Bleeding in the second half of pregnancy often heralds serious and potentially life-threatening complications. Antepartum hemorrhage is defined as any vaginal bleeding in the second half of pregnancy but before birth, usually considered after 20 weeks’ gestation. Major causes include placenta previa, placental abruption, vasa previa, and uterine rupture. These complications are infrequently managed in the emergency department, but emergency physicians must be prepared to make a swift, accurate diagnosis and to lead resuscitative efforts until definitive obstetric management can be obtained. Prompt, coordinated interdisciplinary care can be lifesaving for both mother and fetus. Ultimate management depends on maternal stability and gestational age, and many patients will require emergent cesarean delivery.