28 - vag bleeds Flashcards Preview

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Flashcards in 28 - vag bleeds Deck (21)
1

first step

ABCD
- make sure hemodynamically stable
- IV if not

2

2 general groups of vag bleeds

1. preg related
2. non-preg related
- non-uterine
- ovulatory
- anovulatory

3

3 def. of abnormal bleeds

cycle - 28+/-7 days
flow - 4+/- 2 days
blood 30+/- 20ml

4

7 life threatening causes of vag. bleeds

1. ectopic
2. placentae abruptia
3. placentae previa
4. urertine rupture
5. post-partum hemmorage
6. post-partum or procedue endometritis
7. trauma

5

7 origins of bleeds

- extra-uterine
- uterine
- cevix
- vag
- GU
- intra-abdo
- fistula

6

causes of bleeds in children

- can be normal for 6 weeks
- vagintis, precocious puberty, tumor, trauma
- most due to bike seats
- foreign bodies - bad smelling discharge
- need to exclude abuse

7

bleeds in young women

- assume pregnant
- ovulation 12.5 with 10 being lowe
- ask age of menarche
- contraception
- loss of flow due to loss of estrogen - ANA, excercise
- cause of mid cycle bleed usally pill

8

3 most common causes in post-menopausal

1. estrogens from food and remedies
2. atrophic changes
3. endometrial CA

9

Tx of AUBs

1. IV estrogen to stop bleeds
2. tranexamic acids to stop
3. NSAIDS
4. others refer to gyn

10

questions to ask in bleed in preg. patient

1. hemo stable?
2. febrile?
3. if cervix open can tissue be removed to help pain?
4. is it ectopic?
5. are there retained products?
6. bleeding disorder?
7. Rh status?
- give rhogam to and -ves
8. psych reaction?

11

what it do for inevitable and incomplete abortions

1. pain control
2. serial beta
3. misoprostol for

12

risks for ectopic

- IUD, PID, infert Tx, pevic surgeries

13

what to do for ectopics

- HCG - can be unreliable
- US to look for intraterine preg and adneal mass

14

mgmt of ectopic

- usually surgical
- now some people use methotrexate

15

contraindications to metho

- hemo instable
- impending rupture
- abnormalities at baseline
relative
- high baseline HCG
- fetal cardiac activity

16

3 causes of 3rd tri bleeds

1. abruptio
2. previa
3. rupture

17

def. abruptio

- premature separation
- often due to trauma
-

18

def. previa

- implantation over the os
- painless bleeding preceeded by trauma or intercourse
- NO PELVIC EXAM

19

def. rupture

high mortality
- often during delivery

20

6 causes of post-partum hemmoarge

1. uterine atony - oxytocin
2. rupture
3. laceration tears
4. retained tissue - US
5. uterine investion
6. coagulopath

21

instructions for those being discharged

- return if bleed or lightheaded
- clear fluids for those with surg
- follow up in 24 hours
- psych support