Differential Diagnosis of Major Gynecologic Problems . Gynecology
Dr. Renna de Leon
Vaginal Bleeding
Abnormal Uterine Bleeding
• Prepubertal bleeding
• Menorrhagia - heavy or prolonged menstrual flow
• Metrorrhagia - intermenstrual bleeding
• Postcoital bleeding, and
• Postmenopausal bleeding
Vaginal Bleeding Related to Pregnancy
Pregnancy
• Implantation bleeding;
• Threatened,
• Inevitable,
• Complete, or
• Incomplete abortion;
• Ectopic pregnancy; and
• Molar pregnancy
Implantation Bleeding
• It usually consists of minimal bleeding at about the
time of the first missed menstrual period and
generally lasts a very short time.
• Occasionally, it may be present for 1 to 2 days, with
a flow similar to that of a menstrual period.
• Often, implantation bleeding is not perceptible to • Ectopic pregnancies cause vaginal bleeding because
the patient but can be seen by the physician as a of the separation of the decidua from the
brownish-tinged cervical mucus if a pelvic endometrium as the ectopic pregnancy dies or
examination is per- formed. because of direct bleeding from the site of the
ectopic pregnancy, with the blood being transported
Abortion to the uterus and through the cervix.
• About 20% to 25% of all pregnant women spot • In most but not all cases the patient misses at least
or bleed in the first trimester. one menstrual period, begins to bleed from scant to
Type Threatened Imminent Inevitable Complete Incomplete Missed significant amounts, and generally experiences pelvic
Bleeding +/- + ++ +/- ++ Spotting pain.
Uterine Compatible Compatible Incompatible Incompatible Incompatible Incompatible
size vs • Several types of patients are at high risk for ectopic
Gestation
Uterine +/- ++ +++ - +/- - pregnancy.
contraction
– Prior ectopic pregnancy
Cervical Closed Open Open Closed Open Closed
dilatation – Prior pelvic inflammatory disease
Bag of Intact Intact Ruptured NA Ruptured NA – Undergone tubal reparative procedures,
Water
Others + FHT + FHT + FHT Absent Passage of - FHT – Women who smoke, and
signs of meaty – Those who have been exposed in utero to
pregnancy tissues
<6 wks >6 wks diethylstilbestrol (DES).
Managment Bed rest Expectant Oxytocin Observation Curettage PG – Considered in users of intrauterine devices
D&C
(IUDs), since IUDs only partially protect
from tubular implantation.
– Increasing age is also a risk factor
Ectopic Pregnancy
• Management
• Defined as one that is implanted outside of the
– Medical management
endometrial cavity.
– Laparoscopy
• A primary ectopic pregnancy in a specific organ
– Laparatomy
implies that the pregnancy was implanted directly
within that organ.
Gestational Trophoblastic Disease
• A secondary ectopic pregnancy implies that the
• Describes a heterogeneous spectrum of diseases of
pregnancy ruptured from the fallopian tube and
abnormal trophoblastic proliferation ranging from
reimplanted completely or partially on another
benign to malignant, with varying predilections
organ.
toward local invasion and distant metastasis.
This study source was downloaded by 100000842568006 from CourseHero.com on 05-13-2022 02:04:15 GMT -05:00 1
https://www.coursehero.com/file/74031286/Insignis-GYNECOLOGY-Differential-Diagnosis-of-Major-Gyne-Problemspdf/
, Differential Diagnosis of Major Gynecologic Problems Gynecology
• Molar pregnancies Diagnosis
– CHM • Snow-storm pattern on US
– PHM • BHCG >100,000 IU/L
• GTN
– PSTT Treatment
– ETT • Suction curettage
– Choriocarcinoma • Hysterectomy
• Chemotherapy
Abnormal Uterine Bleeding
POLYP
• Cervical polyp
• Endometrial polyp
ADENOMYOSIS
• Presence of endometrial glands and stroma in the
myometrium
FEATURE COMPLETE MOLE PARTIAL MOLE LEIOMYOMA
Fetal or embryonic ABSENT PRESENT
tissue
Hydatidiform swelling DIFFUSE FOCAL
of
chronic villi
Trophoblastic DIFFUSE FOCAL
hyperplasia
Trophoblast stomal ABSENT PRESENT
inclusion
Genetic parentage PATERNAL BIPATERNAL
Karyotype 46,XX; 46XY 69,XXY; 69,XYY
Persistent HCG 20% 0.5%
CHM
• First trimester vaginal bleeding with or without
passage of molar vesicles
• Large-for-date uterus
• Absence of fetal movement
• Anemia secondary to occult hemorrhage
• Gestational HTN before 20 weeks AOG
• Presence of theca lutein cysts
• Hyperemesis
• Hyperthyroidism
• Respiratory distress
This study source was downloaded by 100000842568006 from CourseHero.com on 05-13-2022 02:04:15 GMT -05:00 2
https://www.coursehero.com/file/74031286/Insignis-GYNECOLOGY-Differential-Diagnosis-of-Major-Gyne-Problemspdf/
Dr. Renna de Leon
Vaginal Bleeding
Abnormal Uterine Bleeding
• Prepubertal bleeding
• Menorrhagia - heavy or prolonged menstrual flow
• Metrorrhagia - intermenstrual bleeding
• Postcoital bleeding, and
• Postmenopausal bleeding
Vaginal Bleeding Related to Pregnancy
Pregnancy
• Implantation bleeding;
• Threatened,
• Inevitable,
• Complete, or
• Incomplete abortion;
• Ectopic pregnancy; and
• Molar pregnancy
Implantation Bleeding
• It usually consists of minimal bleeding at about the
time of the first missed menstrual period and
generally lasts a very short time.
