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Abnormal Bleeding PV

Abnormal Bleeding PV. Common complaint in the out patient dept. Normal menstrual loss- 80 ml. Menorrhagia- normal cycle- increased bleeding, prolonged or excessive Polymennorrhea- short cycles, normal bleeding Poly menorrhagia- short cycles, increased bleeding

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Abnormal Bleeding PV

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  1. Abnormal Bleeding PV Common complaint in the out patient dept

  2. Normal menstrual loss- 80 ml • Menorrhagia- normal cycle- increased bleeding, prolonged or excessive • Polymennorrhea- short cycles, normal bleeding • Poly menorrhagia- short cycles, increased bleeding • Metrorrhagia- loss of cyclicity- irregular bleeding • Metropathia haemorrhagica- amenorrhoea followed by prolonged bleeding

  3. Case scenario 1 • 15 year old with bleeding pv for 1 month • History? • Examn? • Investigations?

  4. History • Menarche • Menstrual history • LMP • PMP • Amount of blood flow- clots? • Pain • Bleeding gums/elsewhere • Fever • Weight gain/loss • Headache/ visual disturbances

  5. Physical exam • Built • Anaemia • Hirsuitism • Goitre • Galactorrhoea • Mass in the abdomen • P/R

  6. Investigations • Hb • BT • CT • Platelet count • Peripheral smear • TFT • ESR • Urine sugar

  7. Treatment • Haematinics • Underlying cause if any • Progesterone to control bleeding- 20-30 mg for 3 days • Cyclical hormone treatment

  8. Case 2 • 28 year old with increased bleeding pv for 15 days • History • Physical exam • Ix

  9. History • Menstrual history • Obstetric history- include MTP • Contraceptive use • Dysmenorrhoea • Discharge pv • Fever/ bleeding tendency/ cough/ hypothyroidism • Post coital bleeding/ irregular spotting

  10. Physical exam • Anaemia • Goitre • P/v- • Visualise cervix- look for erosion, cervicitis, Ca , Polyps, vaginitis • Look at size of uterus, uniformly enlarged?, mass in fornices, tenderness

  11. Investigations • Hb, Tc Dc ESR • Urine sugar • ? Urine beta Hcg • USS if needed • Pap smear

  12. Treatment • If suspicion of pregnancy, USS/ D&C • Attend to cervical lesions if any • Treat polyps with polypectomy • Proper use of contraceptives • If no organic lesion • EACA, Tranexamic acid • Mefenamic acid • Menstrual calender • haematinics

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