Vaginal bleeding (main)

Differential Diagnosis

Nonpregnant Vaginal Bleeding

Systemic Causes

• Cirrhosis
• Coagulopathy (Von Willebrand disease, ITP)
• Group A strep vaginitis (prepubertal girls)
• Hormone replacement therapy
• Anticoagulants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Hypothyroidism
• Polycystic Ovary Syndrome
• Secondary anovulation

Reproductive Tract Causes

• Adenomyosis
• Atrophic endometrium
• Dysfunctional uterine bleeding
• Endometriosis
• Leiomyoma (Fibroid)
• Foreign Body
• Infection (vaginitis, PID)
• IUD
• Neoplasia (especially in women >45 years old or in younger women with other risk factors)
• Vaginal Trauma

Vaginal Bleeding in Pregnancy (<20wks)

• Ectopic pregnancy
• Subchorionic hematoma
• First Trimester Abortion
  • Complete Abortion
  • Incomplete Abortion
  • Inevitable Abortion
  • Missed Abortion
  • Septic abortion
  • Threatened Abortion
• Gestational trophoblastic disease
  • Consider when pregnancy-induced hypertension is seen before 24 wks of gestation
• Heterotopic pregnancy
• Implantation bleeding
• Molar pregnancy
• Non-pregnancy related bleeding
  • Cervicitis
  • Fibroids
  • Implantation bleeding

Vaginal Bleeding in Pregnancy (>20wks)

• Emergent delivery
• Placental abruption
• Placenta previa
• Vasa previa
• Uterine rupture
• Preterm labor
• Vaginal trauma
• Placenta accreta
• Intrauterine fetal demise

Workup

See individual notes:

• Vaginal Bleeding (Non-Pregnant)
• Vaginal Bleeding Pregnant (less than 20wks)
  • First Trimester Abortion
• Vaginal Bleeding Pregnant (greater than 20wks)
• Post-Partum Hemorrhage

See Also

• Rho(D) Immune Globulin (RhoGAM)