Vaginal Bleeding

Description

• Common presenting complaint to EDs
• Most cases have benign etiology
• Some patients may have potentially life-threatening conditions
• Key principles in evaluating women with vaginal bleeding:
  • Any woman capable of childbearing might be pregnant
  • Menstrual and sexual histories do not rule out pregnancy

Etiology

• Early pregnancy:
  • Ectopic pregnancy:
    • Occurs in 2% of pregnancies
  • Abortion:
    • Threatened, incomplete, complete, missed, inevitable, septic
  • Molar pregnancy
  • Trauma
• Later pregnancy:
  • Placenta previa
  • Placental abruption
  • Molar pregnancy
  • Labor
  • Trauma
• Immediate postpartum period:
  • Postpartum hemorrhage
  • Uterine inversion
  • Retained placenta
  • Endometritis

• Abnormal uterine bleeding (formerly dysfunctional uterine bleeding)
• Structural abnormalities:
  • Uterine fibroids
  • Cervical/endometrial polyps
  • Pelvic tumors
• Atrophic endometrium:
  • Most common cause of postmenopausal bleeding
• Rare for systemic disorders to present solely with vaginal bleeding:
  • von Willebrand disease
  • Idiopathic thrombocytopenic purpura
• Trauma
• Foreign bodies
• Infections