ED Treatment of Abnormal Uterine Bleeding Hemodynamically unstable Resuscitation • ABCs! • Fluids + blood transfusion • Correction of any underlying coagulopathy Pregnancy test rule out possible ectopic vs pregnancy related cause Hemorrhage control • IV conjugated estrogen: 25mg Q4-6H • Transexamic acid (PO or [V) • Intrauterine tamponade with 26 French catheter with 30cc saline • Avoid vaginal packing - increased risk of infection, obscures ongoing hemorrhage • Medroxyprogesterone acetate PO Stat GYN consult or transfer for GYN care Hemodynamically stable NSAIDs Monophasic combined oral contraceptives: TID for 7 days • Contraindications: thromboembolic disease, breast cancer, liver dysfunction, smokers aged > 35 years, cardiovascular disease Progestin-only contraceptive: TID for 7 days • Use especially if concern for endometrial path0100' or breast cancer IM progestin xl in ED with 3 day course of PO Outpatient OBGYN follow-up for long-term therapy #AUB #Abnormal #Uterine #Bleeding #Management #Obstetrics #Gynecology
