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...
Duration of bleeding
Average tampon holds ∼5 mL
Average pad holds ∼5–15 mL
Last menstrual period
Home pregnancy tests
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...
Ectopic pregnancy not meeting methotrexate discharge criteria
Pregnancy test for all women of reproductive age
If there is 1st-trimester vaginal bleeding, evaluate for ectopic pregnancy
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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