You are currently using an unsupported browser which could affect the appearance and functionality of this website. Please consider upgrading to the latest version or using alternatives such as Mozilla Firefox, Google Chrome or Microsoft Edge.

Antepartum Haemorrhage (Green-top Guideline No. 63)


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.

COVID disclaimer

This guideline was developed as part of the regular programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers (PDF), and prior to the emergence of COVID-19.

Version history

This is the first edition of this guideline; the second edition of this guideline is currently in development.

Developer declaration of interests

Available on request.

This page was last reviewed 05 December 2011.