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
Quick User Guide
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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
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
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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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