Abnormal vaginal bleeding

Sometimes, babies seem to enjoy going for the flying dropkick, but this shouldn't cause bleeding.

Epidemiology

Pathophysiology

Basically, it either a tumour, trauma, or some sort of abnormality in pregnancy.

Differential Diagnosis

• Miscarriage
• Ectopic pregnancy
• Hormonal abnormalities (including idiopathic menorrhagia)
• Gynaecological cancer
• Trauma
• Iatrogenic

In obstetrics:

• Placental abruption
• Placenta praevia

Clinical and Associated Features

• Miscarriage - often asymptomatic but bleeding, lower abdominal pain plus absence of symptoms of pregnancy are suggestive
• Ectopic pregnancy - bleeding, lower abdominal pain, dysuria, pain on bowel movement
• Idiopathic menorrhagia - common and a diagnosis of exclusion
• Cancer - post-coital bleeding, intermenstrual bleeding (between periods), dyspareunia, sometimes lower abdominal pain

In obstetrics

• placental abruption - contractions, abdominal pain and tenderness, occasionally bleeding
• placenta praevia - usually found incidentally on routine USS or with profuse, sudden bleeding after 28 weeks.