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Antepartum Haemorrhage (Green-top Guideline No. 63)

Published: 05/12/2011

This is the first edition of this guideline.

Update December 2014: New evidence and guidance in this field were reviewed in 2014 and it was decided that revision of this guideline would be deferred to a later date. The version available on the website and app will remain valid until replaced.

Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby. The most important causes of APH are placenta praevia and placental abruption, although these are not the most common. APH complicates 3–5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Up to one-fifth of very preterm babies are born in association with APH, and the known association of APH with cerebral palsy can be explained by preterm delivery.

This guideline has been developed primarily for clinicians working in obstetric units in the UK; recommendations may be less appropriate for other settings where facilities, resources and routine practice differ. This guideline does not include specific recommendations for the management of women who refuse blood transfusion.

The Centre for Maternal and Child Enquiries (CMACE) and the RCOG have published guidance regarding the management of pregnancy in women who decline blood products. The Code of Practice for the Surgical Management of Jehovah’s Witness Patients by the Royal College of Surgeons (England) and Management of Anaesthesia for Jehovah’s Witnesses by the Association of Anaesthetists of Great Britain and Ireland provide useful additional information.