28 - vag bleeds Flashcards
1
Q
first step
A
ABCD
- make sure hemodynamically stable
- IV if not
2
Q
2 general groups of vag bleeds
A
- preg related
- non-preg related
- non-uterine
- ovulatory
- anovulatory
3
Q
3 def. of abnormal bleeds
A
cycle - 28+/-7 days
flow - 4+/- 2 days
blood 30+/- 20ml
4
Q
7 life threatening causes of vag. bleeds
A
- ectopic
- placentae abruptia
- placentae previa
- urertine rupture
- post-partum hemmorage
- post-partum or procedue endometritis
- trauma
5
Q
7 origins of bleeds
A
- extra-uterine
- uterine
- cevix
- vag
- GU
- intra-abdo
- fistula
6
Q
causes of bleeds in children
A
- can be normal for 6 weeks
- vagintis, precocious puberty, tumor, trauma
- most due to bike seats
- foreign bodies - bad smelling discharge
- need to exclude abuse
7
Q
bleeds in young women
A
- assume pregnant
- ovulation 12.5 with 10 being lowe
- ask age of menarche
- contraception
- loss of flow due to loss of estrogen - ANA, excercise
- cause of mid cycle bleed usally pill
8
Q
3 most common causes in post-menopausal
A
- estrogens from food and remedies
- atrophic changes
- endometrial CA
9
Q
Tx of AUBs
A
- IV estrogen to stop bleeds
- tranexamic acids to stop
- NSAIDS
- others refer to gyn
10
Q
questions to ask in bleed in preg. patient
A
- hemo stable?
- febrile?
- if cervix open can tissue be removed to help pain?
- is it ectopic?
- are there retained products?
- bleeding disorder?
- Rh status?
- give rhogam to and -ves - psych reaction?
11
Q
what it do for inevitable and incomplete abortions
A
- pain control
- serial beta
- misoprostol for
12
Q
risks for ectopic
A
- IUD, PID, infert Tx, pevic surgeries
13
Q
what to do for ectopics
A
- HCG - can be unreliable
- US to look for intraterine preg and adneal mass
14
Q
mgmt of ectopic
A
- usually surgical
- now some people use methotrexate
15
Q
contraindications to metho
A
- hemo instable
- impending rupture
- abnormalities at baseline
relative - high baseline HCG
- fetal cardiac activity
16
Q
3 causes of 3rd tri bleeds
A
- abruptio
- previa
- rupture
17
Q
def. abruptio
A
- premature separation
- ## often due to trauma
18
Q
def. previa
A
- implantation over the os
- painless bleeding preceeded by trauma or intercourse
- NO PELVIC EXAM
19
Q
def. rupture
A
high mortality
- often during delivery
20
Q
6 causes of post-partum hemmoarge
A
- uterine atony - oxytocin
- rupture
- laceration tears
- retained tissue - US
- uterine investion
- coagulopath
21
Q
instructions for those being discharged
A
- return if bleed or lightheaded
- clear fluids for those with surg
- follow up in 24 hours
- psych support
