Common obstetric histories - PV bleeding

Question 1

What would you want to ask about PV bleeding in an obstetric patient?

Answer 1

• Duration
• Progression
• Onset
• Timing - intermittent/constant
• Amount of loss
• Pain with blood loss
• Anaemia symtpoms

Question 2

What would you want to ask about on systemic enquiry in an obstetric patient with PV bleeding?

Answer 2

• General - fever, sweats
• Obstetric - foetal movements, contractions
• Gynae - PV discharge, Pain

Question 3

What features assocaited with PV bleeding in an obstetric patient would suggest implantation?

Answer 3

• Light short lived bleeding/spotting
• Dark with pink/brown tint
• 6-12 days after conception - near when menstrual period is expected

Question 4

What features assocaited with PV bleeding suggest ectopic pregnancy?

Answer 4

• Unilateral pain
• Usually between 4-12 weeks

Question 5

What features assocaited with PV bleeding would suggest miscarriage?

Answer 5

• <24 weeks
• Pelvic pain
• Products of conception/clots

Question 6

What features assocaited with PV bleeding would suggest labour as a cause?

Answer 6

• > 24 weeks gestation
• Painful regular rhythmic contraction

Question 7

What features associated with PV bleeding would suggest Placental abruption in an obstetric patient?

Answer 7

• Antepartum haemorrhage
• Continuous abdominal pain
• Uterine contractions

Question 8

What features assocaited with PV bleeding would suggest placenta praevia?

Answer 8

• Painless bleeding > 28 weeks
• Sudden profuse intermittent PV bleeding

Question 9

What features of PV bleeding in an obsetric patient would suggest vasa praevia?

Answer 9

• Painless bleeding after membranes rupture
• Foetal bradycardia

Question 10

What features of PV bleeding suggest Cervical pathology as a cause in an obstetric patient?

Answer 10

• Commonly post-coital/vaginal trauma
• May have PV diacharge

Question 11

What are early causes of PV bleeding in obstetric patients?

Answer 11

• Implantation
• Ectopic
• Miscarriage

Question 12

What are late causes of PV bleeding in obstetric patients?

Answer 12

• Labour
• Placental abruption
• Placenta praevia
• Vasa praevia

Question 13

What causes of PV bleeding can occur at any time during pregnancy?

Answer 13

• Cervical pathology - polyps, cancer, trauma, ectropian
• Cervicitis
• Vaginitis
• PID