{"paper_id":"aacef39f-0115-414d-9a64-b8b53b7750fd","body_text":"Abstract\nVaginal bleeding is a common gynecologic issue, which may require medical and/or surgical intervention. This chapter reviews the differential diagnosis of vaginal bleeding, including trauma, postoperative complications, uterine structural abnormalities (such as fibroids, polyps, and adenomyosis), anovulation, primary menorrhagia, pregnancy-related and postpartum issues, and hematologic and oncologic causes. Emergent assessment, resuscitation, and management options are discussed.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nLevi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009;145:24–33.\nAmerican College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121:891–6.\nDellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.\nCommittee on Trauma. Advanced trauma life support 1 student manual. 8th ed. Chicago: American College of Surgeons; 2008.\nVincent JL, De Backer D. Circulatory shock. N Engl J Med. 2014;370:583.\nRose DK, Cohen MM, DeBoer DP. Cardiovascular events in the postanesthesia care unit: contribution of risk factors. Anesthesiology. 1996;84:772–81.\nGutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: hemorrhagic shock. Crit Care. 2004;8:373–81.\nKato I, Toniolo P, Akhmedkhanov A, Koenig KL, Shore R, Zeleniuch-Jacquotte A. Prospective study of factors influencing the onset of natural menopause. J Clin Epidemiol. 1998;51:1271–6.\nJames AH, Kouides PA, Abdul-Kadir R, Dietrich JE, Edlund M, Federici AB. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol. 2011;158:124–34.\nvan den Burg PJ, Hospers JE, van Vliet M, Mosterd WL, Bouma BN, Huisveld IA. Changes in haemostatic factors and activation products after exercise in healthy subjects with different ages. Thromb Haemost. 1995;74:1457–64.\nRiskin DJ, Tsai TC, Riskin L, Hernandez-Boussard T, Purtill M, Maggio PM, et al. Massive transfusion protocols: the role of aggressive resuscitation versus product ratio in mortality reduction. J Am Coll Surg. 2009;209:198–205.\nHolcomb JB, Wade CE, Michalek JE, Chisholm GB, Zarzabal LA, Schreiber MA, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008;248:447–58.\nHolcomb JB, Zarzabal LA, Michalek JE, Kozar RA, Spinella PC, Perkins JG, et al. Increased platelet: RBC ratios are associated with improved survival after massive transfusion. J Trauma. 2011;71:S318–28.\nErber WN, Perry DJ. Plasma and plasma products in the treatment of massive haemorrhage. Best Pract Res Clin Haematol. 2006;19:97–112.\nLevy JH, Szlam F, Tanaka KA, Sniecienski RM. Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding. Anesth Analg. 2012;114:261–74.\nVore GR, Owens O, Kase N. Use of intravenous Premarin in the treatment of dysfunctional uterine bleeding— a double-blind randomized control study. Obstet Gynecol. 1982;59:285–91.\nCenters for Disease Control and Prevention (CDC). U.S. medical eligibility criteria for contraceptive use, 2010. MMWR Recomm Rep. 2010;59:1–86.\nSingh S, Best C, Dunn S, Leyland N, Wolfman WL, Clinical Practice – Gynaecology Committee, et al. Abnormal uterine bleeding in pre-menopausal women. J Obstet Gynaecol Can. 2013;35:473–9.\nCRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23–32.\nHenry DA, Carless PA, Moxey AJ, O’Connell D, Stokes BJ, Fergusson DA et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2011;(3):CD001886.\nBradley LD, Gueye NA. The medical management of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol. 2016; 214: 31–44.\nSundström A, Seaman H, Kieler H, Alfredsson L. The risk of venous thromboembolism associated with the use of tranexamic acid and other drugs used to treat menorrhagia: a case-control study using the General Practice Research Database. BJOG. 2009;116:91–7.\nMunro MG, Mainor N, Basu R, Brisinger M, Barreda L. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Obstet Gynecol. 2006;108:924–9.