iso-immunisation.