Vaginal Bleeding & OBGYN emergencies Flashcards
Abnormal Uterine Bleeding
- Uterine bleeding that is irregular in volume, frequency, or duration in nonpregnant women
Tintinalli’s Emergency Medicine, 9th edition - Normal menstrual blood loss <30 mL.
Blood loss >80 mL is considered abnormal
PALM-COEIN acronym for AUB
Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not otherwise classified
Abnormal Uterine Bleeding workup
- Pregnancy test
- CBC
- Thyroid studies
- Coagulation studies
- Ultrasound
- CT
Treatment - UNSTABLE AUB
- Immediate resuscitation
- Gynecologic consult - ASAP
Tintinalli’s Emergency Medicine, 9th edition - IV Fluid
- Blood transfusion
- Identify and correct underlying coagulopathies
- Assess for other causes of bleeding (trauma,
infection, foreign bodies, etc.)
Options for Management of Acute Hemorrhage: hormonal vs. hemostatic vs. surgical
- Hormonal
– Give conjugated estrogen IV until bleeding stops - Hemostatic
– Tranexamic acid (prevents fibrin degradation) - Obtain gyn consult before giving IV
- Surgical
– If medical management fails or contraindication
– Options: D&C, hysteroscopy, tamponade, hysterectom
Options for Management of Heavy Menstrual Bleeding: hormonal vs. non-hormonal
- Hormonal
– Oral contraceptive pills, progestin-only regimens - Nonhormonal therapies
– NSAIDs
Ectopic Pregnancy workup
- Most common symptom: abdominal pain or
discomfort (90%) - Rupture pain is lateralized, sharp, severe, sudden
- Definitive diagnosis: US or direct visualization by
laparoscopy or surgery - Treatment: Surgical (laparoscopic salpingostomy) or
Medical (methotrexate)
Spontaneous Abortion
- WHO defines as loss of pregnancy before 20 weeks or
loss of fetus weighing <500 grams - Most common cause of fetal loss: chromosomal abnormalities
- Most common presenting complaint: bleeding with or without abdominal pain
Spontaneous Abortion management
Threatened abortion - discharge and monitor
Incomplete abortion - have uterus evacuated
(misoprostol or D&C)
Complete abortion - discharge and should f/u
Induced Abortion: three major methods
- Instrumental evacuation by vaginal route
- Stimulation of uterine contraction
- Major surgical procedures
Induced Abortion workup
Presentation of complications:
* Abd pain, bleeding, possibly fever
Physical Exam:
* Cervical os is usually open; uterus is boggy, enlarged
Treatment:
* D&C or misoprostol
Septic Abortion
- A spontaneous or other abortion complicated by a
pelvic infection - S/sxs: fever, abd pain, vaginal discharge, vaginal
bleeding, hx of recent pregnancy
MCC of septic abortion
- Most common causes: retained products of conception
due to incomplete abortion, and introduction of vaginal
bacteria by instrumentation
Septic abortion treatment
- Treatment: fluid resuscitation, IV abxs, OB consult for evacuation of the uterus
Preeclampsia
- The presence of HTN after 20 weeks gestation and proteinuria or other maternal organ dysfunction
- Risk factors: prior pregnancy with preeclampsia,
maternal age >40yo, HTN, DM, renal disease, multiple gestation
