Case review: A 20-year-old female patient was admitted to the hospital with 6 hours of heavy vaginal bleeding and 1 hour of dizziness and fatigue.
History of Present Illness: Self-reported 6 hours ago of sudden heavy vaginal bleeding, bright red color, with small blood clots, no abdominal pain, no sore Flesh-like tissue discharge, no nausea, vomiting, dizziness, fatigue, blurred vision 1 hour ago,
Menstrual history: The menstrual cycle is regular, the last menstrual period is 09-25, the menstrual flow is normal, and the menstrual period is the fifth day.
Prior history: She underwent induced abortion 3 months ago, and she reported that the operation went well and the postoperative follow-up was normal.
Vital signs: Blood pressure 105/65 mmHg, pulse rate 144 beats/min, shock was considered, and anti-shock therapy such as fluid replacement was given urgently.
Physical examination: Poor mental state, severe anemia, negative urine pregnancy test, HCG
Repeatedly asked about the medical history, and there was no similar situation in the past. He denied any history of trauma such as a fall or impact on the day, denied any violent sexual life that day, and denied taking health care drugs.
Ultrasonography shows a hypoechoic mass in the cervix
Vaginal examination: profuse vaginal bleeding, clearing blood clots, revealing a ruptured opening of the posterior vaginal fornix, reaching the muscle layer, about 4 cm in length, and active bleeding. Vaginal tamponade was given and suture of the posterior vaginal fornix was performed.
Repeatedly asked the patient for the cause of bleeding: The patient complained that the vaginal implantation of the X tool was caused by having sex with a male friend at the same time. Because the family followed with him, he did not want to let his family and husband know, so he did not dare to Came to the hospital and denied the sex life situation.
Case discussion:
This patient is a young married woman with regular menstruation. The patient’s concealment of the medical history and the lack of timely physical examination of the patient led to a delay in the disease and caused shock. During the diagnosis and treatment of vaginal bleeding patients, The core is diagnosing the cause, and taking appropriate measures to control and treat it in combination with the cause. In judging the etiology of vaginal bleeding patients, attention should be paid to:
Understand the patient’s medical history: The diagnosis and treatment of vaginal bleeding should first know whether the problem has occurred before, and the knowledge of the previous medical history has a strong role in judging the cause. If some medical history is highly suspected, and the patient denies it, it can be clarified according to the physical examination.
Determine the patient’s age: The cause of vaginal bleeding is closely related to the patient’s age. First, let’s first analyze some of the most common problems in this age group:
For example, the common causes of vaginal bleeding in young girls are: vaginal foreign bodies, vaginal inflammation, trauma, blood system diseases, and vegetations.
Common causes in adolescent women: pregnancy-related uterine bleeding, genital inflammation, benign uterine lesions, foreign bodies, and exogenous sex hormones.
Common factors in middle-aged and elderly women: ovarian endocrine and intrauterine disorders, genital tumors, inflammation, and benign uterine lesions.
After eliminating these factors, careful examination can improve the efficiency of examination, avoid delay in treatment due to the long time to find the cause, and also reduce the patient’s economic expenditure to a certain extent and avoid unnecessary inspection.
A comprehensive understanding of the characteristics of vaginal bleeding: It is extremely important to have a detailed inquiry and careful examination of the characteristics of vaginal bleeding. Such as: bleeding volume, bleeding time, bleeding color, bleeding time indicates the duration of blood on the one hand, and blood interval on the other hand.
Appropriate reliance on related instruments: The application of diagnosis and treatment instruments can play a certain role and value in the early diagnosis of etiology, especially the application of ultrasound, but a comprehensive physical examination is still required And the judgment of clinical experience, so as to avoid the misleading of the instrument.
An appropriate treatment plan is based on the cause.
Summary: The diagnosis of the cause of vaginal bleeding in obstetrics and gynecology is an important premise. Only by accurately determining the cause can specific diagnosis and treatment work be carried out and the reliability of diagnosis and treatment work can be guaranteed.
Planning: mango
This article was first published on the professional platform of Lilac Garden: Maternity Time