Antepartum hemorrhage (APH) is a common complication of pregnancy and occurs in about 15% of all pregnancies. It is defined as bleeding from the genital tract between week 20 of the pregnancy and the onset of labor. Obstetric hemorrhage is a significant threat to the fetus and to the mother. Premature delivery and perinatal mortality rates are increased several-fold in connection with second- and third-trimester bleeding episodes. The most frequent causes of APH are abruptio placentae and placenta previa. Other causes include cervical lesions, genital infections, trauma, and rarely vasa previa, vulvovaginal varicosities, and genital tumors. Nongynecologic causes such as hematuria and rectal bleeding also should be considered. Because of the increased risks and high morbidity and mortality rates that are associated with APH, careful clinical evaluation and management is of critical importance.
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