Template:Non pregnant vaginal bleeding treatment: Difference between revisions
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===Moderate continued bleeding=== | ===Moderate continued bleeding=== | ||
Patients can benefit from initiation of birth control or for acute cessation consider medroxyprogesterone therapy in the ED | |||
*'''Medroxyprogesterone''' | *'''Medroxyprogesterone''' | ||
**Give only if endocervical curettage/endometrial biopsy does not need to be performed (young patient) or has already been performed, since the hormone may alter the results | **Give only if endocervical curettage/endometrial biopsy does not need to be performed (young patient) or has already been performed, since the hormone may alter the results | ||
**150mg IM x 1 then 20mg PO Q8hrs x 3 days | **'''High Dose regimen:''' 150mg IM x 1 then 20mg PO Q8hrs x 3 days | ||
**In a trial of 48 patients all had cessation in 5 days.<ref name="highdose">Ammerman SR, Nelson AL. A new progestogen-only medical therapy for outpatient management of acute, abnormal uterine bleeding: a pilot study. Am J Obstet Gynecol. 2013. 208(6):499.e1-e5.</ref> | |||
**In a trial of 48 patients all had cessation in 5 days.<ref>Ammerman SR, Nelson AL. A new progestogen-only medical therapy for outpatient management of acute, abnormal uterine bleeding: a pilot study. Am J Obstet Gynecol. 2013. 208(6):499.e1-e5.</ref> | **'''Alternative regimen:''' 10mg PO q8 x 7 days then 10mg daily x 3 weeks<ref> Aksu F, Madazli R et al. High-dose medroxyprogesterone acetate for the treatment of dysfunctional uterine bleeding in 24 adolescents. Aust N Z J Obstet Gynaecol. 1997;37(2):228–231.</ref> | ||
===Life Threatening=== | ===Life Threatening=== | ||
Revision as of 07:38, 21 September 2016
Mild Bleeding
- Iron supplementation
- Ibuprofen
- For cramps and can theoretically decreases intra-uterine bleeding
Moderate continued bleeding
Patients can benefit from initiation of birth control or for acute cessation consider medroxyprogesterone therapy in the ED
- Medroxyprogesterone
- Give only if endocervical curettage/endometrial biopsy does not need to be performed (young patient) or has already been performed, since the hormone may alter the results
- High Dose regimen: 150mg IM x 1 then 20mg PO Q8hrs x 3 days
- In a trial of 48 patients all had cessation in 5 days.[1]
- Alternative regimen: 10mg PO q8 x 7 days then 10mg daily x 3 weeks[2]
Life Threatening
- Establish large bore IV access
- Prepare for emergent blood transfusion uncrossmatched O-negative blood if typed blood is not available.
- It is possible to temporize bleeding w/ intravaginal packing with kerlix soaked in with thrombin
- If bleeding is due to a traumatic cause emergent surgical repair is necessary
- Tranexamic acid [3]
- Coordinate with OBGYN prior to administration due to the increased thrombotic risk
- Acutely 10 mg/kg IV, max dose of 600 mg[4]
- Then 1-1.5 g TID PO for 5 days
- ↑ Ammerman SR, Nelson AL. A new progestogen-only medical therapy for outpatient management of acute, abnormal uterine bleeding: a pilot study. Am J Obstet Gynecol. 2013. 208(6):499.e1-e5.
- ↑ Aksu F, Madazli R et al. High-dose medroxyprogesterone acetate for the treatment of dysfunctional uterine bleeding in 24 adolescents. Aust N Z J Obstet Gynaecol. 1997;37(2):228–231.
- ↑ Leminen and Hurskainen. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int J Womens Health. 2012; 4: 413–421.
- ↑ Committee on Gynecological Practice. Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women. April 2013. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Management-of-Acute-Abnormal-Uterine-Bleeding-in-Nonpregnant-Reproductive-Aged-Women