Episode 18: The OB/GYN Podcast with Dr. Anand Swaminathan Ft: Dr. Sammy DeAngelis
Learning Points: The Ob/GYN Podcast
The Differential in Vaginal Bleeding in the non-pregnant patient is age specific:
Pre-menarcheal (Less than 8 years old): foreign body, Coagulopathy/Bleeding disorders (e.g. Von Willebrand Disease), Immaturity of the hypothalamic-pituitary- ovarian axis
Menarcheal (8 - 55 years old): Polyps, Fibroids, Malignancy, STI’s, PCOS
Post-menarcheal (> 55 years old): Endometrial Atrophy, Malignancy
Transexamic Acid (TXA) is FDA approved for heavy vaginal bleeding in certain scenarios. Do not hesitate to give it in the Emergency Department.
Similar threshold exists for transfusion at Hb 7 as other populations.
ED Classic teaching: beta HCG levels
Minimum threshold to see an IUP is now 3500 (and not 1500)
Transvaginal Ultrasound should be performed in early pregnancy to evaluate for an IUP
-Beta HCG doubling times depends on initial beta HCG. After 48 hours, expect:
-Beta HCG < 1500 - 49% increase
-Beta HCG 1500-3000 - 40-41% increase
-Beta HCG > 3000 - 33% increase
Consider OB/GYN consult for:
Incomplete abortion with heavy bleeding. May help with D+C and/or medication
Anemia with vaginal bleeding
Post-menarcheal bleeding for endometrial biopsy (case specific)
Pyelonephritis in pregnancy = admission/IV antibiotics. Simple cystitis is case specific and may be treated as an outpatient with close follow up.
Preeclampsia - low threshold for starting magnesium. Baby requires toco monitoring and mother should be transferred right up to L+ D or transferred.
