Non-Pregnant Vaginal Bleeding
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 14 May 2017
⏱️ 10 minutes
🧾️ Download transcript
Summary
Common Causes
* Structural* Cancer* Post-menopausal bleeding is cancer until proven otherwise* Fibroids* Adenomyosis* Polyps* Coagulopathy* Present in approximately 20% of non-pregnant vaginal bleeding* Most common = Von Willebrand Disease* Hormonal causes* Dysfunctional uterine bleeding
Basic Approach to Non-Pregnant Vaginal Bleeding
* Step 1: Pelvic exam* The utility of this is debated* It is best to sound thorough on your clerkship* Have a chaperone present and document this (include the chaperones name)* Step 2: Obtain Labs* CBC* Anemia?* Thrombocytopenia?* Coags* aPTT is prolonged in 50% of patients with Von Willebrand Disease!* Thyroid (TSH)* Can be obtained outpatient* Common cause of hormonal related vaginal bleeding* Step 3: Pelvic ultrasound* Evaluates for ANATOMIC causes of vaginal bleeding* Step 4: NSAIDS* This treats both abdominal pain/cramping* Also improves bleeding* Step 5: Oral contraceptive pills* Can be started on an outpatient basis* Useful in patients with hormonal/dysfunctional uterine bleeding* Stabilizes endometrial lining
Additional Reading
* NBME Shelf Review: OBGYN (EM Clerkship)* Non-Pregnant Vaginal Bleeding (WikiEM)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson and thank you for downloading this week's |
| 0:06.6 | episode of the EM Clerkship Podcast. This week we are talking about vaginal bleeding again. And the |
| 0:17.0 | most important thing to remember about these cases is the pregnancy test. |
| 0:21.8 | The point of care pregnancy test in females of reproductive age is one of the big three stat tests in all of emergency medicine. |
| 0:30.1 | The other two being EKGs and finger stick blood glucose. |
| 0:33.7 | You always need a pregnancy test. |
| 0:38.3 | Now let's say this time that a woman comes in with vaginal bleeding, and it turns out she is not pregnant. |
| 0:47.1 | If the patient is unstable, they need blood, they need OB, and resuscitation, that's easy. |
| 0:52.8 | But what if she's stable? These ones are a little bit trickier. |
| 0:57.2 | How do you manage those? Well, the first thing you need to understand is the cause of the bleeding. |
| 1:05.3 | And there are three big categories that you need to know. The first one is structural and the main can't miss diagnosis |
| 1:13.1 | here is malignancy. Postmenopausal vaginal bleeding needs to be evaluated for malignancy. |
| 1:20.4 | There are other structural causes too like fibroids, polyps, adenomyosis, all incredibly common. But again, postmenopausal vaginal bleeding, |
| 1:31.6 | the life threat is malignancy. The second category is coagulopathy. This is a huge category. |
| 1:38.4 | This is about 20% of your patients actually who come in with non-pregnant vaginal bleeding. |
| 1:44.0 | They have a coagulopathy. |
| 1:46.2 | And then the last category here is hormonal issues. |
| 1:49.6 | This is called dysfunctional uterine bleeding and ovulatory bleeding. |
| 1:54.1 | Thyroid kind of can affect this too, but hormonal issues is your third big category. |
| 1:58.7 | So those are the three. |
| 2:00.0 | Structural, especially malignancy |
| 2:02.5 | and postmenopausal females, coagulopathy, and hormonal issues. Now, let's go through our approach. |
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