🚨 Men's Health

Antepartum Haemorrhage & Placenta Praevia (Nigeria)

Q: Is it normal to have some spotting in pregnancy?

Light spotting in early pregnancy (first trimester) can be caused by implantation or cervical sensitivity. In the second half of pregnancy, any vaginal bleeding is abnormal and requires same-day assessment. Even if the bleeding stops, you must still be evaluated to determine the cause.

Q: Can I have a vaginal delivery with placenta praevia?

No — if the placenta is covering or very close to the cervical opening (major praevia), vaginal delivery is not possible and caesarean section is essential. If the placenta is more than 2 cm from the cervix, vaginal delivery may be considered. This is determined by ultrasound.

Q: What is placenta accreta and why is it dangerous?

Placenta accreta is when the placenta grows abnormally into the uterine wall. It is increasingly common due to rising C-section rates in Nigeria. It causes catastrophic haemorrhage at delivery and often requires hysterectomy to control bleeding. It should be suspected in women with previous caesarean sections and anterior placenta praevia — diagnosed by ultrasound or MRI.

Q: What should I do if I start bleeding heavily at home?

Call for help immediately. Lie down and avoid any vaginal examination. Go to the nearest hospital with an operating theatre by the fastest means available. Bring your antenatal card. Do not drive yourself. Time matters — heavy obstetric bleeding can become life-threatening within minutes.

Vaginal bleeding in the second half of pregnancy — placenta praevia, abruption, and emergency management

Antepartum haemorrhage (APH) — vaginal bleeding after 20 weeks of pregnancy — is a serious complication that requires immediate assessment. The most important causes are placenta praevia (placenta lying over the cervix) and placental abruption (premature separation of the placenta). Both are obstetric emergencies in severe presentations. APH is a significant cause of maternal and perinatal mortality in Nigeria. Every pregnant woman must know that any vaginal bleeding in the second half of pregnancy requires same-day emergency assessment.

Signs and Symptoms

✓ Placenta praevia — painless bright-red vaginal bleeding, typically in the third trimester

✓ Placental abruption — painful dark-red vaginal bleeding with a hard, tender uterus

✓ Abruption may have little or no visible bleeding if the clot is concealed behind the placenta

✓ Fetal distress — abnormal fetal heart rate pattern

✓ Maternal shock — pale, cold, sweating, rapid pulse, low blood pressure

✓ Reduced or absent fetal movements

✓ Sudden severe abdominal pain — classic abruption symptom

Risk Factors

Previous caesarean section — increases placenta praevia and accreta risk
Multiple uterine surgeries or curettage — uterine scarring
Multiple pregnancy — increased placenta surface area
Previous placenta praevia
Smoking — increases abruption risk 2.5-fold
Hypertension and pre-eclampsia — abruption risk
Cocaine use — severe abruption risk
Abdominal trauma — road traffic accident, assault
Grand multiparity (≥5 pregnancies)

When to Seek Help

Emergency — go immediatelyANY vaginal bleeding in pregnancy after 20 weeks — go to the nearest hospital with an operating theatre immediately. Do not wait to see if the bleeding stops

EmergencyAbdominal pain with or without bleeding in late pregnancy — possible placental abruption

EmergencySigns of maternal shock (pale, sweating, rapid breathing, low BP) or reduced fetal movements with bleeding

Same dayEven small amounts of vaginal bleeding or 'bloody show' at <37 weeks — needs assessment to determine cause

Tests & Diagnosis

🧪 Ultrasound — placental localisation

Transvaginal or transabdominal — identifies placenta praevia. DO NOT perform a vaginal examination before placental location is confirmed by ultrasound — digital examination with praevia causes catastrophic haemorrhage

🧪 Fetal heart rate monitoring (CTG)

Detects fetal distress — late decelerations and reduced variability indicate fetal compromise

🧪 Full blood count and crossmatch

Haemoglobin, platelet count, and blood group — 4–6 units crossmatched immediately for major haemorrhage

🧪 Coagulation screen (PT, APTT, fibrinogen)

Severe abruption causes disseminated intravascular coagulation (DIC) — a coagulopathy requiring fresh frozen plasma, cryoprecipitate, and platelets

🧪 Kleihauer-Betke test

Detects fetal red blood cells in maternal circulation — used to calculate anti-D dose in Rh-negative mothers with APH

Treatment Options

ABCDE resuscitation — immediate priority

Large-bore IV access (two lines), IV fluids (crystalloid first), oxygen, left lateral tilt (off inferior vena cava), crossmatch blood, and call obstetric and anaesthetic team immediately

Placenta praevia management

Minor bleed at <37 weeks with stable mother and baby: admit, observe, conservative management. Avoid vaginal examination. Corticosteroids for lung maturity if <34 weeks. Caesarean section — the only safe mode of delivery for major praevia

Placental abruption management

Mild with stable fetus: close monitoring, may continue pregnancy. Moderate-severe or fetal distress: immediate delivery by caesarean section. Massive haemorrhage: blood transfusion, treat DIC, deliver urgently

Blood transfusion

Major haemorrhage protocol — massive transfusion with packed red cells, FFP, cryoprecipitate, and platelets in ratios. Tranexamic acid 1 g IV reduces haemorrhage in obstetric emergencies

Anti-D immunoglobulin

For all Rh-negative women with APH — given within 72 hours of bleeding. Dose based on Kleihauer test result

Corticosteroids for fetal lung maturity

Betamethasone or dexamethasone IM for pregnancies 24–34 weeks where preterm delivery is anticipated — reduces neonatal respiratory distress syndrome

Postpartum haemorrhage prevention

Women with praevia or abruption are at high risk of PPH — ensure access to oxytocin, ergometrine, carboprost, and tranexamic acid immediately after delivery

Frequently Asked Questions

Is it normal to have some spotting in pregnancy?

Light spotting in early pregnancy (first trimester) can be caused by implantation or cervical sensitivity. In the second half of pregnancy, any vaginal bleeding is abnormal and requires same-day assessment. Even if the bleeding stops, you must still be evaluated to determine the cause.

Can I have a vaginal delivery with placenta praevia?