Eui Young Son Department of Emergency Medicine Bundang Jesaeng General Hospital Introduction Abscess Vaginal Bleeding One of the m ost frequent chief complaints of women presenting for EM care ID: 781191
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Slide1
Ch 27. Vaginal
Bleeding
Eui-Young SonDepartment of Emergency Medicine, Bundang Jesaeng General Hospital
Slide2Introduction
Abscess
Vaginal BleedingOne of the most frequent chief complaints of women presenting for EM careNormal : 12.5 ~ 51 years cycle – 28 ± 7 days Average volume – 60mL
Typically,
premenarchal
or postmenopausal vaginal bleeding is rarely life-threatening
BUT, bleeding as a complication of pregnancy
increased risk of morbidity and mortality for mother and fetus
Slide3Definitions of Vaginal Bleeding
Table 27-1
Slide4Epidemiology
Abscess
5% of women aged 30 ~ 45 years20% of all pregnant patients have vaginal bleeding before 20th week more than 50% spontaneously abortEctopic pregnancy자궁외
임신 중
50~80%
가
vaginal bleeding
을 경험
m/c cause of maternal death in the 1
st
trimester of pregnancy
After 20
th
week
30% - Placental abruption
20% - Placenta
previa
Post-partum
first 24 hours – Uterine
atony
after 24 hours – Placenta retention
Slide5Causes of Vaginal Bleeding by Age
Table 27-2
Slide6Diagnostic approach
Fig. 27-1
Slide7Fig. 27-1
Slide8Diagnostic Approach
Fig. 27-2
Slide9Fig. 27-2
Slide10Symptoms & Signs
Abscess
Volume, duration, timing of bleeding tampon or pad : average 20 ~ 30 mLBleeding during or after intercourse Cervical lesion or in pregnancyVaginal bleeding in an adolescentTrauma historySexual assault
Associated Symptoms of
Nausea, breast tenderness, urinary frequency, fatigue
Pregnancy
Vaginal discharge, pelvic pain, fever Pelvic inflammatory disease
Pelvic Examination
May reveal source of bleeding
20
주
이후에는
US
먼저 하기를 권장
(placenta
previa
시
rupture
위험
)
Slide11Empirical Management
Abscess
Pregnant PatientsIf ectopic pregnancy is suspected β-hCG(+), hemodynamically unstable Surgical consultation is required
Vaginal bleeding after 20
th
week of pregnancy
Transabdominal
US
로
Placenta evaluation
이 먼저
Bimanual exam, speculum, TV-US
should not be undertaken until
placenta
previa
is excluded.
3
rd
trimester vaginal bleeding Management – Vaginal delivery is preferred.
But cesarean section is indicated if
(1) fetal distress
(2) severe abruption with a viable fetus
(3) life-threatening hemorrhage
exists
(4) the patient has failed a trial of labor
Slide12Empirical Management
Abscess
Nonpregnant PatientsIn nonpregnant patients with heavy vaginal bleeding, NSAIDs are the mainstay of treatment although exact mechanism is not clearly understood.With
hemodynamically
unstable
IV conjugated estrogen (
Premarin
) 25mg within 1~5 hours
If bleeding continues insert a pediatric
Foley catheter
into the cervical
os
and
inflate
to stop the bleeding, and 24 hours waiting.
With stable patients, close OPD f/u is needed
Oral contraceptives
Outpatient ultrasound
Endometrial Biopsy (35
↑
years)
Slide13Disposition
Abscess
Post-partum uterine atony or coagulopathy medical management is sufficientIn a preadolescent patient Abuse must be ruled out before the patient is d/c
Nonpregnant
, stable patients
Malignancy
always should be suspected, and additional gynecologic w/u is required.
Lab study such as
thyroid function,
prolactin
levels
may be helpful
But they are not required in the emergency department setting.