Vaginal bleeding (main): Difference between revisions

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==Background==
==Background==
*Undifferentiated vaginal bleeding is normally approached by rapidly determining pregnancy status and, if pregnant, estimated gestation age
*Subsequent workup is then performed based on these factors
{{Vaginal bleeding definitions}}
==Clinical Features==
*Vaginal bleeding


==Differential Diagnosis==
==Differential Diagnosis==
{{VB DDX nonpregnant}}
{{DDX undifferentiated VB}}
 
{{VB DDX less than 20}}


{{VB DDX greater than 20}}
==Evaluation==
===Workup===
*Pregnancy test (urine or serum)
*Hemoglobin (CBC or POC)
*Consider type & screen


===[[Postpartum hemorrhage]]===
===Diagnosis===
{{PALM-COEIN Classification}}


==Workup==
==Management==
'''See individual notes:'''
'''See individual pages:'''
*[[Vaginal Bleeding (Non-Pregnant)]]
*[[Vaginal Bleeding (Non-Pregnant)]]
*[[Vaginal Bleeding Pregnant (less than 20wks)]]
*[[Vaginal Bleeding Pregnant (less than 20wks)]]
**[[First Trimester Abortion]]
*[[Vaginal Bleeding Pregnant (greater than 20wks)]]
*[[Vaginal Bleeding Pregnant (greater than 20wks)]]
*[[Post-Partum Hemorrhage]]
*[[Post-Partum Hemorrhage]]
*[[Vaginal bleeding (peds)]]
==Disposition==
*See individual diagnoses


==See Also==
==See Also==
*[[Rho(D) Immune Globulin (RhoGAM)]]
{{DDX undifferentiated VB}}
 
==External Links==
 
==References==
<references/>


[[Category:OB/GYN]]
[[Category:OBGYN]]

Latest revision as of 19:00, 12 January 2021

Background

  • Undifferentiated vaginal bleeding is normally approached by rapidly determining pregnancy status and, if pregnant, estimated gestation age
  • Subsequent workup is then performed based on these factors

Vaginal bleeding definitions

  • Menorrhagia: >7 day (prolonged) or >80 mL/day (excessive) uterine bleeding at regular intervals
  • Metrorrhagia: irregular vaginal bleeding outside the normal cycle
  • Menometrorrhagia: excessive irregular vaginal bleeding
  • Intermenstrual bleeding: variable amounts between regular menstrual periods
  • Midcycle spotting: spotting just before ovulation (due to decline in estrogen)
  • Polymenorrhea: frequent and light bleeding
  • Postcoital bleeding: vaginal bleeding after intercourse, suggesting cervical pathology
  • Postmenopausal bleeding: recurrence of bleeding >6 mo after menopause
  • Amenorrhea: bleeding that is absent for > 6 months

Clinical Features

  • Vaginal bleeding

Differential Diagnosis

Vaginal bleeding (main)

Evaluation

Workup

  • Pregnancy test (urine or serum)
  • Hemoglobin (CBC or POC)
  • Consider type & screen

Diagnosis

PALM-COEIN Classification of Vaginal Bleeding[1]

  • PALM: structural causes
    • Polyp (AUB-P)
    • Adenomyosis (AUB-A)
    • Leiomyoma (AUB-L)
    • Malignancy and hyperplasia (AUB-M)
  • COEIN: nonstructural causes
    • Coagulopathy (AUB-C)
    • Ovulatory dysfunction (AUB-O)
    • Endometrial (AUB-E)
    • Iatrogenic (AUB-I)
    • Not yet classified (AUB-N)

Management

See individual pages:

Disposition

  • See individual diagnoses

See Also

Vaginal bleeding (main)

External Links

References

  1. The International Federation of Gynecology and Obstetrics