“What’s the Flow?”
What is the PALM-COEIN classification system?
This classification system separates structural and nonstructural causes of abnormal uterine bleeding.
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This hypertensive disorder is characterized by hypertension and proteinuria after 20 weeks gestation.
What is preeclampsia?
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The history should focus on current bleeding attributes and include what information?
onset, duration, and pattern.
In a 7-year-old child with a history of vaginal bleeding, which finding would prompt the most urgent referral?
Frequent nosebleeds that last longer than 10 minutes
This age group is most likely to experience AUB from structural causes such as fibroids, polyps, and malignancy.
What are women ages 19–39 years?
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What quantity of bleeding is considered abnormal?
Menstrual bleeding lasting more than 7 days or blood loss greater than 80 mL.
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A nulliparous pregnant patient developing hypertension and proteinuria in the second half of pregnancy likely has this condition.
What is preeclampsia?
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Patients who present with AUB should follow up with a gynecologist within this time frame?
24 to 72 hours after discharge from the urgent care.
Regarding structural causes of AUB, which of the following is TRUE?
a. Structural causes are common causes of bleeding in adolescent females.
b. Fibroids or leiomyomas are malignant myometrial tumors.
c. The structural causes of bleeding are noted in the “COEIN” of the PALM-COEIN classification system.
d. NSAIDs have been shown to help decrease bleeding in patients with AUB.
d. NSAIDs have been shown to help decrease bleeding in patients with AUB.
When obtaining history, these symptoms should be asked about to assess hemodynamic instability from blood loss.
“What are dizziness, shortness of breath, chest pain, weakness, or syncope?”
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The most common cause of AUB in adolescents ages 12–18.
What is immaturity of the hypothalamic-pituitary-ovarian axis?
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This syndrome is defined by hemolysis, elevated liver enzymes, and low platelets.
What is HELLP syndrome?
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The most common cause of AUB in postmenopausal woman is?
Endometrial atrophy
Which of the following interventions would be appropriate in a 13-year-old child with yellow vaginal discharge who denies sexual activity?
Testing for gonorrhea/chlamydia, as well as bacterial culture
These severe complications can occur in untreated preeclampsia.
What are stroke, pulmonary edema, renal failure, or eclampsia?
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This test should always be performed in women presenting with AUB.
What is a pregnancy test?
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This fetal complication is commonly associated with preeclampsia.
What is fetal growth restriction?
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Postcoital bleeding can be indicative of what?
Hormonal changes, sexually transmitted infection, cervicitis, or malignancy. One study found that unanticipated (often postcoital) vaginal bleeding was associated with chlamydia infection in approximately 40% of cases.
A 29-year-old female presents for AUB. She has a history of irregular menstrual periods and is obese, has facial acne, and hair on her chin. You suspect your patient most likely has what?
PCOS
The differential diagnosis of AUB in nonpregnant females is broad and includes benign causes. What is one of those causes?
weight changes or stress,
A woman with heavy bleeding since menarche, frequent nosebleeds, and easy bruising may have this disorder.
What is von Willebrand disease?
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Routine screening for this vital sign is required at every prenatal visit.
What is blood pressure?
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Which of the following is most effective in reducing menstrual blood loss?
Levonorgestrel-releasing intrauterine device system
These newer therapies are emerging treatment options for AUB.
What are levonorgestrel-releasing IUDs and elagolix?
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These return precautions should be documented before discharge.
What are worsening bleeding, soaking pads hourly, dizziness, syncope, or severe pain?
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