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Vaginal bleeding

  • Common ddx

    • fibroids, PCOS, pregnancy-related, coagulopathy, anovulation/DUB
  • Serious ddx

    • ectopic pregnancy, endometrial cancer
  • Labs

    • pelvic exam
    • endometrial biopsy if postmenopausal
    • if previa on ddx then avoid digital exam.
    • CBC
    • type and cross if needed
    • hCG, pregnancy test if unknown
    • coags, factor levels if suspect coagulopathy
    • TVUS
  • Tx

    • IV fluids, transfusion if needed
    • For DUB: iron -> progestin -> estrogen
    • for uterine atony: uterine massage + oxytocin 20 units/L NS at 200 mL/h
    • OCPs for PCOS
  • Non-pregnancy ddx

    • adenomyosis, uterine polyp, endometrial hyperplasia, VWD, trauma, IUD spotting, exogenous estrogen
  • 1st-2nd trimester ddx

    • normal pregnancy, threatened abortion, spontaneous abortion
  • 3rd trimester ddx

    • placenta abruption, placenta previa, labor, uterine rupture
  • Postpartum ddx

    • uterine atony, vaginal laceration, retained products, uterine inversion, amniotic fluid embolism
  • Rare ddx

    • fetal vessel rupture, cervical ectropion, vasa previa
  • HPI

    • onset
    • triggering events
    • frequency, amount, anything in the blood
  • ROS

    • pain
    • LMP, pregnancy, gestational dates
    • easy bleeding/bruising
  • PMH, PSH, PGynH

  • FH

  • SH

  • Meds

  • Allergies

  • Px

    • vitals
    • abd: rebound, tenderness
    • pelvic exam
    • endometrial biopsy if postmenopausal
    • if previa on ddx then avoid digital exam.

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    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.