Vaginal Bleeding + Vaginitis Flashcards
Non-Ob DDx of vaginal bleed
Trauma
Cervical polyp or cancer
Vaginitis
Hemorrhagic cyst
Perineal lesion
Vulvar varicosities
Ob DDx of vag bleed
Physiologic
Abnormal pregnancy (ectopic, molar)
Abortion
Types of spontaneous abortion
Spontaneous: pregnancy loss >20w
Inevitable (cervix dilated, no products expelled)
Incomplete (some expelled, retained products)
Complete (products expelled)
Missed (fetal demise but no uterine activity)
Recurrent (>3)
Septic (complicated by uterine infection)
RF for spontaneous abortion
advanced age, thrombophilia, autoimmune disease (antiphospholipid antibody syndrome), infection (BV, HSV, GC, CT, HIV, CMV), IUD
Ix for ?abortion
Ix: bHCG (66% rise in 48hrs = viable), group and screen, US
Management of spontaneous abortion
Expectant
Medical: misoprostol 800mcg vaginally then repeated 24hrs later if no bleeding
RhoGAM if Rh negative (<12w = 120mcg, >12w 300mcg)
Surgical: vacuum aspiration
Counselling with miscarriage
Acknowledge + dispel guilt
Acknowledge + legitimise grief
Assess grief
Counsel how to tell others
Include partner
Provide comfort + support
Reassure about future
Warn about anniversary phenomenon
Pre-abortion counselling
Pregnancy options: abortion, term pregnancy, adoption
Abortion methods
Risks: bleeding, cramping, GI sx, HA, may need SA
Supports, confirm decision is voluntary
Emotional needs
Contraception
Process for medical abortion
If >49d pregnant, Rh neg = give RhoGAM 24hr prior to MA
Mifepristone 200mg PO then 24hrs later misoprostol 800mcg
FU day 14
What is the Apt test?
positive = fetal blood, negative = maternal blood
Sx lichen sclerosus
Sx:
Pruritis
Dyspareunia
Dysuiria
PV bleeding
White, polygonal papules that turn to plaques, shiny porcelain appearance, can obliterate labia minora
Dx + rx of lichen sclerosus
Dx: biopsy
Management:
Asymptomatic = nothing
Symptomatic = topical steroids (clobetasol)
What demographic is most at risk + what types of cancer cause vulvar cancer?
Women >65
Squamous + melanoma
Sx, dx + rx of vulvar cancer
Long term pruritus, lumps or masses
Dx: biopsy
Management: surgery, RT
Sx + rx of thrush (acute + recurrent)
Vulvovaginal: asymptomatic, itchy, dysuria, dyspareunia, white DC
Acute: clotrimazole 500mg PV x 1 dose + fluconazole 150mg PO
Recurrent: fluconazole 150mg PO Q3D x 3 doses then q1week for 6 months