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Batch Notes Gyne DDX of Vaginal Bleeding
Batch Notes Gyne DDX of Vaginal Bleeding
Ursua PQ1
Differential Diagnosis of Vaginal bleeding *differentiate pathologic from non normal (menstruation). Take consideration the AGE of the patient. *if the patient is in age of reproduction, check SEXUAL ACTIVITY *amount of bleeding - normal bleeding : 50 ml - spotting : ectopic pregnancy *fully soaked napkin : 30-40 ml Obstetric (pregnancy related causes) *the first diagnosis PREGNANCY FIRST HALF 1. ABORTION - The fetus is less than the age of the viability (20 weeks AOG) - Depending of type of abortion 2. ECTOPIC PREGANCY - (+) bleeding is due to the hormones which affects the endometrium. - The endometrium regresses as decidualization and secreted as decidual cast - The space in the fallopian tube is not enough, hence there is no enough stimulus to stimulate corpus luteum to produce HCG, decreasing the progesterone levelsm hence decidua will not attach which then result to vaginal bleeding 3. GESTATION TROPHOBLASTIC DISEASE - Hydatidiform mole (H-mole) will result into cancer - Classic manifestation : (+) pearls, sago like consistency along with bleeding 4. LOW LYING PLACENTA - *doc said due to placenta previa SECOND HALF 1. PLACENTA PREVIA - Normal: placenta is implanted at fundal region b. Outright bleeding - The placenta peripherally is detached Placenta precedes the uterus 2. ABRUPTIO PLACENTA - Ablatio Placentae - Premature separation of placenta that is NORMALLY IMPLANTED - Types: a. Concealed - The placenta is centrally detached causing HEMATOMA - (+) BOARD LIKE RIGIDITY - (+) SEVEREDIRECT BOUND TENDERNESS
3. VASA PREVIA - Normal: all vessels are enlarged - Crisscrossing of vessels - Ddx: intrauterine fetal death Dead fetus is perceived by the body as foreign, causing the uterus to contract resulting to dilatation of cervix, hence expulsion POST PARTUM FOUR TS 1. TONE - uterine atony (failure of the uterus to contract) 2. TISSUE a. Retained Placenta fragments Placenta accrete Mismanagement of placenta b. Unclotted round 3. TRAUMA a. Ruptured vagina Use of RITGENS MANEUVER to prevent forceful release of fetus 4. THROMBIN - Coagulation factor problems a. Aplastic anemia b. Hemophilia
Gynecologic causes 1. TUMORS (please educate patient that not all tumors are malignant.) a. Benign - Polyps - Fibroids : myoma o Well circumscribed o More bleeding at intracavity
Medical Causes 1. PLATELET DISORDERS - Dengue hemorrhagic fever 2. CLOTTING FACTOR ABNORMALITY Prepubertal Period 1. PHYSIOLOGIC - Withdrawal from exposure to estrogen - Vulvar o Vulvitis
b. Malignant - Cervical Ca : due to STDs which are highly preventable - Endometrial Ca - Fallopian tube Ca 2. INFECTION a. Endometritis b. Cervivitis 3. FOREIGN BODY - Recurrent bleeding especially in children o Toys o Coin o Lego parts o M&Ms o Wisp of cotton 4. HORMONAL ABNORMALITIES a. Endogenous : medications b. Exogenous - Breakthrough bleeding 2 Saint Louis University School of Medicine Batch 2015 Condylomata: Molloscum contagiosum: warts