\nAHFS Drug Information 2007. McEvoy GK, editors. Norethindrone, Norethindrone acetate. Bethesda: American Society of Health-System Pharmacists; 2007. p. 3235–7.\nDonnez J, Tomaszewski J, Vázquez F, Bouchard P, Lemieszczuk B, Baró F, et al. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med. 2012;366:421–32.\nMatsuo H. Prediction of the change in bone mineral density induced by gonadotropin-releasing hormone agonist treatment for endometriosis. Fertil Steril. 2004;81:149–53.\nTan YH, Lethaby A. Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013;(11):CD010241.\nSharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011;83:719–24.\nBhat R, Cabey W. Evaluation and management of congenital bleeding disorders. Emerg Med Clin North Am. 2014;32:673–90.\nMartin-Hirsch PL, Bryant A. Interventions for preventing blood loss during the treatment of cervical intraepithelial neoplasia. Cochrane Database Syst Rev. 2013;(12):CD001421.\nKauff ND, Chelmow D, Kawada CY. Intractable bleeding managed with Foley catheter tamponade after dilation and evacuation. Am J Obstet Gynecol. 1995;173:957–8.\nAshok PW, Templeton A, Wagaarachchi PT, Flett GM. Midtrimester medical termination of pregnancy: a review of 1002 consecutive cases. Contraception. 2004;69:51–8.\nSuarez RA, Grimes DA, Majmudar B, Benigno BB. Diagnostic endometrial aspiration with the Karman cannula. J Reprod Med. 1983;28:41–4.\nWen J, Cai QY, Deng F, Li YP. Manual versus electric vacuum aspiration for first-trimester abortion: a systematic review. BJOG. 2008;115:5–13.\nChapa HO, Antonetti AG, Sandate J, Silver L. Emergent thermal balloon ablation for acute uterine hemorrhage: a report of 2 cases. J Reprod Med. 2010;55:511–3.\nNakayama K, Rahman MT, Rahman M, Ishikawa M, Yeasmin S, Katagiri A, et al. Microwave endometrial ablation is a highly efficacious way to emergently control life-threatening uterine hemorrhage. Arch Gynecol Obstet. 2011;283:1065–8.\nYeasmin S, Nakayama K, Ishibashi M, Katagiri A, Iida K, Nakayama N, et al. Microwave endometrial ablation as an alternative to hysterectomy for the emergent control of uterine bleeding in patients who are poor surgical candidates. Arch Gynecol Obstet. 2009;280:279–82.\nDickersin K, Munro MG, Clark M, Langenberg P, Scherer R, Frick K, et al. Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB) Research Group. Hysterectomy compared with endometrial ablation for dysfunctional uterine bleeding: a randomized controlled trial. Obstet Gynecol. 2007;110:1279–89.\nLopera J, Suri R, Kroma GM, Garza-Berlanga A, Thomas J. Role of interventional procedures in obstetrics/gynecology. Radiol Clin North Am. 2013;51:1049–66.\nGhai S, Rajan DK, Asch MR, Muradali D, Simons ME, TerBrugge KG. Efficacy of embolization in traumatic uterine vascular malformations. J Vasc Interv Radiol. 2003;14:1401–8.\nBulman JC, Ascher SM, Spies JB. Current concepts in uterine fibroid embolization. Radiographics. 2012;32:1735–50.\nKatz MD, Sugay SB, Walker DK, Palmer SL, Marx MV. Beyond hemostasis: spectrum of gynecologic and obstetric indications for transcatheter embolization. Radiographics. 2012;32:1713–31.\nGizzo S, Saccardi C, Patrelli TS, Di Gangi S, Breda E, Fagherazzi S, et al. Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature. Fertil Steril. 2013;99:2097–107.\nSweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012;85:35–43.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nCopyright information\n© 2016 Springer International Publishing Switzerland\nAbout this chapter\nCite this chapter\nBrady, P.C., Carusi, D. (2016). Vaginal Hemorrhage. In: Handbook of Consult and Inpatient Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-27724-0_2\nDownload citation\nDOI: https://doi.org/10.1007/978-3-319-27724-0_2\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-319-27722-6\nOnline ISBN: 978-3-319-27724-0\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}