Tuesday, January 19, 2021

Non-Pregnant Vaginal Bleeding

emDocs - January 18, 2021 - By Emily Guy, Julie T. Vieth
Reviewed by: Marina Boushra; Alex Koyfman; Brit Long
  • Initial evaluation should assess for hypovolemia and hemodynamic instability. If the patient is unstable, follow the tried-and-true tenants: large bore IVs, monitors, resuscitation with blood products.
  • Perform a focused gynecologic history and physical examination, including a chaperoned pelvic examination, to assess for the underlying cause of heavy vaginal bleeding.
  • Initial treatment should focus on medical management:
    • Massive bleeding: conjugated estrogen 25mg IV +/- TXA 1300mg PO or 10mg/kg IV
    • Stable bleeding: OCPs, progestin-only pills, NSAIDs, oral TXA
  • The need for surgical treatment depends on the patient’s stability, severity of bleeding, response to medical management, or contraindication to medical management.
    • Consult gynecology early in patients with severe bleeding.
    • Attempt tamponade with a 26F foley inflated with 30ml saline.
  • May pack the vagina with betadine-soaked gauze as a temporizing measure. Close follow-up with gynecology is recommended even for stable patients."