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Antepartum bleeding (APH), also prepartum hemorrhage, is bleeding during pregnancy from the 24th week [7] (sometimes defined as from the 20th week [8] [7]) gestational age up to the birth of the baby. [5] The primary consideration is the presence of a placenta previa which is a low lying placenta at or very near to the internal cervical os.
Implantation bleeding may be confused with a regular period. [4] [5] Heavy vaginal bleeding in the first trimester or bleeding associated with pain, may be a sign of a complication, such as a miscarriage or an ectopic pregnancy, that would need to be assessed by a healthcare provider. [6]
Early pregnancy loss is a term often used interchangeably with spontaneous abortion and miscarriage and refers to pregnancy loss during the first trimester. [7] It is the most common cause of early pregnancy bleeding and is associated only with heavy (versus light) bleeding. [8] However, patients typically remain hemodynamically stable.
This clinical sign can be observed during a patient's examination as early as 8 to 12 weeks' gestation, serving as an early sign of pregnancy, but it is rarely seen before 7 weeks' gestation. [1] The discovery of this colour change dates back to approximately 1836 when French doctor Étienne Joseph Jacquemin (1796–1872) first identified it. [2]
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[1] [2] Such bleeding could be visible or external, namely bleeding from the vagina, or it could be internal into the pelvic cavity or form a hematoma. Normal menstruation is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with a pregnant state or during delivery is an obstetrical hemorrhage.
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