Abnormal uterine bleeding
One of the most common disease in gynae ward
Definition
- infrequent episode of bleeding(oligomenorrhea)
- prolong duration of menses (longer than 7 days)
- excessive flow of menses (soaking>1 every 1-2hr, passing blood clot>50cents, soak pads for >2-3hrs in a row)
- coital bleeding
- intermenstrual bleeding
Risk factor:
Palm coin mneumonic
Mx:
- make sure you asked the menstrual history throughly, it would aid in differential diagnosis and approach.
- age
- cycle length
- duration of bleeding
- flow: heavy, medium, light
- any contraceptive use?
- when is the last mentrual date (LMP)
- any dysmenorrhea
- any abortion done before/ miscarriage/ last SI(sexual intercourse)
- hx of anemia/
- any family hx of cancer/ social hx/ past medical hx
1. v/s
- BP (low?),
- PR(tachy?)
- temperature
- SPO2
- physical examination: pallor? bruising?
2. Set up
- call for help
- 2 large bore IV branulla
- GXM 2pint standby
- send FBC, coag,
- O2 supply
- pelvic ultrasound
3. ensure hemodynamicallly stable
- IVD run fast (hartman+NS)
- T. tranxenamic acid
- IV tranxenamic acid
- if its retained products of conception: attempt to remove if possible (D+C), if unable, arrange for ERPOC
- pregnancy test if possible.
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