MIDWIFERY DYSFUNCTIONAL UTERINE BLEEDING.pdf

midwifery presentation

1. DYSFUNCTIONAL
UTERINE
BLEEDING

2. INTRODUCTION TO DUB
DUB refers to any heavy or unusual bleeding from the uterus.
It can occur during your menstruation, during or after sex and
post menopause.
It is defined as a change in volume, regularity and time that has
been present for 6 months or longer.

3. CAUSES
P- Polyp
A- Adenomyosis
L- Leiomyoma
M- Malignancy
C- Coagulopathy
O- Ovulatory dysfunction
E- Endometrial dysfunction
I- Iatrogenic
N- Not otherwise classified

4. POLYPS. Tumors in the endometrium which may bleed.
ADENOMYOSIS. Endometrial tissue within the myometrium.
LEIOMYOMATA. Fibroids.
MALIGNANCY. Bleeding can be caused by cervical cancer.
COAGULOPATHY. Bleeding in patients with clotting dysfunction
disorders.
OVULATORY DYSFUNCTION. Cyclical production of progesterone.
ENDOMETRIAL DYSFUNCTION. A diagnosis of exclusion when no
structural causes an be identified.
IATROGENIC. Bleeding arising from use of medication such as
anticoagulants and hormonal contraceptives
NOT OTHERWISE CLASSIFIED. No known cause.

5. SIGNS AND SYMPTOMS
Heavy menstrual bleeding1.
Bleeding or spotting between periods2.
Unusual bleeding after sex or post menopause3.
Irregular cycles longer than 35 days or less that 21 days4.

6. COMPLICATIONS
Hypovolemic shock1.
Iron deficiency anemia2.
Infertility due to ovulatory dysfunction3.
Endometrial cancer4.

7. DIAGNOSIS
History of frequency, duration, volume and regularity for the past 6
months
1.
.
2. Lab tests. FBC, pregnancy test, Coagulation screening, LH and FSH
tests
3.Imaging. U/S to detect polyps and fibroids
Hysteroscopy to visualize the uterus
MRI

8. TREATMENT
Polyps - Typically removed via hysteroscopy1.
2.Adenomyosis - Progestin-secreting Intra Uterine Device, COCs
3. Leiomyoma- Myomectomy or hysterectomy
4. Malignancy - Surgery, chemtherapy, radiation therapy
5.Coagulopathy- Tranexamic acid (antifibrinolytic) and Recombinant
Activated Factor VII for Von Willebrand's disease
6. Ovulatory Dysfunction - Continuous progestin exposure
7. Endometrial dysfunction - COCs, NSAIDs, Tranexamic acid
8. Iatrogenic - Vaginal estrogen
9. NOC - Ultrasound guided treatment

9. REFERENCES
https://emedicine.medscape.com

10. THANK
YOU VERY
MUCH!