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Flashcards in OB/GYN Emergencies Deck (10):
1

Approach to Vaginal Bleeding in a Hemodynamically Stable Patient

Determine if patient is pregnant
Determine the amount and length of time of vaginal bleeding
Do a complete pelvis unless suspicious of placenta previa

2

Important History with Vaginal Bleeding

Assess amount of bleeding: # pads/tampons used and any clots
Pattern of periods: regularity, late/missed
Sexual history: # partners, condoms/assess risk
Pain: where, quality, radiation

3

Physical Exam with Vaginal Bleeding

Vitals
Mucosal hemorrhage, petechia
Signs of PCOS
Abdominal exam
Pelvic exam: source of bleeding, signs of trauma, cervical motion tenderness, uterine size, contour, masses, and tenderness

4

Tests for Vaginal Bleeding

Qualitative and quantitative hCG tests
CBC
Type and cross if significant bleeding
Type and screen if not needed immediately
Coag tests if coagulopathy suspected
STIs tests if suspected infection

5

Differential Diagnosis of the Prepubertal Patient

Vulvovaginitis
Foreign body
Trauma
Urethral prolapse
Sexual abuse
Hormone secreting tumor

6

Presentation of Vulvovaginitis

Bloody vaginal discharge
Pruritis

7

Presentation of Foreign Body in the Vagina

Bloody vaginal discharge
Foul smelling

8

Presentation of Sexual Abuse

Blood from sexual trauma
Bruising
C/O pain
Approach carefully

9

Differential Diagnosis of the Premenopausal Non-pregnant Patient

Ruptured ovarian cyst
Ovarian torsion
PID
Dysfunctional uterine bleeding
Uterine leiomyoma
Uterine polyp
Genital trauma secondary to sexual abuse

10

Differential Diagnosis of the Peri-/Post-Menopausal Patient

Endometrial cancer
Anti-coagulant medication
Hormonal therapy
Other medications
Coagulopathy