Vaginal Bleeding

last authored: Sept 2009, David LaPierre

 

Introduction

PV bleeding is the most common gynecologic complaint. It occurs in 20-30% of pregnancies, with about half of these ending in miscarriage.

 

The Case of...

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Differential Diagnosis

Vaginal bleeding is, of course, most often physiologic. Changes in period frequency or severity can be alarming to patients but not signify anyhting worrying.

 

Bleeding during pregnancy is discussed separately.

 

 

Nonobstetric bleeding

Postmenopausal women

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History and Physical Exam

  • history
  • physical exam

History

History is influenced b

HPI

  • colour, amount, clots
  • onset
  • previous bleeding

associated symptoms

  • abdominal pain
  • discharge?
  • dyspareunia
  • light-headedness, syncope
  • last menstrual period

reproductive history

  • period frequency, regularity, duration, severity (bleeding, cramps)
  • menarche
  • birth control
  • obstetric history
  • sexually transmitted infections
  • Pap history

medical history

  • trauma
  • bleeding disorders (nose, bruising, gums)
  • systemic causes of bleeding

family history

  • miscarriages/stillbirths
  • congenital anomalies

review of systems

Physical Exam

  • vitals (stable or unstable)?
  • abdominal exam:
    • uterine,tenderness
    • peritoneal signs
    • uterus
  • pelvic exam (CONTRAINDICATED in late pregnancy until placenta previa is ruled out)
    • cervical os - open or closed?
    • adenexal tenderness/masses
    • uterine size
    • cervical motion tenderness
    • trauma
    • vaginitis
    • cervicitis
    • cervical polyps

 

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Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

  • quantitative beta-hCG
  • CBC
  • blood type (Rh status)
  • swabs

if bleeding is severe,

  • type and cross-match
  • PT and PTT

 

Diagnostic Imaging

  • ultrasound

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Management

Treatment is aimed at the underlying cause.

Ruptured ectopic pregnancy is treated with emergency laparoscopy or laparotomy.

 

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Pathophysiology

 

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Additional Resources

Merck manual

 

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Topic Development

created: DLP, Aug 09

authors: DLP, Aug 09

editors:

reviewers:

 

 

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