DYSFUNCTIONAL UTERINE BLEEDING.ppt

DUB is a topic of midwifery nursing.

1. GOOD AFTERNOON

2. DYSFUNCTIONAL
UTERINE BLEEDING

3. DYSFUNCTIONAL UTERINE
BLEEDING
State of abnormal uterine bleeding
without any clinically detectable organic
pelvic pathology-tumour , inflammation
or pregnancy.
Incidence :10% amongest new patients
attending OPD

4. HORMONAL CYCLE

5. TYPES OF DUB
Regular bleeding or
ovular bleeding
Irregular bleeding or
anovular bleeding

6. OVULAR BLEEDING
OVULAR BLEEDING CONDITIONS:
-Childbirth
-Abortion
-During adolescent
-Premenopausal period
-PID

7. CAUSES OF REGULAR BLEEDING
1.Menorrhagia:
Cyclic bleeding at excessive in
amount >80 ml or duration or both.
Two varieties are found:
Irregular shedding of the
endometrium
Irregular ripening of the endometrium

8. IRREGULAR SHEDDING OF THE
ENDOMETRIUM
Incomplete withdrawal of LH even on
26
th
day of cycle -incomplete atrophy
of the corpus luteum-persistent
secretion of progesterone.
Persistent LH-inhibition of FSH-
supresses ripening of the follicle in the
next cycle-less oestrogen-less
regeneration
Variation of the endometrial receptors-
influence of oestrogen & progesterone

9. IRREGULAR RIPENING OF THE
ENDOMETRIUM
Poor formation and inadequate function
of the corpus luteum-inadequate
secretion of both oestrogen and
progesterone –inadequate support to
endometrial growth-slight bleeding
before menses.

10. 2.EPIMENORRHOEA: Cyclic bleeding where the
cycle is reduced to an arbitrary limit of 21 days
or less and remains constant at that frequency .
OR
EPIMENORRHAGIA: If the frequent cycle is
associated with excessive and prolonged
bleeding, it is called epimenorrhagia.

11. 3. OLIGOMENORRHOEA:
Menstrual bleeding occurring more than
35 days apart and which remains
constant at that frequency.
Causes:
-Ovarian unresponsiveness to FSH
-Secondary to pituitary dysfunction

12. PATHOLOGY OF DUB
The uterus: Uniformly enlarged due to
myohyperplasia
The endometrium: Overgrown, thick,
vascular, hyperplasia, swiss cheese
pattern.
The ovary: Cystic changes seen in one
or both the ovaries.

13. ANOVULAR BLEEDING
MENORRHAGIA:
-The endometrial growth is under the
influence of oestrogen and
progesterone throughout the cycle.
Due to anovulation endometrium
become fragile.

14. CYSTIC GLANDULAR HYPERPLASIA
OR METROPATHIA HAEMORRAGE:
After period of amenorrhoea for a
month or two months bleeding is
present which is painless.
Premenopause and adolescence
commonly seen.
Overion dysfunction-failure of LH
effect.

15. PATHOPHYSIOLOGY OF DUB
Local causes in the endometrium
Incordination in the hypothalamopituitory-
overian axis
Disturb normal hormonal balance
Disturb endometrial blood vessels and
capillaries
Abnormal uterine bleeding

16. CLINICAL FEATURES OF DUB
Menorrhagia
Polymenorrhoea
Menometrorrhagia
Prolonged painless bleeding
Sever anaemia
Enlarged cystic ovary felt on one or both
sides of the uterus

17. SYMPTOMS

18. Investigations of DUB
AIM:
To confirm the menstrual abnormality.
To exclude the organic pelvic pathology.
To identify the etiology of DUB.
To workout the definite therapy
protocol.

19. Investigations of DUB
History taking
General and systemic examination
Internal examination
Plan of special investigations
Blood values
Diagnostic uterine curettage
USG
Hysteroscopy, hysterography
Laproscopy

20. DIFFERENTIAL DIAGNOSIS
A)Pelvic condition :Abortion, disturbed tubal
gestation, endometrial TB and polyp, small
fibriod, endometrial carcinoma, IUCD.
B)Endocrinopathy : Granulosa cell tumour,
hypothyroidism causes anovulation
C)Haematological : Idiopathic thrombocytopenic
purpura, lukaemias, Von willebrand disease

21. MANAGEMENT OF DUB
Different phases:
Pubertal and adolescent menorrhagia < 20
yrs
Reproductive period (20-40 yrs.)
Premenopausal (> 40 yrs.)
Postmenopausal

22. M/N :PUBERTY MENORRHAGIA
•Rest , assurance
•Haematinics
Fails heavy bleeding
Admit for investigation
PRIMARY DUB SECONDARY DUB

23. PRIMARY DUB
PROGESTIN THERAPY(Metroxy
progesterone acetate10-20 mg/day)
Responsive
continue 2-3 cycles
Unresponsive conjugated
oestrogen 20-40 mg IV
every 6-8 hrs

24. M/N IN REPRODUCTIVE PERIOD
RESPO
NSIVE –
FOLLO
W UP
UNRESP
ONSIVE
REGULAR
CYCLE
IRREGULAR
CYCLE
INVESTIGATIONS
PATHOLOGY
DETECTED,
TREAT
ACCORDING
NEGATIVE
FINDINGS
USG,D+C
LAPEROSCO
PY, BIOPSY
FAMILY COMPLETED
HYSTERECTOMY
MEDICAL M/N,
FOLLOW UP

25. MEDICAL MANAGEMENT
PROGESTERON
COMBINED OESTROGEN –PROGESTERON
OESTROGEN
PROGESTIN RELEASING IUD
DANAZOL
CLOMIPHANE CITRATE
GnRH ANALOGUES
ANTIFIBRINOLYTIC DRUGS

26. SURGICAL MANAGEMENT

27. SURGICAL MANAGEMENT
UTERINE CURRETTAGE
ENDOMETRIAL ABLATION OR
RESECTION
HYSTERECTOMY

28. PREMENOPAUSAL M/N
MALIGNANCY EXCLUDED
ENDOMETRIUM
PROLIFERATIVE
ENDOMETRIUM HYPERPLASIA,
ATYPICAL HYPERPLASTIC
HYSTERECTOMY
PROGESTINS
RESPONSIVE
FOLLOW UP
UNRESPONSIVE
HYSTERECTOMY

29. M/N OF POSTMENOPAUSAL DUB
Exclude genital malignancy as in the
perimenopausal group
Bleeding stops •Bleeding continues
•Recurs
Follow up
Recurs
Hysterectomy

30. NURSING MANAGEMENT

31. NURSING MANAGEMENT
ASSESSMENT
GENERAL AND SYSTEMIC
EXAMINATION
NURSING CARE

32. NURSING DIAGNOSIS
ALTERED NUTRITION LESS THAN BODY
REQUIREMENT RELATED TO LOSS OF BLOOD
ANXIETY RELATED TO LOSS OF BLOOD
KNOWLEDGE DEFICIT REGARDING
MANAGEMENT AND DISEASE CONDITION
ACTIVITY INTOLERANCE RELATED TO
WEAKNESS
HIGH RISK FOR INFECTION RELATED TO
UNMET HYGIENE

33. DISCHAGE PLANNING
DIET
REST AND SLEEP
DRUGS
FOLLOW UP
PERSONAL HYGIENE

34. GREEN LEAFY
VEGETABLES

35. CEREALS AND PULSES

36. ALL YELLOW AND RED
VEGETABLES