Medical management should be the initial treatment for most patients, if clinically appropriate. Options include intravenous conjugated equine estrogen, multi-dose regimens of combined oral contraceptives or oral progestins, and tranexamic acid. Decisions should be based on the patient’s medical history and contraindications to therapies.
Full Answer
What are the treatment options for vaginal bleeding?
Jul 21, 2021 · In all cases of severe bleeding, the first step is patient stabilization with attention to the ABCs. In most cases, vaginal bleeding is handled by an obstetrician or gynecologist. Severe bleeding may require blood transfusions and vaginal packing. Beyond this, treatment depends on the etiology of the patient's vaginal bleeding.
What are the treatment options for vaginal lacerations?
• Post-menopausal bleeding is defined as new onset bleeding that occurs in a woman older than 40 years of age after one year of no bleeding (amenorrhea). Post-menopausal bleeding occurs in between 4% - 11% of women, and is usually attributable to an intrauterine source. 1 . However, bleeding can occur from the cervix, vagina, vulva,
How should you assess a young female with nontraumatic vaginal bleeding?
General treatment guidelines when caring for a woman with traumatic vaginal bleeding includes transporting to an appropriate facility A placenta previa is MOST accurately defined as development of the placenta over the cervical opening Braxton-Hicks contractions are characterized by alleviation of pain with movement or changing positions
What is the first step in the treatment of severe bleeding?
General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the following, EXCEPT: supplemental oxygen and keeping the patient supine. carefully removing any foreign bodies from the vagina. treating external lacerations with sterile compresses. refraining from placing any dressings into the vagina.
What is the purpose of platelet transfusion?
Platelet transfusion (2–3 adult doses) should be considered as an additional measure for critical bleeding or prevention of bleeding before emergency surgery (2C). Platelet transfusion should be considered to prevent bleeding in severe thrombocytopenia (<10 × 10 9 /l) caused by abciximab (2C).
What are the five fibrinolytic agents?
The fibrinolytic agents currently licensed in the UK are: alteplase, tenecteplase, reteplase, urokinase and streptokinase. All five agents function indirectly by promoting generation of plasmin, which then mediates clot lysis.
How are low molecular weight heparins derived?
Low molecular weight heparins (LMWH) are derived from UFH through chemical or enzymatic depolymerization. The ratios of anti‐Xa to anti‐IIa activities vary between products depending on LMWH chain length. However the half‐life of the anticoagulant activity of LMWH lasts approximately 4 h. The mechanism of action of LMWH and differences from UFH were recently reviewed (Gray et al, 2008 ). LMWH activity may be monitored with the anti‐Xa test. Although LMWH may also prolong the APTT, this test should not be used to assess the extent of drug effect.
Is bivalirudin a thrombin inhibitor?
Bivalirudin is a recombinant peptide thrombin inhibitor and is the only licensed hirudin in the UK. The lepirudin licence was recently withdrawn and so it is not considered in this guideline. Bivalirudin is cleared predominantly through proteolysis by thrombin (80%) and only 20% is excreted renally. The half‐life is approximately 25 min, 1 h in severe renal impairment and 3·5 h in dialysis‐dependent patients (Chew, 2002 ). Bivalirudin activity may be monitored by ACT or by APTT. The PT is minimally prolonged at therapeutic bivalirudin concentrations. The pharmacology and clinical applications of bivalirudin have been reviewed recently (Warkentin et al, 2008 ). Given the short plasma half‐life of bivalirudin, cessation of treatment and general haemostatic measures are often sufficient for correction of the effect except when there is prolonged clearance due to renal impairment. An in vivo study showed that modified ultrafiltration after CPB surgery in patients with normal renal function reduced the half‐life by 20% and reduced postoperative blood loss (Koster et al, 2008 ).
Is tirofiban a reversible blocker?
Tirofiban and eptifibati de are fully reversible blockers of the fibrinogen binding site on GPIIb/IIIa that have rapid onset of action and short plasma half‐lives (tirofiban c. 1·5 h; eptifibatide c. 2·5 h). Both agents are eliminated by the kidneys (tirofiban c. 66% renal clearance; eptifibatide c. 50%) and confer increased bleeding risk in patients with renal impairment (Smith & Gandhi, 2001 ). However, in the absence of renal impairment, the bleeding risk diminishes rapidly after cessation of treatment (Peerlinck et al, 1993 ). Thombocytopenia is uncommon in patients receiving tirofiban and eptifibatide and a causal association has not been proven (Madan & Berkowitz, 1999 ).
Is Danaparoid a heparin?
Danaparoid is a heparinoid consisting of a mixture of glycosaminoglycans with an anti‐Xa/anti‐IIa ratio > 20 (Hirsh, 1992 ). Danaparoid is excreted renally and has a plasma half‐life of anti‐Xa activity of approximately 24 h (Danhof et al, 1992 ). Danaparoid may be monitored by anti‐Xa assay using a danaparoid standard. Major bleeding occurred in 8·1% of patients treated with danaparoid for heparin‐induced thrombocytopenia (HIT) (Magnani & Gallus, 2006 ). Continued bleeding after cardiopulmonary bypass surgery (CPB) on danaparoid has been reported despite intensive blood product replacement (Schmahl et al, 1997; Westphal et al, 1997; Gitlin et al, 1998; Fernandes et al, 2000; Pamboukian et al, 2000 ). There is no specific antidote for danaparoid. However, plasmapheresis removes danaparoid effectively from the circulation (Schmahl et al, 1997 ). An ex vivo study showed partial restoration of thrombin generation when rFVIIa was added at supra‐therapeutic doses to plasma spiked with danaparoid, but not with addition of APCC and FFP (Gatt et al, 2008 ).
What is the physical examination of a sexual assault victim?
The physical examination of a sexual assault victim should be: limited to a brief survey for life-threatening injuries. In contrast to bleeding caused by external trauma to the vagina, bleeding caused by conditions such as polyps or cancer: may be relatively painless.
What are the consequences of a PID?
Potentially life-threatening consequences of PID include: ovarian abscess and ectopic pregnancy. General treatment for a woman with vaginal bleeding and shock following sexual assault includes all of the following, EXCEPT: A. supplemental oxygen and lower extremity elevation.