• Occasionally, it may be present for 1 to 2 days, with
a flow similar to that of a menstrual period.
• Often, implantation bleeding is not perceptible to • Ectopic pregnancies cause vaginal bleeding because
the patient but can be seen by the physician as a of the separation of the decidua from the
brownish-tinged cervical mucus if a pelvic endometrium as the ectopic pregnancy dies or
examination is per- formed. because of direct bleeding from the site of the
ectopic pregnancy, with the blood being transported
Abortion to the uterus and through the cervix.
• About 20% to 25% of all pregnant women spot • In most but not all cases the patient misses at least
or bleed in the first trimester. one menstrual period, begins to bleed from scant to
Type Threatened Imminent Inevitable Complete Incomplete Missed significant amounts, and generally experiences pelvic
Bleeding +/- + ++ +/- ++ Spotting pain.
Uterine Compatible Compatible Incompatible Incompatible Incompatible Incompatible
size vs • Several types of patients are at high risk for ectopic
Gestation
Uterine +/- ++ +++ - +/- - pregnancy.
contraction
– Prior ectopic pregnancy
Cervical Closed Open Open Closed Open Closed
dilatation – Prior pelvic inflammatory disease
Bag of Intact Intact Ruptured NA Ruptured NA – Undergone tubal reparative procedures,
Water
Others + FHT + FHT + FHT Absent Passage of - FHT – Women who smoke, and
signs of meaty – Those who have been exposed in utero to
pregnancy tissues
<6 wks >6 wks diethylstilbestrol (DES).
Managment Bed rest Expectant Oxytocin Observation Curettage PG – Considered in users of intrauterine devices
D&C
(IUDs), since IUDs only partially protect
from tubular implantation.
– Increasing age is also a risk factor
Ectopic Pregnancy
• Management
• Defined as one that is implanted outside of the
– Medical management
endometrial cavity.
– Laparoscopy
• A primary ectopic pregnancy in a specific organ
– Laparatomy
implies that the pregnancy was implanted directly
within that organ.
Gestational Trophoblastic Disease
• A secondary ectopic pregnancy implies that the
• Describes a heterogeneous spectrum of diseases of
pregnancy ruptured from the fallopian tube and
abnormal trophoblastic proliferation ranging from
reimplanted completely or partially on another
benign to malignant, with varying predilections
organ.
toward local invasion and distant metastasis.
This study source was downloaded by 100000842568006 from CourseHero.com on 05-13-2022 02:04:15 GMT -05:00 1
https://www.coursehero.com/file/74031286/Insignis-GYNECOLOGY-Differential-Diagnosis-of-Major-Gyne-Problemspdf/
, Differential Diagnosis of Major Gynecologic Problems Gynecology
• Molar pregnancies Diagnosis
– CHM • Snow-storm pattern on US
– PHM • BHCG >100,000 IU/L
• GTN
– PSTT Treatment
– ETT • Suction curettage
– Choriocarcinoma • Hysterectomy
• Chemotherapy
Abnormal Uterine Bleeding
POLYP
• Cervical polyp
• Endometrial polyp
ADENOMYOSIS
• Presence of endometrial glands and stroma in the
myometrium
FEATURE COMPLETE MOLE PARTIAL MOLE LEIOMYOMA
Fetal or embryonic ABSENT PRESENT
tissue
Hydatidiform swelling DIFFUSE FOCAL
of
chronic villi
Trophoblastic DIFFUSE FOCAL
hyperplasia
Trophoblast stomal ABSENT PRESENT
inclusion
Genetic parentage PATERNAL BIPATERNAL
Karyotype 46,XX; 46XY 69,XXY; 69,XYY
Persistent HCG 20% 0.5%
CHM
• First trimester vaginal bleeding with or without
passage of molar vesicles
• Large-for-date uterus
• Absence of fetal movement
• Anemia secondary to occult hemorrhage
• Gestational HTN before 20 weeks AOG
• Presence of theca lutein cysts
• Hyperemesis
• Hyperthyroidism
• Respiratory distress
This study source was downloaded by 100000842568006 from CourseHero.com on 05-13-2022 02:04:15 GMT -05:00 2
https://www.coursehero.com/file/74031286/Insignis-GYNECOLOGY-Differential-Diagnosis-of-Major-Gyne-Problemspdf/
