Antepartum Haemorrhage (APH)

Antepartum haemorrhage (APH) is defined as genital tract bleeding between the 24th week of pregnancy and the onset of labour 

 

It occurs in 2-5% of pregnancies worldwide and is a leading cause of maternal, neonatal death and morbidity in sub-Saharan Africa and south Asia

Research Overview

Placental abruption (when the placenta detaches from the uterine wall too early) and placenta praevia (when the placenta covers all or part of the cervix) are the most common causes of APH.

Around 1 – 2% of women with APH die from the bleeding, but APH poses a much greater risk to the fetus as fetal death occurs in 20 – 35% of APH cases. 

APH accounts for 20% of antepartum stillbirths and one in three preterm births.

Prematurity can lead to neonatal death, particularly in Low Middle-Income Countries (LMICs) that lack neonatal intensive care units.

Unfortunately, health researchers are still in the early stages of seeking funding for research on this topic.

The only ‘treatments’ are immediate delivery (with the risks of prematurity) and supportive care (bed rest, transfusion, and steroids for fetal lung maturity). There is currently no treatment to stop the bleeding and trials are needed.

More Resources

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TXA for Antepartum Haemorrhage

Tranexamic Acid for women with antepartum bleeding
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More Treatments

TXAcentral is a resource for health professionals caring for people with acute bleeding
TXAcentral brings together randomised trial evidence on the effectiveness and safety of tranexamic acid
Data on many of the trials are also available at the freeBIRD website

In trauma patients with significant bleeding and those with traumatic brain injury (TBI), TXA has been  shown to reduce mortality in both extracranial and intracranial bleeding

Postpartum Haemorrhage (PPH) is the leading cause of maternal death worldwide, responsible for around 100 000 deaths each year. TXA given as quickly as possible after birth and no later than 3 hours, reduces death due to bleeding and the need for surgery to stop bleeding

GI Bleeding is a common emergency that causes substantial mortality and morbidity worldwide. TXA was found to not reduce deaths from GI bleeding and showed an increased risk of thromboembolic events

Every year there are over 300 million surgical procedures worldwide. Bleeding is an important complication and many patients require a blood transfusion. TXA reduces blood loss in surgical patients by about one‐third. However, the effects of TXA on thromboembolic events and mortality in surgery are uncertain

There is ongoing research looking at how Tranexamic Acid (TXA) could be utilised for other bleeding conditions