Chapter 14 – Acute Pelvic Pain and Other Gynaecological Emergencies

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Vaginal bleeding

Acute gynaecological emergencies may present with bleeding and subsequent hypovolaemic shock. Severe bleeding and shock require management and resuscitation in an emergency setting. Treatment primarily involves identification of the source and control of bleeding, reversal of possible coagulopathy, and administration of adequate fluids and blood products to maintain normal tissue perfusion.(18)

Prompt physical examination including assessment of vital signs, vaginal and pelvic examination and rapid bedside ultrasound in the emergency setting are important management tools. A pregnancy test should be performed in all patients of reproductive age presenting with bleeding.

Causes of severe vaginal bleeding may include:

miscarriage or threatened miscarriage gestational trophoblastic disease ectopic pregnancy complication of termination of pregnancy anovulatory bleeding vaginal trauma uterine fibroids gynaecological malignancy antepartum or postpartum haemorrhage ... Buy now