Antepartum Hemorrhage Explained: Causes, Diagnosis, and Life-Saving Management I Moreh Mentorship

In this video, we provide an in-depth discussion on Antepartum Hemorrhage (APH), covering everything you need to know:

✅ Key causes: Placenta previa, placental abruption, vasa previa, cervical ectopic pregnancy, and more.
✅ Symptom analysis: Differentiating based on pain, bleeding patterns, and associated features.
✅ Physical examination: Essential steps, findings, and precautions.
✅ Investigations: The role of ultrasound, lab tests, and other diagnostics.
✅ Management strategies: Tailored plans based on gestational age, maternal stability, and fetal well-being.

Time codes

0:00 - 1:54 - Case Scenario
1:55 - 3:40 - Most important question to ask patient with Per vaginal bleeding
3:41 - 6:31 - Causes of Antepartum Hemorrhage (Differential diagnoses)
6:32 - 16:44 - What to ask during history taking
16:45 - 22:39 - How to summarize relevant history
22:40 - 29:38 - What to look for during physical examination
29:39 - 33:15 - How to summarize physical examination findings
33:16 - 39:36 - What relevant investigations to order and what results mean
39:37 - 43:13 - Summary of investigations
43:14 - 53:57 - How to manage Antepartum Hemorrhage
53:58 - 55:11 - Test your knowledge on Antepartum Hemorrhage

Whether you're a medical student, healthcare professional, or someone looking to learn more about obstetrics, this video offers clear, systematic insights into APH diagnosis and management.

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Answer to scenario question:

CASE ANALYSIS
Most Likely Diagnosis
The most likely diagnosis is placenta previa because:

💡 Painless vaginal bleeding is the hallmark symptom.
💡 No associated contractions or abdominal pain rules out placental abruption.
💡 Stable vitals and a reassuring fetal heart rate suggest no immediate maternal or fetal compromise.

NEXT STEPS IN MANAGEMENT

Initial Stabilization and Assessment

Establish IV access and take blood samples for:
Complete blood count (CBC): To assess hemoglobin levels for anemia.
Blood type and crossmatch: In case of the need for transfusion.
Coagulation profile: To rule out any clotting abnormalities.
Kleihauer-Betke test (if Rh-negative): To assess for fetomaternal hemorrhage.
Reason: Ensures readiness to manage maternal hemorrhage and guides further intervention.
Avoid Digital Vaginal Examination

Perform speculum examination instead.
Reason: Digital examination can worsen bleeding in placenta previa.
Imaging

Perform an urgent transabdominal ultrasound (and transvaginal if necessary) to:
Confirm the location of the placenta.
Assess for evidence of placenta previa or vasa previa.
Reason: Imaging is the gold standard for diagnosing placenta previa.
Monitoring

Continuous fetal heart rate monitoring: To detect fetal distress.
Maternal monitoring: Regularly check vitals and observe for signs of active bleeding.
Reason: Ensures maternal and fetal well-being.
Prepare for Delivery (if necessary)

If bleeding is controlled:
Admit for observation.
Administer corticosteroids to promote fetal lung maturity.
Plan for delivery at 36–37 weeks if stable.
If bleeding persists or worsens:
Consider emergency cesarean delivery.
Reason: To balance fetal maturity and maternal-fetal safety.
Other Considerations

Administer Rho(D) immunoglobulin if the patient is Rh-negative.
Reason: Prevents Rh sensitization in future pregnancies.