Antepartum hemorrhage is associated with all of the following except?

PGIMS Rohtak NO - 2017

Obstetrics & Gynaecology

Medium

Appeared in: PGIMS Rohtak NO - 2017

Explanation

Antepartum hemorrhage (APH) refers to vaginal bleeding after 20-24 weeks of gestation but before the onset of labor.
APH is a serious complication that often indicates placental issues (like previa or abruption) or other problems that threaten maternal or fetal health.
These complications frequently necessitate iatrogenic or spontaneous preterm birth to prevent further harm.
Therefore, APH is associated with delivering before term, making an association with postterm pregnancy (pregnancy extending beyond 42 weeks) incorrect.

Option A: Antepartum hemorrhage is a well-established risk factor for postpartum hemorrhage. The underlying causes, such as uterine atony or placental abnormalities, often persist after delivery.
Option B: Anemia is a direct consequence of blood loss. Antepartum hemorrhage, by definition, involves bleeding, which leads to a decrease in maternal hemoglobin and hematocrit, resulting in anemia.
Option C: APH significantly increases the risk of perinatal mortality. This is primarily due to complications like placental abruption, fetal hypoxia, and the high rate of associated preterm births, which is a leading cause of neonatal death.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications and associations of Antepartum Hemorrhage (APH) as background academic context rather than a clinical decision trigger.
Nurses must recognize that any vaginal bleeding in late pregnancy is abnormal and requires immediate assessment and intervention.
Key nursing actions for APH include continuous monitoring of maternal vital signs and fetal heart rate, quantifying blood loss, establishing large-bore IV access for fluid and blood product administration, and preparing for a potential emergency delivery.
What if? If a patient with APH also has a history of multiple prior cesarean sections, the index of suspicion for placenta accreta spectrum (a cause of both APH and catastrophic PPH) must be extremely high. This requires mobilizing a multidisciplinary team, ensuring availability of massive transfusion protocols, and planning for a potential peripartum hysterectomy.

How to Approach the Question

First, identify the core concept of the question, which is Antepartum Hemorrhage (APH).
Next, notice the critical keyword 'except'. This signals that you must find the option that is NOT a known complication or association of APH.
Systematically evaluate each option's relationship with APH:
Does bleeding before birth (APH) increase the risk of bleeding after birth (PPH)? Yes, the underlying causes are often related.
Does significant blood loss (hemorrhage) cause anemia? Yes, this is a direct physiological result.
Does a major pregnancy complication like APH increase the risk of fetal or newborn death? Yes, often due to prematurity or hypoxia.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 48-68