p/v medical abbreviation in gynaecology?

Per Vaginal (PV) Bleeding

Assessment and management is based on pregnancy being diagnosed with bHCG.

Non pregnant PV bleeding may represent a spectrum from benign to significant pathology and other than clear and obvious simple explanations will require seeking advice and referral to gynaecological services:

Abnormal or normal menstrual period, first menstrual period

Trauma, FB, sexual assault

Hormonal contraception related

Infection UTI, PID, retained tampon

Cancer – cervical or uterine

Bleeding from another source (rectal, anal)

A clear history is essential

Bleeding history

Duration

Volume by pads and clots

Increasing / decreasing?

Associated with pain (ectopic)?

Products of conception or tissues seen

Other symptoms, such as urinary, general (anorexia/infection) or syncope (blood loss)

Examination may alert you to significant pathology

General examination:

Primary survey, ABCDE approach as in any patient particularly if unstable. (In unstable patients this will involve IV access and fluid)

Specific examination

Abdominal- tenderness and peritonism may indicate ruptured ectopic and potential for life threatening bleeding

PV examination- indicated if there is concern about a local non uterine cause of bleeding or about clots in the os leading to pain or vaginal symptoms. We suggest PV examination in cases of trauma, peritonism, large volume bleeding and shock.

Where there is no significant pain, vaginal vault or cervical pathology is not a concern and there are no other specific indications then it is not necessary.
Laboratory

FBC - WCC for infection, WCC often raised in pregnancy - so not specific if raised.

BHCg - quantitative - confirm pregnancy.

Blood Group and hold - If patient is unstable consider O-ve blood. May need anti-D if Rhesus negative.

NSW Health Guidelines - Maternity - Rh (D) Immunoglobulin (Anti D) - GL2015_011
Imaging

Pelvic ultrasound scan, to determine:

Intrauterine pregnancy

Tubal pregnancy

Evidence of bleeding such as pelvic / abdominal free fluid

Other pathology

Ectopic Pregnancy

1-2% pregnancies are ectopic.

Whenever there is bleeding in early pregnancy then we need to consider any red flags for ectopic pregnancy:

Past history of ectopic pregnancy

Previous PID

Intrauterine contraceptive device in situ

Previous tubal surgery

Smoker

Abdominal tenderness or peritonism

Associated pain

Absence of identified intrauterine pregnancy at appropriate bHCG levels (risk of intra and extra uterine pregnancy in IVF patients)

Lower than expected bHCG levels for dates

Resources

Acute Antepartum Haemorrhage Management Framework Placenta Praevia: PV Bleeding Algorithm

ACEM Guidelines on diagnostic imaging (G126) - see page 7

Patient Factsheets

Bleeding in early pregnancy