O+G
UTERINE BLEEDING
PromptDifferential uterine bleeding
ResponseReproductive age
Pregnancy
Cervical cancer - lesion seen on spec
Trauma - history of trauma, laceration on examination
Lesions - Endometrial cancer, fibroids, polyps - ultrasound showing endometrial mass, bulky uterus on bimanual)
Coagulopathy - known coagulopathy, meds, abnormal coags
Hypothyroidism - Abnormal TFT’s
Infection - PID (STI) - cervical motion tenderness, purulent discharge, recent instrumentation
Postmenopausal
Lesions - Endometrial cancer, fibroids, polyps - ultrasound showing endometrial mass, bulky uterus on bimanual)
Medications - anticoagulation, exogenous hormone use
Atrophic vaginitis
Trauma - SA, post coital, FB
DUB - absence of any other cause, age, perimenopausal
Pregnancy
Cervical cancer - lesion seen on spec
Trauma - history of trauma, laceration on examination
Lesions - Endometrial cancer, fibroids, polyps - ultrasound showing endometrial mass, bulky uterus on bimanual)
Coagulopathy - known coagulopathy, meds, abnormal coags
Hypothyroidism - Abnormal TFT’s
Infection - PID (STI) - cervical motion tenderness, purulent discharge, recent instrumentation
Postmenopausal
Lesions - Endometrial cancer, fibroids, polyps - ultrasound showing endometrial mass, bulky uterus on bimanual)
Medications - anticoagulation, exogenous hormone use
Atrophic vaginitis
Trauma - SA, post coital, FB
DUB - absence of any other cause, age, perimenopausal
PromptImportant questions in PV bleeding
ResponseQuantity + duration (pads) - degree of bleeding/concern
Pregnancy status ? miscarriage/ectopic
History of menstrual problems/cycles - ? theraputic options
Anticoagulation disorders/meds - ?specific therapy required
Associated symptoms (Eg: syncope) ? needs inpatient management
Shoulder tip pain ? ectopic
Others
Pregnancy status ? miscarriage/ectopic
History of menstrual problems/cycles - ? theraputic options
Anticoagulation disorders/meds - ?specific therapy required
Associated symptoms (Eg: syncope) ? needs inpatient management
Shoulder tip pain ? ectopic
Others
PromptExamination in uterine bleeding
ResponseAbdo examination - ? ectopi - lateralising pain or peritonism
Vital signs - Tachy/hypotensive suggests needs active mgmt
Posturap BP - marker for hypovolaemia needs treatment
Spec - ? trauma, ? cervical lesion/mass, ? Products in cervics
Thyroid exam - ? Cause
Vital signs - Tachy/hypotensive suggests needs active mgmt
Posturap BP - marker for hypovolaemia needs treatment
Spec - ? trauma, ? cervical lesion/mass, ? Products in cervics
Thyroid exam - ? Cause
PromptPharmacologic management of DUB
ResponseTXA 500-1000 mg TDS
NSAID’s - Ibuprofen 400 mg TDS (Mefanamic acid)
Norethisterone 5mg TDS
NSAID’s - Ibuprofen 400 mg TDS (Mefanamic acid)
Norethisterone 5mg TDS