Vaginal Bleeding
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Basics
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
PREGNANT PATIENTS- Early pregnancy:
- Ectopic pregnancy:
- Occurs in 2% of pregnancies
- Abortion:
- Threatened, incomplete, complete, missed, inevitable, septic
- Molar pregnancy
- Trauma
- Ectopic pregnancy:
- 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
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
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
PREGNANT PATIENTS- Early pregnancy:
- Ectopic pregnancy:
- Occurs in 2% of pregnancies
- Abortion:
- Threatened, incomplete, complete, missed, inevitable, septic
- Molar pregnancy
- Trauma
- Ectopic pregnancy:
- 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
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