Bleeding in Pregnancy
Bleeding in pregnancy is a frequent emergency presentation with a wide differential. Priorities are rapid maternal assessment and resuscitation, early localisation of the pregnancy (intra‑uterine versus extra‑uterine), assessment of fetal wellbeing when appropriate, and prevention of Rh sensitisation in RhD‑negative women.
Use gestational age to guide likely causes and immediate actions. Follow local maternity/Early Pregnancy Assessment Unit (EPAU) pathways and national guidance (notably NICE NG126 for early pregnancy and intrapartum haemorrhage/PPH guidance; Resuscitation Council UK for maternal resuscitation).
Definitions and epidemiology (key figures)
- Miscarriage: spontaneous pregnancy loss before 23 completed weeks; early ≤12 weeks; late 12-23 weeks. Approximately 20% of recognised pregnancies end in miscarriage.
- First‑trimester bleeding (≤13 weeks): occurs in up to 30% of pregnancies; about half continue to a viable pregnancy.
- Ectopic pregnancy: implantation outside the endometrial cavity. Incidence ~11.1 per 1,000 pregnancies.
- Antepartum haemorrhage (APH): bleeding from 24 weeks until delivery. Incidence ~3.5%.
- Placenta praevia: incidence ~0.48%.
- Vasa praevia: incidence ≈ 1:2,500 deliveries.
- RhD incompatibility: a proportion of births involve an Rh‑negative mother and Rh‑positive fetus; anti‑D immunoglobulin prevents maternal sensitisation.
General approach - priorities
- Rapid triage and resuscitation: treat airway, breathing and circulation first. If unstable, call the resuscitation team and obstetrics/gynaecology immediately.