Abnormal vaginal bleeding Flashcards Preview

Obstetrics and Gynaecology > Abnormal vaginal bleeding > Flashcards

Flashcards in Abnormal vaginal bleeding Deck (13):
1

Define: menorrhagia, polymenorrhagia, metorrhagia, premenarchia, postmenopausal

Menorrhagia: menstrual blood loss of >80 mL per cycle

Polymenorrhoea: menstruation more frequent than every 3 weeks

Metrorrhagia: abnormal uterine bleeding between menstrual periods

Premenarchal bleeding: vaginal bleeding that occurs before a girl is 9 years old

Postmenopausal bleeding: vaginal bleeding that occurs >12 months after menopause has been established.

2

Incidence

25%

3

Common differential

Cervical cancer
Cervical polyp
Ectropion

Thyroid
PCOS

Endometrial polyp
Fibroid
Endometritis

DUB
Menorrhagia

Miscarriage

4

Other uncommon

EndoM/ovarian/vaginal Ca
Cushing
+Prolactin
Renal/hepatic failure
VWD
GTD
Ectopic
Cervicitis
Vaginitis
Anticoagulant
Contraceptive related

5

History

Questions may include:
When did symptoms start and how long do they last?

Does the patient think the bleeding is excessive and is it interfering with normal life?

Are there any associated symptoms such as pain, fatigue, dyspnoea on exertion, or unexplained weight loss?

Is there intermenstrual or postcoital bleeding?

What is the possibility of the patient having an STD?

Could she be pregnant? If she is pregnant, does she have any pain associated with the bleeding

Does the patient use contraceptives; if so, which ones and for how long?

What is the result of the last smear test (if she has ever had one)?

Is there a known history of uterine pathology such as leiomyomas (fibroids), endometrial polyps, and adenomyosis (endometrial glandular growth into the myometrium)?

Is the patient taking any medication, such as anticoagulants, corticosteroids, HRT, or herbal supplements?

Does the patient bruise easily, is minor wound bleeding prolonged, and is there a family history of coagulation disorders?

Dysuria, frequency, hematuria?
Hemorrhoids, fissue?

6

Physical examination

General:
-Anemia
-Hypothyroidism
-PCOS
-Acanthosis nigricans
-Liver disease stigmata

Genital- inspection
Speculum
Bimanual

7

Investigations

Serum or urine pregnancy
bHCG
Maternal Rh/antibodies-may require anti-D
FBC- anemia, malignancy
Blood iron
TSH, prolactin, Testosterone/Progesterone/LH, liver- if indicated
PT/PTT
VWD

?Colposcopy, ?Hysteroscopy
TVUS/TAUS
Papsmear

8

When is TVUS useful and TAUS

TVUS->ectopic/miscarriage
TAUS->uterine fibroids

9

Endometrial thickness warranting endometrial biopsy

>15mm

10

When is hysteroscopy warranted

Endometrial cavity pathology suspected

11

Red flags

Cervical cancer
Miscarriage
PID
Endometritis
Endometrial Ca
Ovarian Ca
Vaginal cancer
Acute leukemia
Lymphoma
Ectopic
GTD
Placental abruption, placenta praevia
Endometrial hyperplasia

12

Medical management for non-pregnancy, repro age women, hemodynamically stable, need urgent control of bleeding

High dose estrogen->acute
Medroxyprogesterone->less acute
OCPs
LNG-IUS
GnRH agonist->Leuprolide depot->in prep for surgery
Tranexamic acid
NSAID- mefenamic acid

13

Surgical management for non-pregnancy, repro age women, hemodynamically stable, need urgent control of bleeding

D&C->can provide tissue for pathology
Myomectomy
Endometrial ablation
UAE