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

2. 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

3. 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

4. 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

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

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

7. 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

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

9. 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.

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