Vaginal bleeding: Difference between revisions

Revision as of 15:26, 8 February 2017

Template:DiseaseDisorder infobox Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Vaginal bleeding refers to bleeding in females that are either a physiologic response during the non-conceptional menstrual cycle or caused by hormonal or organic problems of the reproductive system. Vaginal bleeding may occur at any age, but always needs investigation when encountered in female children or postmenopausal women. Vaginal bleeding during pregnancy may indicate a possible pregnancy complication that needs to be medically addressed.

Anatomy

Blood loss per vaginam (Latin: from the vagina) typically arises from the lining of the uterus (endometrium), but may arise from uterine or cervical lesions, the vagina, and rarely from the Fallopian tube. During pregnancy it is usually but not always related to the pregnancy itself. Rarely, the blood may actually arise from the urinary tract (hematuria), although the vast majority of women can identify the difference. It can also be a sign of vaginal cancer.

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular	Hereditary hemorrhagic telangiectasia , Placenta vein rupture
Chemical/Poisoning	Medroxyprogesterone acetate, Ulipristal
Dental	No underlying causes
Dermatologic	Actinomycosis
Drug Side Effect	Clomiphene, Dicoumarol, Dienogest, Estradiol valerate , Ganirelix, Hormonal contraception, Mifepristone, Misoprostol, Oral contraception, Phenprocoumon, Progestagens, Spironolactone, Tamoxifen, Tiagabine, Trimethadione, Warfarin
Ear Nose Throat	No underlying causes
Endocrine	Anovulation, Autoimmune thyroid diseases , Decreased menses , Exogenous hormonal preparations, Graves disease , Hormonal contraception, Hormonal disorder, Hormonal imbalance, Hyperoestrogenic states, Hyperthyroidism, Hypothyroidism, Low estrogen levels, Neuroendocrine carcinoma of the cervix , Precocious puberty, Primary cortisol resistance , Thyroid disorders
Environmental	Smoking , Tampon
Gastroenterologic	Abdominal cancer , Peritoneum cancer , Peritoneum disorders
Genetic	Von willebrand disease, Y chromosome pericentric inversion
Hematologic	Anemia, Ante-partum hemorrhage, Autoimmune thrombocytopenia , Bleeding tendency, Blood clotting disorders, Clotting disorder, Dysfunctional uterine bleeding, Hereditary hemorrhagic telangiectasia , Thinning vaginal lining, Thrombocytopenia , Thrombocytopenic purpura, Tubal ligation syndrome , Von willebrand disease
Iatrogenic	No underlying causes
Infectious Disease	Actinomycosis , Bladder infection, Cervix infection, Chlamydia, Endometrial infection, Endometriosis , Endometritis, Lichen sclerosis , Ovary infection, Puerperal fever , Sexually transmitted diseases, Uterine infection, Uterine polyps, Vaginal infection, Vaginitis
Musculoskeletal/Orthopedic	Cervical cancer, Cervical dysplasia, Pelvic cancer , Uterine atony
Neurologic	No underlying causes
Nutritional/Metabolic	Vitamin a embryopathy
Obstetric/Gynecologic	Abortion, Abruptio placentae , Adenomyosis, Amniocentesis, Anovulation, Ante-partum hemorrhage, Asherman syndrome , Cervical ectropion, Cervical polyps, Cervical smear, Cervicitis , Cervix cancer, Cervix disorder, Cervix infection, Choriocarcinoma , Chorionic villus sampling, Contraceptive implants, Decreased menses , Dysfunctional uterine bleeding, Ectopic pregnancy, Endometrial cancer, Endometrial hyperplasia, Endometrial infection, Endometrial stromal sarcoma , Endometriosis , Endometritis, Endometrium atrophy, Estrogen withdrawal, Fallopian tube cancer , Fibroids, Fibromyoma, Foreign body, Genital tract tumors, Glassy cell carcinoma of the cervix , Hydatidiform mole , Iucd, Malignant mixed mullerian tumor , Menopause , Menstruation, Miscarriage, Mittelschmerz , Oral contraception, Ovarian cancer , Ovarian cyst, Ovary infection, Pelvic inflammatory disease , Perimenopause , Placenta previa , Placenta vein rupture, Placental abruption, Placental hypertrophy, Polycystic ovary syndrome, Precocious puberty, Pregnancy complications , Pregnancy, Premature menarche, Primary dysmenorrhoea, Primary fallopian tube cancer, Primary malignant melanoma of the cervix , Progestagens, Puerperal fever , Sarcoma botryoides , Secondary fallopian tube cancer , Spontaneous abortion, Thinning vaginal lining, Threatened miscarriage, Tubal ligation syndrome , Urethral caruncle, Urethral prolapse, Uterine atony, Uterine cancer , Uterine disorder, Uterine fibroids, Uterine growths, Uterine infection, Uterine polyps, Uterine sarcoma , Vaginal cancer, Vaginal foreign body, Vaginal infection, Vaginal injury, Vaginitis, Vitamin a embryopathy , Vulva disorder, Vulva injury, Vulval squamous cell carcinoma, Vulvovaginitis
Oncologic	Abdominal cancer , Adenocarcinoma, Cervical cancer, Cervix cancer, Choriocarcinoma , Endometrial cancer, Endometrial stromal sarcoma , Fallopian tube cancer , Fibroids, Fibromyoma, Genital tract tumors, Glassy cell carcinoma of the cervix , Malignant mixed mullerian tumor , Myoma , Neuroendocrine carcinoma of the cervix , Ovarian cancer , Pelvic cancer , Peritoneum cancer , Primary fallopian tube cancer, Primary malignant melanoma of the cervix , Sarcoma botryoides , Secondary fallopian tube cancer , Trophoblastic cancer , Tumors, Uterine growths, Uterine sarcoma , Vaginal cancer, Vulval squamous cell carcinoma
Ophthalmologic	No underlying causes
Overdose/Toxicity	Amphetamine abuse , Smoking
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Bladder bleeding, Bladder infection
Rheumatology/Immunology/Allergy	Condyloma acuminate, Granuloma inguinale , Graves disease , Uterine fibroids
Sexual	Chlamydia, Condyloma acuminate, Gonorrhea , Granuloma inguinale , Molestation , Sexual intercourse, Sexually transmitted diseases
Trauma	Abortion, Miscarriage, Molestation , Trauma, Urethral prolapse, Vaginal injury, Vulva injury
Urologic	Urethral caruncle
Miscellaneous	No underlying causes

