Vaginal Bleeding

Vaginal Bleeding is a topic covered in the 5-Minute Emergency Consult.

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  • 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


  • 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
  • Dysfunctional uterine bleeding (DUB)
  • 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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