bluestar
Forum Guru
Topics: 236
Posts: 724
|
a 16 year old female comes to ER because of heavy vaginal bleeding. She has no pain. Since menarche, menses have usually been irregular. She doesn't use alcohol, tobacco or drugs. body temp 37C, Bp 110/60 mmHg, pulse 90, RR 16, PE shows continuous vaginal bleeding, pregnancy test is negative, coagulation test are within normal limits, ultrasound shows no abnomalities. which of the following is the most appropriate next step in management?
a, emergency D&C
b, high dose medroxyprogesterone
c, intravenous conjugated estrogens
d, hysteroscopy
e, start high dose GnRH agonists
please explain your answer
___________________
I leave no trace of wings in the air, but I am glad I have had my flight
|
| dimps
Forum Guru
Topics: 63
Posts: 446
|
c , intravenous conjugated estrogens
patient is having anovular bleeding & it is heavy ....to stop heavy bleeding estogen is the best option
___________________
hi how r u
|
| dev
Forum Guru
Topics: 70
Posts: 1,794
|
hi
why not A??
dev
|
| bluestar
Forum Guru
Topics: 236
Posts: 724
|
can you explain why estrogen can stop heavy bleeding?
___________________
I leave no trace of wings in the air, but I am glad I have had my flight
|
| bahbah
Forum Senior
Topics: 18
Posts: 50
|
I read this in emedicine :
Prolonged uterine bleeding suggests the epithelial lining of the cavity has become denuded over time. In this setting, a progestin is unlikely to control bleeding. Estrogen alone will induce return to normal endometrial growth rapidly.
Hemorrhagic uterine bleeding requires high-dose estrogen therapy.
If bleeding is not controlled within 12-24 hours, a D&C is indicated.
|
| bluestar
Forum Guru
Topics: 236
Posts: 724
|
then what's the indication of progesterone have you read?
___________________
I leave no trace of wings in the air, but I am glad I have had my flight
|
| bahbah
Forum Senior
Topics: 18
Posts: 50
|
Mostly this is a case of DUB ( because preg test, u/s , coagualtion all are negative )
http://www.emedicine.com/med/topic2353.htm#sectio...
Medical Care:
1.Oral contraceptives
Oral contraceptive pills (OCPs) suppress endometrial development, reestablish predictable bleeding patterns, decrease menstrual flow, and lower the risk of iron deficiency anemia.
Acute episodes of heavy bleeding suggest an environment of prolonged estrogenic exposure and buildup of the lining.
Bleeding usually is controlled within the first 24 hours, as the overgrown endometrium becomes pseudodecidualized. Seek alternate diagnosis if flow fails to abate in 24 hours.
2.Estrogen
Estrogen alone, in high doses, is indicated in certain clinical situations.
Prolonged uterine bleeding suggests the epithelial lining of the cavity has become denuded over time. In this setting, a progestin is unlikely to control bleeding. Estrogen alone will induce return to normal endometrial growth rapidly.
Hemorrhagic uterine bleeding requires high-dose estrogen therapy. If bleeding is not controlled within 12-24 hours, a D&C is indicated.
Beginning progestin therapy shortly after initiating estrogen therapy to prevent a subsequent bleeding episode from treatment with prolonged unopposed estrogen is wise.
3.On rare occasions, a young patient with anovulatory bleeding also might have a bleeding disorder.
Desmopressin, a synthetic analog of arginine vasopressin, has been used as a last resort to treat abnormal uterine bleeding in patients with documented coagulation disorders.
Treatment is followed by a rapid increase in von Willebrand factor and factor VIII, which lasts about 6 hours.
|
| ayeshah_l
Forum Elite
Topics: 29
Posts: 284
|
mechanism of action of Estrogen
Causes vasospasm of uterine arterioles and initiate several coagulation related functions which decrease uterine bleeding.
Use in pharmacological doses also causes rapid groith of endometrial tissue over denuded new and raw epithelial surface
|
|
| |
| | | | | | | | |
