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8.02 Vaginal Bleeding


Presentation

A menstruating woman complains of greater than usual bleeding, which is either off her usual schedule (metrorrhagia), lasts longer than a typical period, or is heavier than usual (menorrhagia) perhaps with crampy pains and passage of clots.

What to do:

What not to do:

Discussion

The essential steps in the emergency evaluation of vaginal bleeding are fluid resuscitation of shock, if present, and recognition of pregnancy and its complications of spontaneous abortion or ectopic pregnancy. Treatment of more chronic and less severe dysfunctional uterine bleeding usually consists of iron replacement and optional use of oral contraceptives to decrease menstrual irregularity (metrorrhagia) and volume (menorrhagia). Bed rest has not been shown to improve the outcome for a threatened abortion, but is still usually part of the regimen. Medroxyprogesterone (Provera) 10mg po x10d can also be given to stop dysfunctional uterine bleeding, but warn the patient to expect a heavy bleed when it is stopped.

References


Table of Contents
from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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