OB/GYN Emergencies

Question 1

Approach to Vaginal Bleeding in a Hemodynamically Stable Patient

Answer 1

Determine if patient is pregnant
Determine the amount and length of time of vaginal bleeding
Do a complete pelvis unless suspicious of placenta previa

Question 2

Important History with Vaginal Bleeding

Answer 2

Assess amount of bleeding: # pads/tampons used and any clots
Pattern of periods: regularity, late/missed
Sexual history: # partners, condoms/assess risk
Pain: where, quality, radiation

Question 3

Physical Exam with Vaginal Bleeding

Answer 3

Vitals
Mucosal hemorrhage, petechia
Signs of PCOS
Abdominal exam
Pelvic exam: source of bleeding, signs of trauma, cervical motion tenderness, uterine size, contour, masses, and tenderness

Question 4

Tests for Vaginal Bleeding

Answer 4

Qualitative and quantitative hCG tests
CBC
Type and cross if significant bleeding
Type and screen if not needed immediately
Coag tests if coagulopathy suspected
STIs tests if suspected infection

Question 5

Differential Diagnosis of the Prepubertal Patient

Answer 5

Vulvovaginitis
Foreign body
Trauma
Urethral prolapse
Sexual abuse
Hormone secreting tumor

Question 6

Presentation of Vulvovaginitis

Answer 6

Bloody vaginal discharge

Pruritis

Question 7

Presentation of Foreign Body in the Vagina

Answer 7

Bloody vaginal discharge

Foul smelling

Question 8

Presentation of Sexual Abuse

Answer 8

Blood from sexual trauma
Bruising
C/O pain
Approach carefully

Question 9

Differential Diagnosis of the Premenopausal Non-pregnant Patient

Answer 9

Ruptured ovarian cyst
Ovarian torsion
PID
Dysfunctional uterine bleeding
Uterine leiomyoma
Uterine polyp
Genital trauma secondary to sexual abuse

Question 10

Differential Diagnosis of the Peri-/Post-Menopausal Patient

Answer 10

Endometrial cancer
Anti-coagulant medication
Hormonal therapy
Other medications
Coagulopathy