Local genital causes of antepartum haemorrhage
Once placenta praevia and placenta abruption have been objectively excluded in patients presenting with APH, local genital causes should be explored. The local genital causes include cervical ectropion, cervical polyp, cervicitis, vaginitis, and bleeding from trauma to the vulva and vaginal varicosities (77).
Bleeding from cervical ectropion and cervical polyp is usually self-limiting and can present as postcoital bleeding during pregnancy. Reassurance and an explanation is usually all that is required in most cases. Women with cervical polyps should be followed up after the pregnancy to assess the need for polypectomy.Cervical neoplasia should be suspected when the cervix looks grossly abnormal especially in patients with a poor cervical screening history and these women should be referred urgently for assessment by a gynaecology oncologist. Severe vaginal candidiasis can be associated with vaginal spotting as the yeast plaque sloughs off from the vaginal wall and the symptoms usually resolve with topical antifungal treatment.
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