Summary

In this study session, you have learned that:

1. Late pregnancy bleeding (ante-partum haemorrhage) can cause maternal and fetal death, and should be treated as a potentially life-threatening emergency.
2. The most common causes of life-threatening late pregnancy bleeding are placental abruption and placenta previa, or more rarely it can result from a ruptured uterus.
3. Less serious bleeding can arise from a varicose vein in the genital area, or blood resulting from a heavy show, which usually stops on its own.
4. Placental abruption can present with both concealed (internal) and revealed (externally visible) bleeding from the vagina; the blood is usually dark and the woman may report abdominal pain.
5. Placenta previa often presents with painless, bright red bleeding and can be associated with abnormal presentation of the fetus. Usually (but not always) fetal condition is normal.
6. Never do a vaginal examination in women with late pregnancy bleeding as this may precipitate severe bleeding.
7. Initial assessment of the woman's vital signs and initiation of IV fluid therapy are the critical first steps in managing haemorrhagic shock in women with severe late pregnancy bleeding.
8. After putting up an IV infusion, transfer the patient immediately to a District Hospital or higher health facility with an operating theatre, as most cases require surgical intervention.