Abnormal uterine bleeding obstetrics & gynecology.pdf

Abnormal uterine bleeding by intern doctor Mohammed Gaber nada.
Al-azhar university hospitals , Damietta

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I.D: MOHAMED GABER NADA

2. CONTENT
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Introduction
Definition
Patterns
Classification & Causes
Diagnosis
Treatment
Case Study

3. INTRODUCTION
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Normal menstrual bleeding
Start at the period from puberty to menopause characterized
by :
•Regularity
•Duration from 2 to 7 days
•Frequent every 28 days
•Amount from 30 to 50 ml
Other than this ranges equal abnormal bleeding

4. Patterns Classification
According to Figo system {PALM COIEN}
P for polyp
A for adenomyosis
L for leiomyoma
M for Malignancy
C for coagulopathy
O for ovulatory dysfunction
E for endometrial hyperplasia
I for iatrogenic cause
N Not yet classified
A) Cyclic bleeding :
Menorrhagia
Polymenorrhea
Polymenorrhagia
B) Acyclic bleeding
-Metrorrhagia
-Menometrorrhagia
-intermenstrual bleeding

5. According To Origin
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•Organic {structural}
General ex bleeding tendency , HTN , DM , Drugs
Local ex PALM , pregnancy complications , contraception complications
•A organic { Not structural }
Cyclic (ovular) ex menorrhagia
Acyclic (Anovular) ex metropathia hemorrhagica { COEIN }
This is called DUB
Abnormal uterine bleeding in absence of obvious organic cause

6. According to age
PRESENTATION TITLE
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A) Before puberty
precious puberty
Foreign bodies
pre pubertal vulvovaginitis
B) Childbearing period
PALM COEIN
pregnancy complications
Contraception complications
C) After menopause
Endometrial carcinoma most serious cause
Atrophic endometritis
Hormonal replacement therapy
Systemic causa as HTN

7. Diagnosis
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HISTORY
Age
Marital status
Present history
Contraception
Pregnancy
SYMPTOMS
Period of
amenorrhea.
Bleeding
characterized by
Painless profuse
prolonged
irregular
GENERAL
EXAMINATION
Anemia
Metastasis
Jaundice
General disorders
as thyroid
LOCAL
EXAMINATION
Pelviabdominal
swelling
PV for local cause
Cusco speculum
INVESTIGATIONS
CBC thyroid function test
Tumor markers as CA-125
US TV & TA for organic
cause or not.
D&C for diagnostic and
therapeutic.
Hysteroscopy or
laparoscopy

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Treatment
A) treatment for the organic cause
ex
-polyp resection
-adenomyosis TAH BSO
-leiomyoma myomectomy & Hysterectomy
-endometrial carcinoma surgery & adjuvant therapy
B) General measures
1-correction of anemia by iron & vitamins.
2-anti PG as ibuprofen.
3-anti-fibrinolytics as tranexamic acid ( Kapron ).
4-homeostatic as daflon, dicynone.

9. C) Hormonal Therapy
1-Progestins
-Provera 10 Mg For 21 Days
-LNG-IUS (Mirena) Lead To Bleeding Risk 90% In 1 Yrs
2-Coc Once Daily: 21 Days , Stop 1 Wk. , Repeat
if patient complain of infertility induction of ovulation
D) surgical
1-D&C diagnostic and therapeutic.
2-hysteroscopic endometrial ablation.
-The best if patient surgical unfit
3-Hysterectomy
-if failed all above measures to stop bleeding
-associating pathology is found
-old age
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PRESENTATION TITLE

10. Management Of Acute Bleeding
A)Hospitalization & resuscitation
esp.
-if hemoglobin less than 7 mg/dl
-bad general condition
B) Emergent D&C
-the best treatment of choice for hemodynamically
unstable
C) if persistent bleeding after curettage
-High doses of IV estrogen
D) others
-Intrauterine balloon tamponade
-Uterine artery embolization
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11. Case study
A 59-year-old woman awoke with blood on her nightdress, which was bright red but not heavy. There were no clots of
blood and there was no associated pain. The bleeding has recurred twice since in similar amounts.
Her last period was at the age of 49 years and she has had no other intervening bleeding episodes. She suffered hot
flushes and night sweats around the time of her menopause, which have now stopped. She is sexually active but has
noticed vaginal dryness on intercourse
recently.
She has always had normal cervical smears, the last one being 7 months ago. She had two children by spontaneous
vaginal delivery and had a laparoscopic sterilization aged 34 years. She has never used hormone-replacement therapy
(HRT). She takes atenolol for hypertension and omeprazole for epigastric pain.
Examination
She is slightly overweight. Abdominal examination is normal. The vulva and vagina appear thin and atrophic and the
cervix is normal. The uterus is small and anteverted and with no palpable adnexal masses.
An outpatient endometrial biopsy is taken at the time of examination and sent for histological examination.
Investigation
Transvaginal ultrasound scan
Endometrial biopsy report: the specimen shows atrophic endometrium with no evidence of inflammation, hyperplasia or
malignancy.11
PRESENTATION TITLE

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Questions
• What is the likely diagnosis?
• How would you manage this patient?

13. AUB
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14. THANK YOU
Al-azharUniversity Hospital –New Damietta