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Vaginal Bleeding 1 (overview) (Postmenopausal (51y) (Reproductive…
Vaginal Bleeding 1 (overview)
Vaginal bleeding divided by age group (not comprehensive)
Life threatening bleeding from Uterus
Postmenopausal (51y)
Reproductive
Premenarche (11y)
Common cause of bleeding
Foreign Body :earth_asia:
placed by the girl :girl::skin-tone-2:
:warning: :red_flag:
Sexual trauma
STI
Consideration: Precocious Puberty
Dx: Speculum exam
w/ Anesthesia (traumatic :explode:)
Common cause of bleeding: PAD
P
regnancy :pregnant_woman::skin-tone-2:
A
natomy
D
ysfunctional Uterine bleeding
Cervical :crab:
Dx: UPT :pregnant_woman:
Common cause of bleeding
Vaginal atrophy
(postcoital bleed)
benign
:warning::red_flag:Endometrial :crab:
Consideration: Hormone replacement therapy
Dx: r/o :crab:
Endometrial biopsy
(:crab: until proven otherwise)
Lifethreatening bleeding
2 large bore IV
(for PRBC)
IVF
:ocean: bolus
Type & Cross
transfuse PRBC prn
IV Estrogen
Shuts down acute uterine bleed
Sx
:hocho: (if no improvement)
Is this life threatening or not?
Hgb
(may be normal/unchanged)
1.1 Severe change in Hbg/time
Reassess after IVF :ocean:
Hgb <7 absolute indication
Assess hemodynamic stability
Orthostatics
if orthostatic (not frank hypotensive) must give back volume w/ crystalloids, prepare to give blood.
Velocity of blood loss indicates need more than the clinical presentation
Sx intervention
intracavitary tamponade
:balloon:
Inflates and stops bleeding (temporarily)
D&C
(preferred)
finds bleed/stops, preserves fertility
Uterine artery Embolization
(all else fails)
Vascular diseases: AVM & fibroids
Total Abn Hysterectomy
(definitive therapy)
works 100% of time = infertile