When bleeding occurs during pregnancy there are both maternal and fetal considerations. The reasons can be varied and this chapter explores the recognition, investigation and management of a significant antepartum haemorrhage during pregnancy. Key learning points: Recognise the importance of early involvement of senior members of the multi-professional team, including the neonatologist. Obtain large-bore intravenous access and take bloods for full blood count (FBC), group and screen, Kleihauer and clotting profile (including fibrinogen) in a suspected major APH. Consider that there may sometimes be causes of APH that are not uterine or placental in origin. Placenta accreta spectrum (PAS) disorders should be considered in any pregnant woman who has a low-lying anterior placenta and has had a previous caesarean birth. Measure/weigh all blood loss (if possible). Bleeding may be concealed in major APH, so perform a through clinical assessment for signs of hypovolaemia and shock. Assess the fetus, even if the woman is clinically stable.