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Uterine Bleeding, Acute Abnormal — History and Physical — Clinical Pathway: Emergency

Uterine Bleeding, Acute Abnormal Clinical Pathway — Emergency Department

History and Physical

  • Inspect the external genital area on all adolescents
  • Most patients do not require pelvic exam
  • Exam under anesthesia may also be required in select cases
History
  • Age menarche
    • 50% of cycles are anovulatory in the first 12-18 mos following menarche
  • AUB Definition
    • Cycle length < 21 days or > 45 days
    • Duration > 7 days
    • Excessive bleeding
      • Blood loss > 80 mL
      • Large clots > 1 inch
      • Flooding accidents
      • Changing soiled regular pad/tampon > every 1-2 hrs
    • Symptoms of volume depletion (dizzy, syncope, fatigue)
  • Assess for Bleeding Disorder
    • Nosebleeds, minor cuts > 10 min, seeking care
    • Bleeding w/dental extraction, surgery
    • Family history
      • Fe deficiency, bleeding disorder
      • Post-partum hemorrhage, heavy menses
  • Medications
    • Hormone use, other medications
    • Risk of STI, pregnancy
    • Trauma
    • Symptoms, suggestion of systemic disease
Physical
  • VS, including orthostatic VS, mental status, perfusion
  • Abdominal tenderness
  • External genitalia
    • Bleeding
    • Clitoral size
    • Evidence of trauma, foreign body, infection
  • Pelvic exam (source/amount of bleeding)
    • As indicated
  • Thyroid enlargement
  • Androgen excess: acne, hirsutism
  • Bruising, petechiae
  • Galactorrhea

 

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