Assessment of vaginal bleeding Flashcards
Causes of post coital bleeding
Cervical ectropion Cervical polyp Cervical cancer Cervicitis Vaginal cancer Vaginitis
Hx of miscarriage
Missed period Reproductive age Suprapubic pelvic pain Moderate to severe vaginal bleeding Post coital bleeding
Hx of PID
Discharge STI + Sexual partners Lower abdominal pain Intermenstrual bleeding Fever
Ix for miscarriage
Serum / Urinary hCG = Positive
USS = confirms viability of fetus
Rhesus = identifies if -ve present
Ix for PID
Cervical excitation test
WWC elevated
Culture for gonorrhoeae or chlamydia
Hx of uterine fibroids
Bowel/bladder change due to mass/pressure
Pelvic pain/pressure
↑alcohol and red meat
Black
Nulliparous
Ix for uterine fibroids
TVUS = myomas
Exam of uterine fibroids
Bulky pelvic mass palpable on bimanual
Hx of endometrial polyp
Irregular spotting/bleeding between periods
Ix for endometrial polyp
TVUS - endometrial thickening
Hx of cervical polyp
Contact bleed - post coital / examination
Ix for cervical polyp
Speculum reveals polyp
Hysteroscopy visualises polyp
TVUS - visualises further
Ix of ectropion
Contact bleed
Exam of ectropion
Speculum shows red rather than pink outer cervix due to shift in transformational zone
Hx of menorrhagia
Heavy excessive menstrual bleeding
Findings on exam of menorrhagia
Signs of underlying etiology e.g.
PCOS - acne, weight, hirsuitism
Anaemia - pallor
Hx of PCOS
Irregular cycles
Interspersed amenorrhoea
Obesity, hirsuitism, acne, obesity
Ix for PCOS
Serum LH: Elevated
Serum prog: decreased
Serum test: elevated
Hx of DUB
Irregular menstrual period
Painless bleeding
Peripubertal / perimenopausal
Hx of Endometrial cancer
> 50 years
Intermenstrual bleeding
Obesity, nulliparity, late menopause, unopposed estrogen use, tamoxifen use
Smoking
Hx or FHx of HNPCC
Exam findings of endometrial cancer
Uterine enlargement and irregularity on bimanual
Ix finding of endometrial cancer
TVUS - focally thickened endometrium
Biopsy - adenocarcinoma
Hx of ovarian cancer
FHx of Ovarian Ca or Breast Ca
BRCA1 / BRCA2
No previous use of COCP
Non-specific GI Sx more prominent than gyne sx
e. g.
- Bloating
- Dyspepsia
- Nausea
- Diarrhoea
- Constipation
Urinary urgency is common
Exam findings in ovarian cancer?
Ascites with shifting dullness
Abdominal distension w dullness to percussion
Pleural effusion with diminished breath sounds
Pelvic mass
Hx of vaginal cancer
contact bleed
Hx of ectopic pregnancy
Missed period / Amenorrhoea Pelvic pain Recent intercourse Reproductive age Known gynecological anatomic abnormality Hx of ectopic or pelvic infections (STI / appendicitis)
Exam findings of ectopic
Tenderness on lower abdominal palpation
Pain and palpable mass on bimanual
Guarding
Shoulder tip pain referred
Ix findings of ectopic?
USS (Abdominal and TV) = gestational sac in extra-uterine location
hCG = positive
Hx of gestational trophoblastic disease (choriocarcinoma)
Missed period / amenorrhoea Reproductive age Abdominal distention Hx of hydatiform moles / molar pregnancy Acute onset vaginal bleeding
Ix of choriocarcinoma?
hCG: positive
USS: snowstorm appearance
Hx of placental abruption
2nd or 3rd trimester Smoking / cocaine use Trauma Hypertension Thrombophilia C-section Vaginal bleeding (may be concealed) Woody hard placental abruption
Ix findings for placental abruption
Fetal monitoring:
- late deceleration
- loss of variability
- sinusoidal fetal heart rate
- fetal bradycardia (persistently <110)
Hx for placenta praevia
2nd / 3rd trimester Hx of scarred uterus Smoking Hx of multiple / missed pregnancies Advanced maternal age
Painless PV bleeding
No uterine tenderness
Hx of endometriosis
20-40 yrs
Cramping cyclical pelvic pain
Dysparenuia
