ACUTE ABNORMAL UTERINE BLEEDING

Aub2ACUTE ABNORMAL UTERINE BLEEDING

1. Mahmood Al haddabi r2 MANAGEMENT OF acute aub

2. Introduction Abnormal Uterine bleeding (AUB) bleeding from the uterus that is abnormal in: Regularity Volume Frequency Duration In the absence of pregnancy

3. Acute AUB ; episode of heavy bleeding that require immediate intervention to prevent further blood loss. Can be spontaneous or on top of chronic AUB.

4. Approach the general process for evaluating patients who present with AUB: Determine patient acuity. Determine the most likely etiology. Choosing the most appropriate treatment

5. Assessment of the patient Assessment for signs of hypovolemia and vital signs.

6. Etiologies History: Details of the current bleeding episode + related symptoms. Past menstrual, gynecologic and medical history. Systemic disease such as: leukemia, liver diseases Medications.

7. Physical Examination Signs of hypovolemia . Pelvic examination (speculum and bimanual)

8. treatment to control the current episode of heavy bleeding. To reduce menstrual blood loss in subsequent cycles

9. Acute AUB managment IV conjugated estrogen: In one RCT shown to stop bleeding by 72% within 8 hours compared 38% who receive placebo. The only medication approved by FDA for acute AUB. Intrauterine tamponade : With 26F infused with 30 mL saline

10. COC and oral progestins commonly used in acute AUB. One study compared (TID dose for one week) COC Vs medroxyprogestrone acetate. Study found bleeding stopped in 88% who took COC compared to 76% who took medroxyprogestrone acetate within median time of 3 days .

11. Antifibrinolytic : Such as Tranexamic acid. Prevent fibrin degradation. Effective for chronic AUB. Reduce bleeding by 30-55%

12. Long term treatment for chronic AUB Levonorgestrel intrauterine system. OCO (monthly or extended cycles). Progestin therapy (oral or IM) Tranexamic acid. NSAIDS

13. Patients with known or suspected bleeding disorder may responds to the hormonal and non-hormonal management. Consultation with hematologiest is recommended. Desmopressin may help treat acute AUB in patients with von Willebrand disease.

14. Factor VIII and von Willebrand factor may reqiured to control severe hemorrhage. Patients with bleeding disorders or platelet function abnormalities should avoid NSAIDs

15. Surgical management based on the clinical stability of the patient, severity of bleeding, contra-indication to medical management. Includes : Dilation and curettage (D&C). Endometrial ablation. Uterine artery embolization. Hysterectomy.