Hemodynamically unstable reproductive-age patient with acute uterine bleeding: Initial management

Acute uterine bleeding in a reproductive-aged patient refers to bleeding that is either profuse or prolonged, and may be an isolated or recurrent event. Hemodynamically unstable patients require immediate vascular access and blood product replacement. Treatment of the underlying condition (eg, submucosal fibroid, bleeding disorder, endocrine abnormality), if present, may prevent the episode from recurring. Hemodynamically stable patients are managed differently; refer to related UpToDate content.

D&C: dilation and curettage; UAE: uterine artery embolization; IV: intravenous.

* Intrauterine tamponade (ie, with an intrauterine balloon or gauze packing) is used in conjunction with administration of blood products to stabilize the patient while more definitive therapy (ie, D&C) is implemented.

¶ UAE may be used as an alternative to D&C in some patients (eg, suspected arteriovenous malformation); hysterectomy is rarely performed.

Δ The safety of pregnancy after UAE is uncertain and may be associated with adverse outcomes (eg, miscarriage, preterm birth, placental problems, malpresentation); refer to related UpToDate content.

◊ How to choose the medical regimen is discussed in related UpToDate content.

§ Estrogen therapy is contraindicated in patients at high risk for venous thromboembolism and coronary or cerebral thrombosis. This is discussed in detail in related UpToDate content.

¥ An endometrial specimen should be collected prior to hormonal therapy, whenever possible.

‡ The risk of thrombotic events with short-term tranexamic acid is controversial; refer to related UpToDate content.

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Hemodynamically unstable reproductive-age patient with acute uterine bleeding: Initial management