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Vaginal Bleeding, Emergency Medicine

Carla C. Valentine Reviewed 06/2017



  • 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 bleedin...


Signs and Symptoms


  • Light headedness

  • Fatigue

  • Weakness

  • Thirst

  • Duration of bleeding

  • Quantity:

    • Average tampon holds ∼5 mL

    • Average pad holds ∼5–15 mL

  • Last menstrual period

  • Home pregnancy tests

  • Prior ...



  • Establish IV 0.9% NS with 1–2 L fluid bolus for significant bleeding or hypotension

  • Administer high-flow oxygen in pregnant or unstable patients

  • In later pregnancy:

    • Place patient in...



Admission Criteria

  • Ectopic pregnancy not meeting methotrexate discharge criteria

  • Uterine inversion

  • Septic abortion

  • Placental abruption

  • Postpartum hemorrhage

  • Endometritis

  • Unstable DUB

  • Newl...

Pearls and Pitfalls

  • Pregnancy test for all women of reproductive age

  • If there is 1st-trimester vaginal bleeding, evaluate for ectopic pregnancy

Additional Reading

  • Casablanca  Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am.  2008;35:219–234.

  • McWilliams  GD, Hill  MJ, Dietrich  CS 3rd. Gynecologic emergencies....



  • 623.8 Other specified noninflammatory disorders of vagina

  • 640.90 Unspecified hemorrhage in early pregnancy, unspecified as to episode of care or not applicable

  • 641.80 Other antepartum hemorrha...

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