Uterine Bleeding, Acute Abnormal Clinical Pathway — Emergency Department

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metric

Adolescent with Suspected
Acute Abnormal Uterine Bleeding

Conserving IVF During Shortage

ED Triage

Concern for Hemorrhagic Shock

Manage as clinically indicated

ED Team Assessment
- History and Physical
  - VS, Orthostatic BP changes
  - Symptoms of hypovolemia, anemia
- Differential Diagnosis
Initial Labs
- HCG, CBC
- Type and screen, PT/INR, PTT
  as indicated
- STI testing as indicated
IV Fluids as indicated

HCG +

PHL: Consider transfer to HUP
- Interfacility Transfer Process
KOPH: Consider transfer to Paoli
Consider Social Work Consult

Mild

Moderate

Severe

Hgb > 12 mg/dL, if checked
and
No significant ongoing blood loss

Hgb 8-12 mg/dL
or
Significant ongoing blood loss

Hgb < 8 mg/dL
or
Hemodynamic instability

Discharge Considerations

ED APP follow-up for Moderate/Severe AUB discharged from the ED, occurs in 3 days
Follow-up with Adolescent Specialty Clinic/Gynecology or PCP
Refer to Hematology if concern for Bleeding Disorder

Posted: June 2015
Last Revised: November 2024, Revisions

Authors:
- J. Pletcher, MD;
- C. Jacobstein, MD;
- J. Posner, MD;
- J. Lavelle, MD;
- L. Karel, Pharm D;
- K. Smith-Whitley, MD;
- C. Witmer, MD;
- A. Paul, DO;
- S. DiGirolamo, CRNP

Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Adolescent with Acute Abnormal Uterine Bleeding

Evidence