Vaginal Bleeding History Flashcards
General outline for this type of history
Intro - WIPER
HPC
- O’SOCRAT
- ICE
- MenstRUAL history:
- Lower abdominal pain/ pelvic pain:
- Sexual history:
- Discharge:
- ROS:
Obstetric history
PMH
DH
FH
SH
What does O’SOCRAT mean in this history?
Open question - Classic open ended question, what seems to be the problem?/ can you tell me a bit more about the bleeding?
Site - When and where did you notice the bleeding exactly? Is it definitely from the vagina?
Onset - When did you first notice the bleeding?
Character - Precisely how much is there? Has it come in clots? Colour?
Radiation - Which do you use tampons or padding? Do they get soaked?
Associated symptoms - (later)
Timing - When do you notice the bleeding? Are there gaps in the bleeding? How often is it there? Does it occur mid cycle? Is it post-coitial?
Outline MenstRUAL history:
Is there any chance you could be pregnant? When was your last period?
Regularity - How frequent are you periods? What has the longest time been between them and the shortest time?
Underwear - Are you periods painful or heavy?
Age of menarche - When did you have your first period?
Last menstrual cycle - When was your last period?
Lower abdominal pain/ pelvic pain:
Abdo pain - Have you have any pain below your belly button?
Dyspareunia - Do you have any pain during sex? If so, what kind? A deep pain or is it when entering?
Sexual history:
Last smear - When was your last cervical smear? (Should be once every 3 years from 25 to 50, then once every 5 years, very important to show you are thinking about cervical and endometrial cancer as a possible diagnosis)
Sexual activity - Are you shaggin?
Partner - with a regular partner or different partners?
Contraception/ HRT - Are you currently taking the contraceptive pill/ hormone replacement therapy?
Discharge questions:
Other than blood is there any other kind of discharge?
Onset - When was it noticed?
Colour - What colour is it?
Odour - Does it have a bad smell?
Amount - How much is there?
Important points for Systems review:
Any weight loss? How is your eating? Any tiredness recently? Any breathlessness? Any waterworks issues?
Obstetric history
PMH
DH
FH
SH
Obstetric history:
Gravity How many pregnancies have you had?
Complications Did you have any significant problems with any of them? Did you carry them to term?
PMH:
Have you ever suffered from any medical conditions?
Ask specifically about previous cancer, particularly breast, ovarian endometrial and cervical, STIs or bleeding disorders.
DH:
Are you on any medications?
Any allergies?
FH:
Do any conditions run in the family?
Ask specifically about previous cancer, particularly breast, ovarian endometrial and cervical, STIs or bleeding disorders.
SH:
Are you currently working?
Do you smoke? Drink alcohol? How much?
Who is at home with you?
Important points for differentials
Differentials of PV bleeding depends on TIMING of the bleed
Is it intermenstrual, postcoitial, post menopausal?
Could it simply be their period? Do they have a bleeding disorder or do they take any anticoagulant/antiplatelet medications?
Outline differentials
Investigations?
Abdominal and pelvic examinations
PV examinations to confirm it is a PV bleed, look for pathology
Bloods = FBC and clotting
Urine HCG
STI screen = high vaginal and endometrial swabs
Cervical smear (if overdue/ for smear)
Colposcopy after abnormal smear
Transvaginal USS
Urgent USS if suspect ectopic
Management:
Management:
Urgent referral for PMB (postmenopausal bleeding) or IMB (intermenstrual bleeding)/ PCB (postcoitial bleeding) if suspicion.
Atrophic vaginitis = topical lubricant/cream or HRT (topical or systemic).
Polyps = removed and sent for histology
Ectopic pregnancy = surgical intervention (laparoscopic or open)
STI = appropriate antibiotics
