National Women's Annual Clinical Report 2010

5.5 Antepartum Haemorrhage
Methods
Antepartum haemorrhage has been defined here to include vaginal bleeding from any
cause at or beyond 20 weeks during pregnancy and labour, and includes placenta praevia
without bleeding. While bleeding before 20 weeks is also important we do not reliably
collect these data.
Data cleaning involved reconciling antenatal summary data and intrapartum complication
data with indications for induction and operative birth. Data were also reconciled with
inpatient coding data.
Findings
Table 30: Antepartum haemorrhage incidence
1995 1996 1997 1998 1999 2000 2005 2006 2007 2008 2009 2010
Total APH 460 451 453 451 484 594 398 411 533 424 438 438
Incidence % 5.0 4.9 5.6 6.0 6.5 7.6 5.5 5.7 6.9 5.6 5.7 5.7
Proven
101 96 115 82 49 54 41 44 58 36 39 50
abruption
Proven
placenta
praevia
APH (uncertain
origin)
86 67 94 91 74 69 81 68 94 73 66 58
273 287 281 278 361 471 276 299 381 315 333 330
In 2010, 438 women (5.7% of the total pregnant population) had an antepartum
haemorrhage or placenta praevia without bleeding. This figure has not changed
significantly from year to year and there have been no trends in incidence over time.
In our population placenta praevia is significantly more common with increasing maternal
age: there was an incidence of 0.5% (16 of 3276 women) in women aged 30 or under
rising to 0.9% in women aged >=30 (42 of 4433 women). The incidence of placenta
praevia in women with a previous Caesarean section was 1.3% (16 of 1197 women)
compared to 0.6% (18/2862) among multipara without previous Caesarean consistent
with previous Caesarean section being a risk factor for placenta praevia. The incidence of
the more serious diagnosis of placenta accreta and percreta should be recorded. Many
studies have shown these problems to be associated with previous Caesarean section.
Smoking status, BMI and hypertensive disease were not associated with placenta
praevia.
Table 31: Maternal outcomes of pregnancies complicated by antepartum haemorrhage
Placenta
praevia
n=58
Placental
abruption
n=50
APH
uncertain
origin
n=330
No APH
n=7271
n % n % n % n %
Mode of birth
Normal vaginal 0 0.0 11 22.0 176 53.3 4089 56.2
Operative vaginal 0 0.0 5 10.0 40 12.1 897 12.3
CS elective 37 63.8 2 4.0 39 11.8 1144 15.7
CS emergency 21 36.2 32 64.0 75 22.7 1141 15.7
Maternal transfusion 9 15.5 6 12.0 15 4.5 173 2.4
Women with a placenta praevia had a significant requirement for blood products with 16%
of women requiring transfusion during pregnancy or birth.
60