Download Bleeding - Operational Medicine

Abnormal Bleeding
CAPT Mike Hughey, MC, USNR
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 1
Causes of Abnormal Bleeding
1. Pregnancy
2. Malignancy
3. Mechanical Problems
4. Hormonal Problems
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 2
Rule out Pregnancy
• Patients of childbearing
age with unexplained
abnormal bleeding should
have a pregnancy test
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 3
Rule out Malignancy
•
•
•
•
Invasive Cancer of the Cervix
Cervical cancer (Pap)
Vaginal cancer (Exam)
Ovarian cancer (Exam)
Uterine cancer
(Endometrial biopsy, but
under age 40, cancer
very rare)
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 4
Mechanical Problems
Polyps
Fibroids
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 5
Hormonal Problems
• Anovulation
• Ovulatory bleeding
• Delayed menses
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 6
Clinical Management: Evaluation
1. Pregnancy Test
2. CBC (anemia)
3. Recent negative Pap smear
4. Pelvic exam
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 7
Clinical Management: Treatment
BCPs
Bedrest
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 8
Clinical Management: MEDEVAC
If BCPs/Bedrest fail to resolve
the bleeding and it is heavy,
MEDEVAC is the next step.
Surgery (D&C, hysteroscopy,
etc.) will be needed.
This is best undertaken in other
than operational settings.
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 9
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 10