Pv Bleeding A+E

1. PV BLEEDING
BY
ASRUL BIN ISMAIL
PPPU29

2. PV BLEEDING
NORMAL
ABNORMAL
TRAUMA

3. WHAT IS PV BLEEDING??
PV BLEEDING IS A REFERS TO BLEEDING FROM THE VAGINA.

4. NORMAL PV BLEEDING
-Normal menstruation occurs as the endometrium
sloughs from the uterus, with consequent
bleeding.
-The flow lasts for three to five days; in some
cases as short as one day, or as long as eight
days.
- Normal blood loss is around 30 mls per cycle;
the normal range is up to 80 mls per cycle.

6. ABNORMAL PV BLEEDING
1.Menorrhagia (heavy periods)
- A 'heavy' period is a blood loss of 60-80 ml or more.
- However, it is difficult to measure the amount of blood that lose
during a period.
- For practical purposes, a period is probably heavy if it causes one or
more of the following:
-Flooding through to clothes or bedding.
-Need frequent changes of sanitary towels or tampons.
-Need double sanitary protection (tampons and towels).
- Pass large blood clots.
-Menorrhagia means heavy periods that recur each month. Also, that
the blood loss interferes with quality of life.
- For example, if it stops you doing normal activities such as going
out, working, or shopping.
-Menorrhagia can occur alone or in combination with other symptoms
such as Fibroids , Other conditions of the uterus such as
endometriosis, Hormone problems , The IUD (Intrauterine Device
or 'coil') , Warfarin , Some drugs used for chemotherapy , Blood
clotting disorders .

7. 2. Ectopic Pregnancy
- Ectopic means 'misplaced'.
- Most ectopic pregnancies occur when a fertilised egg attaches to
the inside lining of a fallopian tube (a 'tubal ectopic')
- The pregnancy often dies after a few days. About half of ectopic
pregnancies probably end like this.
- May have no symptoms, and may never have known that you were
pregnant. Sometimes there is slight pain and some vaginal bleeding like a
miscarriage

8. 3. Abortion
-abortion is the loss of a pregnancy at any stage up to the 24th week.
-A loss after this time is called a stillbirth.
- Most abortion occur before 13 weeks of pregnancy, but some occur later.
- It is common to have some light vaginal bleeding sometime in the first 12
weeks of pregnancy.
-This does not always mean that you are going to miscarry.
-Often the bleeding settles and the the growing baby is healthy.
-This is called a 'threatened' abortion

9. 4. Placenta Praevia
-Placenta praevia exists when the placenta is inserted wholly or in part into
the lower segment of the uterus
-Symptomatic placenta praevia is associated with the sudden onset of
painless bleeding in the second or third trimester .
-Placenta praevia is often graded as:
I - Encroaches the lower segment but does not reach cervical os
II - Reaches the internal cervical os but does not cover it
III - Covers part of the cervical os
IV - Completely covers the os, even when the cervix is dilated.

10. 5. Antepartum haemorrhage
- is bleeding from the vagina during pregnancy from twenty four weeks .
-medical attention should be sought immediately, as if it is left untreated it
can lead to death of the mother and/or fetus
- Bleeding without pain is most frequently bloody show, which is benign;
however, it may also be placenta previa (in which both the mother and
fetus are in danger).
-Painful APH is most frequently placental abruption (which may also lead
to adverse fetal and/or maternal outcomes).
6. Post-partum Haemorrhage (PPH)
- Primary post-partum haemorrhage is loss of blood estimated to be
>500ml, from the genital tract, within 24 hours of delivery.
- Secondary PPH is defined as abnormal bleeding from the genital tract,
from 24 hours after delivery until 6 weeks post-partum.

11. TRAUMA PV BLEEDING
- Blunt trauma from a fall or bicycle injury is
common cause of vaginal bleeding during
childhood.
- Abrasions and lacerations of vulva, vagina,
and,less commonly, cervix may occur.
- Sexual abuse or rape is another common cause
of genital tract injury and bleeding.
- Trauma also may injure urethra, bladder,rectum,
and abdominal viscera.

12. Ix for Pv Bleeding
•Taking Hx from patient
–LMP
–GESTATIONAL HISTORY
–PASSAGE TISSUE
–AMOUNT OF BLEEDING
–CRAMPS ??
–LAST INTERCOURSE
–PMH
–RISK FACTOR
•Do ix
–FBC
–UPT
–PT/APTT
–BLOOD X-MATCH

13. •PHYISICAL EXAMINATION
–LOOK PT PALE OR NOT
–COMPLETE PELVIC EXAM
–ULTRASOUND

14. Mx In PV BLEEDING
•Initial assessment by emergency
department
•Assess vital sign
•UPT
•Establish gestation based on LMP or do
early scan
•Abdominal palpation
•Speculum bimanual assessment

15. •Set line for iv solution
•If Hb low start for blood transfusion

16. Mx in abbortion
•Syntometrin / pitocin given to ensure
uterus contract
•For retained POC , consult for possible
D&C
•If septic give IV antibiotics

17. Reference
•www.patient.uk
•www.wikipedia.com