Obstetrical bleeding

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Obstetrical bleeding
Synonyms Obstetrical hemorrhage, maternal hemorrhage
Specialty obstetrics
Frequency 8.7 million (2015)[1]
Deaths 83,000 (2015)[2]

Obstetrical bleeding also known as obstetrical hemorrhage and maternal hemorrhage, refers to heavy bleeding during pregnancy, labor, or the puerperium. Bleeding may be vaginal and external, or, less commonly but more dangerously, internal, into the abdominal cavity. Typically bleeding is related to the pregnancy itself, but some forms of bleeding are caused by other events.

About 8.7 million cases of obstetrical hemorrhage occurred in 2015.[1] It is a major cause of maternal death resulting in 83,000 in 2015.[2]

Early pregnancy[edit]

In ICD-10, early pregnancy bleeding (code O20.9) refers to obstetrical hemorrhage before 20 completed weeks of gestational age.[3][4]

First trimester bleeding, is obstetrical hemorrhage in the first trimester (0 weeks-12 weeks of gestational age). First trimester bleeding is a common occurrence and estimated to occur in approximately 25% of all (clinically recognized) pregnancies.[5][6]

Differential diagnosis of first trimester bleeding is as follows, with the mnemonic AGE IS Low (during first trimester):

Later pregnancy[edit]

Antepartum bleeding (APH), also prepartum hemorrhage, is bleeding during pregnancy from the[9] 24th week (sometimes defined as from the 20th week[9][10]) gestational age to term. The primary consideration is the presence of a placenta previa that is a low lying placenta, a condition that usually needs to be resolved by delivering the baby via cesarean section. Also a placental abruption (in which there is premature separation of the placenta) can lead to obstetrical hemorrhage, some times concealed.

During labor[edit]

Besides placenta previa and placental abruption, uterine rupture can occur as a very serious condition leading to internal or external bleeding. Bleeding from the fetus is rare, usually not heavy, but always very serious for the baby. This condition is called as Vasa Previa. Occasionally this condition can be diagnosed by ultrasound. There are also tests to differentiate maternal blood from fetal blood which can help in determining the source of the bleed.[11]

After delivery[edit]

Bleeding after delivery, or postpartum bleeding, is the loss of greater than 500 ml of blood following vaginal delivery, or 1000 ml of blood following cesarean section. Other definitions of post partum bleeding are haemodynamic instability, drop of haemoglobin of more than 1 g % or requiring blood transfusion.

Unrelated bleeding[edit]

Pregnant patients may have bleeding from the reproductive tract due to trauma, including sexual trauma, neoplasm, most commonly cervical cancer, and hematologic disorders.

See also[edit]


  1. ^ a b GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.". Lancet (London, England). 388 (10053): 1545–1602. PMC 5055577Freely accessible. PMID 27733282. doi:10.1016/S0140-6736(16)31678-6. 
  2. ^ a b GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.". Lancet (London, England). 388 (10053): 1459–1544. PMC 5388903Freely accessible. PMID 27733281. doi:10.1016/s0140-6736(16)31012-1. 
  3. ^ page 436 in: 2013 ICD-10-CM Draft Edition, by Carol J. Buck, Elsevier Health Sciences, 2013. ISBN 9781455774883.
  4. ^ 2014 ICD-10-CM Diagnosis Code O20.9 from 2014 ICD-10-CM/PCS Medical Coding Reference].
  5. ^ Pregnancy, Bleeding. eMedicineHealth. URL: http://www.emedicinehealth.com/pregnancy_bleeding/article_em.htm. Accessed on: April 12, 2009.
  6. ^ Elective Abortion at eMedicine
  7. ^ Hasan, R.; Baird, D. D.; Herring, A. H.; Olshan, A. F.; Jonsson Funk, M. L.; Hartmann, K. E. (2009). "Association Between First-Trimester Vaginal Bleeding and Miscarriage". Obstetrics & Gynecology. 114 (4): 860–867. doi:10.1097/AOG.0b013e3181b79796. 
  8. ^ Kirk, E.; Bottomley, C.; Bourne, T. (2013). "Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location". Human Reproduction Update. 20 (2): 250–61. PMID 24101604. doi:10.1093/humupd/dmt047. 
  9. ^ a b patient.info » PatientPlus » Antepartum Haemorrhage Last Updated: 5 May 2009
  10. ^ The Royal Women’s Hospital > antepartum haemorrhage Retrieved on Jan 13, 2009
  11. ^ Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management (PDF). Royal College of Obstetricians and Gynaecologists. January 2011. Retrieved June 25, 2015. [page needed]

External links[edit]

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