Haemorrhage (Antepartum)
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Population Covered By The Guidance
This pathway provides guidance for investigating pregnant patients with antepartum haemorrhage.
Date reviewed: October 2013
Date of next review: June 2023
Published: November 2013
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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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| 1a |  |
Low Lying Placenta Praevia Image 1a and 1b (Transvaginal Ultrasound, 33 weeks gestation): On transvaginal scan, the placenta is situated on the posterior uterine wall (arrow) and extends to 15mm of the internal cervical os. The cervix is long and closed through its entire length and measures 38mm. Normal fetal measurements and activity are noted which are not illustrated. |
| 1b |  |
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| 2a |  |
Partial Placenta Praevia Image 2a and 2b (Transvaginal Ultrasound): The placenta partially overlies the internal cervical os (arrow). |
| 2b |  |
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| 3a |  |
Complete Placenta Praevia Image 3a and 3b (Transvaginal Ultrasound): The placental completely covers the top of the internal cervical os (arrow). |
| 3b |  |
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Teaching Points
Teaching Points
- The term antepartum haemorrhage (APH) typically refers to vaginal bleeding during the second half of pregnancy. The main causes are 1,2
- Normal ‘bloody show’
- Placenta Praevia
- Placental abruption
- Vasa praevia
- Transabdominal US is the standard method of evaluating patients with APH
- Resuscitation always takes priority over imaging
References
References
Date of literature search: July 2013
The search methodology is available on request. Email
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Morrison EH. Common peripartum emergencies. Am Fam Physician. 1998;58(7):1593-604. (Review article)
- Neilson JP. Interventions for treating placental abruption. Cochrane database of systematic reviews (Online). 2003 2003 (1):CD003247-CD003247. (Review article)
- Catanzarite V, Maida C, Thomas W, Mendoza A, Stanco L, Piacquadio KM. Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases. Ultrasound Obstet Gynecol. 2001;18(2):109-15. (Level III evidence)
- Farine D, Peisner DB, Timortritsch IE. Placenta previa - is the traditional diagnostic approach satisfactory? J Clin Ultrasound. 1990;18(4):328-30. (Level III evidence)
- Royal College of Obstetricians and Gynaecologists. Green-top guideline No. 63: Antepartum haemorrhage. 2011 [cited 2013 July 1] (Evidence based guideline). View the reference
- Royal College of Obstetricians and Gynaecologists. Green-top guideline No. 27: Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management. 2011 [cited 2013 July 1]. (Evidence based guideline). View the reference
- 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):256-60. (Level II evidence)
- Leerentveld RA, Gilberts EC, Arnold MJ, Wladimiroff JW. Accuracy and safety of transvaginal sonographic placental localization. Obstet Gynecol. 1990;76(5):759-62. (Level III evidence)
- Smith RS, Lauria MR, Comstock CH, Treadwell MC, Kirk JS, Lee W, et al. Transvaginal ultrasonography for all placentas that appear to be low-lying or over the internal cervical os. Ultrasound Obstet Gynecol. 1997;9(1):22-4. (Level III evidence)
- Maher MA, Abdelaziz A, Bazeed MF. Diagnostic accuracy of ultrasound and MRI in the prenatal diagnosis of placenta accreta. Acta Obstet Gynecol Scan. 2013;92(9):1017-22. (Level III evidence)
- Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol. 2006;108(3 Pt 1):573-81. (Level III evidence)
- Shih JC, Palacios Jaraquemada JM, Su YN, Shyu MK, Lin CH, Lin SY, et al. Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray-scale and color Doppler techniques. Ultrasound Obstet Gynecol. 2009;33(2):193-203. (Level II/III evidence)
- Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. J Ultrasound Med. 2002;21(8):837-40. (Level III evidence)
- Harlev A, Levy A, Zaulan Y, Koifman A, Mazor M, Wiznitzer A, et al. Idiopathic bleeding during the second half of pregnancy as a risk factor for adverse perinatal outcome. J Matern Fetal Neonatal Med. 2008;21(5):331-5. (Level II evidence)
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Consent to Procedure or Treatment Radiation Risks of X-rays and Scans |
Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
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