Haemorrhage (bleeding) remains a very serious complication of pregnancy, accounting for a third of maternal deaths in childbirth around the world.
Antepartum Haemorrhage (APH)
Bleeding from 24 weeks up to delivery of the baby. Fortunately, in the majority of cases the amount of bleeding is small and no cause is found. In a small number of women with APH, there may be a serious underlying cause. This is why it is important to seek medical assistance if you experience bleeding. If there is pain associated with the bleeding, you may be having a placental abruption (where the placenta tears away from the womb). This can be life threatening and may require urgent delivery, hence the recommendation about seeking advice early.
Post partum haemorrhage (PPH)
Bleeding after delivery of the baby. We divide PPH into primary (first 24 hours) and secondary (>24 hours and up to 6 weeks), because the causes and management are different. Primary PPH (>500mls) is just as serious as APH. It is most often caused by a lax uterus and can be controlled using drugs that make the womb contract and stop bleeding. Other causes include blood clotting problems (DIC), stuck or retained placenta, uterine tears, cervical tears, vaginal tears. It is important to try and control a PPH as quickly as possible, so forgive the doctors and midwives if they are very busy and don’t talk to you until things are under control.
Secondary PPH is more bleeding than expected, and is usually caused by infection in the womb. This can be treated with antibiotics. Occasionally a hysteroscopy evacuation is required.