Antepartum haemorrhage

Antepartum haemorrhage (APH) remains a leading cause of maternal and perinatal morbidity and mortality across the world. As a key component of obstetric haemorrhage, it features high on the list of near-miss obstetric events; thus highlighting the continued importance of developing strategies aimed at reducing the negative impact on maternal and fetal outcome. The causes of APH include placenta praevia, placenta accreta, placenta abruption, vasa praevia, and local genital causes. Some cases of APH would be retrospectively classified as of unknown origin. Placenta praevia, placenta abruption, and vasa praevia have the greatest impact on maternal and fetal morbidity and mortality. The impact of APH on pregnancy outcome is more pronounced in low-resourced countries when compared to developed economies; therefore, a system-oriented approach based on sound evidence and multidisciplinary involvement with regularly rehearsed drills is required to drive a sustained improvement in the management of APH across the world. The rising incidence of placenta accreta, with the associated risk and complexity, presents an ongoing challenge, and the adoption of a composite care bundle that incorporates key components of multidisciplinary care is highly recommended.