Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

Management of Antepartum Haemorrhage

Antepartum haemorrhage is bleeding from the genital tract in pregnancy before birth. Management prioritizes maternal stabilization, fetal assessment, avoidance of harmful examination, identification of likely cause, preparation for definitive care, and urgent referral.

Purpose

  • Prevent hypovolaemic shock and further bleeding
  • Assess maternal and fetal wellbeing
  • Prepare timely medical, operative, or referral management

Indications

  • Any vaginal bleeding after the stage defined by local obstetric guidance
  • Suspected placenta praevia, abruption, trauma, labour-related bleeding, or other cause
  • Bleeding with pain, contractions, rupture of membranes, or fetal concern

Equipment

  • Emergency call and referral resources
  • Vital-sign and fetal-monitoring equipment
  • Large-bore IV supplies and prescribed fluids
  • Blood-sampling and cross-match supplies
  • Clean pads, PPE, oxygen, urinary-output equipment
  • Antenatal record and transfer documentation

Preparation

  • Ensure emergency equipment, blood sampling, IV supplies, oxygen, and referral transport are ready.
  • Use standard precautions and protect the woman from cold and unnecessary exposure.

Procedure steps

  • Call for help, assess airway, breathing, circulation, consciousness, pain, and amount or source of bleeding.
  • Position the woman safely, provide oxygen if indicated, keep her warm, and avoid unnecessary movement.
  • Obtain IV access, take blood samples as ordered, monitor vital signs frequently, and quantify blood loss with pads or approved methods.
  • Assess fetal heart and gestation when maternal condition permits; do not delay maternal resuscitation.
  • Do not perform a digital vaginal examination until placenta praevia has been excluded by the authorized clinician.
  • Review history, abdominal pain, uterine tone, contractions, trauma, membranes, and fetal status without causing harm.
  • Commence prescribed fluid or blood preparation and maintain accurate input-output.
  • Notify the obstetric team, prepare for ultrasound, theatre, delivery, or transfer according to findings.
  • Explain actions to the woman and support person while maintaining privacy.
  • Document times, observations, bleeding, interventions, response, communication, and transfer or definitive plan.

Precautions

  • Treat all antepartum bleeding as potentially serious.
  • Avoid digital vaginal examination until placenta praevia is excluded.
  • Do not leave the woman alone or delay referral for routine paperwork.
  • Monitor for shock and fetal compromise continuously.

Aftercare

  • Continue maternal and fetal monitoring during transfer or definitive care.
  • Provide emotional support and explain the evolving plan.

Nursing considerations

  • Prioritize resuscitation and multidisciplinary communication.
  • Use clinical findings and trends to identify deterioration early.

Patient education

  • Explain why urgent assessment is needed and advise the woman to report increasing bleeding, pain, dizziness, or reduced movement.
  • Do not eat or drink if surgery is likely unless instructed otherwise.

Documentation

  • Record onset, amount and character of bleeding, maternal and fetal observations, examinations, treatment, communication, and times.
  • Complete referral, blood, and emergency records.

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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