Causes in Alphabetical Order

3

Investigation

The diagnosis can often be made on the basis of the bleeding history, physical examination, and other medical tests as appropriate. Typically a pregnancy test and additional hormonal tests, a Pap smear, a transvaginal ultrasound are needed. If bleeding was excessive or prolonged, a CBC may be useful to check for anemia. Abnormal endometrium may have to be investigated by a hysteroscopy with a biopsy or a dilation and curettage.

Differential Diagnosis

In alphabetical order. ^[1] ^[2]

Abortion
Adherent placental residue
Adnexitis
Adrenal disease
Atonic secondary bleeding
Carcinoma
Cervical Cancer
Cervical ectopia
Cervical erosion
Cervical neoplasms
Cervical polyp
Cervicitis
Chorionepithelioma
Colpitis Senilis
Corpus luteum deficiency syndrome
Ectopic Pregnancy
Endometrial polyps
Endometriosis
Endometritis
Estrogen-progestogen therapy
Estrogen breakthrough bleeding
Fibrinogen deficiency
Follicle persistence
Granulosa cell tumor
Hydatidiform mole
Hypothalamic or pituitary lesion
Inadequate corpus luteum
Injuries
Intrauterine device (IUD)
Lacerated placenta
Midcycle ovulatory bleeding
Myoma
Neoplasms
Placenta Previa
Postcoital hemorrhage
Premature placental abruption
Prolapsed uterus
Rupture hemorrhage
Ruptured uterus
Stress/psychogenic factors
Thyroid disease
Trauma
Uterine adenomytosis
Uterine leiomyomas
Vaginal Cancer
Vaginal infections
Vaginal varices
Varicosis of the vagina
Velamentous insertion
Vulvar Cancer

Treatment

The treatment will be directed at the cause. Hormonal bleeding problems during the reproductive years, if bothersome to the woman, are frequently managed by use of combined oral contraceptive pills.

Contraindicated medications

Vaginal Bleeding is considered an absolute contraindication to the use of the following medications:

Hydroxyprogesterone caproate, Dinoprostone

Complications

A possible complication from protracted vaginal blood loss is iron deficiency anemia, which can develop insidiously. Eliminating the cause will resolve the anemia, although some women require iron supplements or blood transfusions to improve the anemia.

References

↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

Template:WikiDoc Sources

[1] Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

[2] Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

[1]

[2]

v t e Symptoms and signs: circulatory (R00–R03, 785)
Cardiovascular	Template:Navbox subgroup
Myeloid/blood	Template:Navbox subgroup

v t e Symptoms and signs: respiratory system (R04–R07, 786)
Hemorrhage	Epistaxis Hemoptysis
Abnormalities of breathing	Respiratory sounds Stridor Wheeze Crackles Rhonchi Hamman's sign Apnea Dyspnea Hyperventilation/Hypoventilation Hyperpnea/Tachypnea/Hypopnea/Bradypnea Orthopnea/Platypnea Trepopnea Biot's respiration Cheyne-Stokes respiration Kussmaul breathing Hiccup Mouth breathing/Snoring Breath-holding
Other	Asphyxia Cough Pleurisy Sputum Respiratory arrest Hypercapnia/Hypocapnia Pectoriloquy: Whispered pectoriloquy Egophony Bronchophony Pleural friction rub Fremitus Silhouette sign
Chest, general	Chest pain Precordial catch syndrome

v t e Symptoms and signs: digestive system and abdomen (R10–R19, 787,789)
GI tract	Template:Navbox subgroup
Accessory	Hepatosplenomegaly/Hepatomegaly Jaundice
Abdominopelvic	Ascites
Abdominal – general	Abdominal pain (Acute abdomen, Colic, Baby colic) Splenomegaly Abdominal guarding · Abdominal mass · Rebound tenderness Shifting dullness · Bulging flanks · Puddle sign · Fluid wave test

v t e Symptoms and signs: Symptoms concerning nutrition, metabolism and development (R62–R64, 783)
Ingestion/Weight	decrease: Anorexia • Weight loss/Cachexia/Underweight increase: Polyphagia • Polydipsia • Orexigenia • Weight gain
Growth	Delayed milestone • Failure to thrive • Short stature (e.g., Idiopathic)