Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Abnormal Bleeding CAPT Mike Hughey, MC, USNR.

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Presentation transcript:

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Abnormal Bleeding CAPT Mike Hughey, MC, USNR

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 2 Causes of Abnormal Bleeding 1. Pregnancy 2. Malignancy 3. Mechanical Problems 4. Hormonal Problems

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 3 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 4 Rule out Malignancy Cervical cancer (Pap) Vaginal cancer (Exam) Ovarian cancer (Exam) Uterine cancer (Endometrial biopsy, but under age 40, cancer very rare) Invasive Cancer of the Cervix

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5 Mechanical Problems Fibroids Polyps

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6 Hormonal Problems Anovulation Ovulatory bleeding Delayed menses

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 7 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 8 Clinical Management: Treatment BCPsBedrest

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 9 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 10