ºÝºÝߣ

ºÝºÝߣShare a Scribd company logo

DL 16-AUB.pptx

•Download as PPTX, PDF•
•
orampo
orampo

This document discusses abnormal uterine bleeding (AUB), including definitions, classifications, causes, clinical features, investigations, and management. It describes the normal menstrual cycle and defines common terms used to describe abnormal bleeding patterns. It covers the FIGO (PALM-COEIN) classification system for AUB and discusses causes and treatments for different types of abnormal bleeding throughout a woman's reproductive life, including puberty menorrhagia, metrorrhagia, and metropathia hemorrhagica. Investigations include ultrasound, hysteroscopy, and dilation and curettage. Treatment depends on the underlying cause but may include hormonal therapy, NSAIDs, intrauterine devices, endometrial ablation procedures,

1 of 32
Download to read offline
Abnormal uterine bleeding
SLO 1.Discuss about the definition, incidence, pathogenesis and PALM- COEIN classification of AUB. 2. Discuss the etiology, clinical features, investigations and treatment of puberty menorrhagia. 3. Discuss about the Metropathica hemorrhagica, irregular ripening and Halban’s disease.
Objectives • Normal uterine bleeding • Common terminologies • Classification • Pathogenesis • Investigation • Management
Normal uterine bleeding • Normal duration – 3-7 days • Normal cycle frequency – 21- 35 days • Normal amount – 30- 80ml • Normal control of menstrual bleeding Menstrual bleeding- Platelet aggregation forms clot Prostaglandin F2alpha- myometrial contraction, constricts Endometrial vessels
Common terminologies • Menorrhagia – Cyclical bleeding Excessive In amount or duration . Polymenorrhea – frequent cycles <21 days . Epimenorrhagia- frequent cycles + excessive bleeding . Metrorrhagia – intermenstrual bleeding . Oligomenorrhea- cycles frequency > 35days Hypomenorrhea- Scanty bleeding, cycle duration less than 2 days . Menometrorrhagia- Bleeding irregular and excessive
Abnormal uterine bleeding • Excessive bleeding forom the uterus through the gental tract with palpable pelvic organ pathology or macroscopic / microscopic pathology.
Menorrhagia- causes • Pelvic • Fibroid uterus • Adenomyosis • Endometriosis • IUCD in utero • Chronic tubo ovarian mass • Tubercular endometritis • Retroverted uterus • Granulosa cell tumour
Continued…… • Systemic Liver dysfunction . Congestive cardiac failure . Severe hypertension Endocrine hypothyroidism . Hyperthyroidism Hematological Idiopathic thrombocytopenic purpura . Leukemia . Von willebrand disease . Platelet deficiency
DL 16-AUB.pptx
Polymenorrhea - causes • Dysfunctional –during adolescence • - preceding menopause • - following delivery and abortion • Ovarian hyperemia • PID and ovarian endometriosis
Metrorrhagia - causes • Causes of acyclic bleeding • DUB • Submucous fibroid • Uterine polyp • Carcinoma cervix • causes of contact bleeding • Ca cervix • Mucous polyp of cervix • Vascular ectopy of cervix • Cervicitis • Cervical endometriosis
• Causes of Intermenstrual bleeding • Urethral caruncle • Decubitus ulcer • Breakthrough bleeding • Iucd in utero • Ovular bleeding
Oligomenorrhea • Causes • Age related – adolescence and menopause • Obesity • Stress related and exercise related • Endocrine –Pcos, hyperthyroidism, hyperprolactinemia • Androgen producing tumours – ovarian , adrenal tumours • Tubercular endometritis • Drugs – phenothiazine, cimetidine, methyldopa
Hypomenorrhea • Causes • Uterine synechiae • Tubercular endometritis- late cases • Oral contraceptive • Thyroid dysfunction • Malnutrition
FIGO classification • PALM COEIN • Polyp • Adenomyosis • Leiomyoma • Malignancies • Coagulopathy • Ovulatory dysfunction • Endometrial causes • Iatrogenic • Not yet classified
DL 16-AUB.pptx
DL 16-AUB.pptx
Dysfunctional uterine bleeding • Abnormal uterine bleeding without any palpable pelvic organ pathology either macroscopic or microscopic. • Common during extremes of reproductive life, following pregnancy during lactation • Immature hypothalamic pituitary ovarian axis- anovulatory cycle • Types • Anovulatory cycles- • Ovulatory cycles
Pathogenesis • PGE2 and PGI2- vasodilators antiplatelet aggregates • PGF2alpha and Thromboxane A2- vasoconstriction and platelet aggregates • Progesterone- secretes PGF2alpha • Anovulatory cycles- absence of progesterone- reduced PGF2alpha- vasodilatation- menorrhagia • Tissue plasminogen activator - fibrinolytic enzyme- increased- menorrhagia • Low endothelin(vasoconstrictor)- vasodilatation- menorrhagia
Puberty menorrhagia • Causes • Hypothalamic pituitary ovarian dysfunction • Blood dyscrasia- coagulation disorders, thrombocytopenic purpura, von willebrand disease, leukemia • Hypothyroidism • Genital tuberculosis • Liver disorders • Feminising ovarian tumour, adrenal hyperplasia
Clinical features • Often Initial cycles regular • Heavy regular cycles or • Normal bleeding for several days • Investigations • Hb, bleeding time, clotting time, coagulation factors, blood film • Xraychest - tb • Thyroid function test • Ultrasound • D &C - tb endometrium
Management • Treat cause, anemia • Anovulatory cycles-acute - IV premarin 25mg 6-8hrly Estrogen for 21days Progesterone- for 10 days for 3-6cycles • Chronic - oral combined pills or cyclical progesterone • NSAIDs- mefenemic acid ,naproxen, ponstan, ibuprofen • Mirena IUCD, Arterial embolisation, Uterine tamponade- foley catheter for 24hrs • Anti tb treatment • Iv tranexemic acid with oestrogen • Desmopressin analogue of arginine vasopressin iv or nasal spray- von willebrand disease
Reproductive age • Causes • PALM COEIN classification • PALM- structural abnormaties- studied by imaging and histopathological study • COEIN- non structural- coagulation disorders and hormonal dysfunction
Investigation • Ultrasound- polypus, adenomyosis, leiomyoma, malignancy • Saline sonography- polypus • Hysteroscopy- polypus • Dilitaion and curettage • Papsmear
Childbearing and premenopausal women • Metropathia hemorrhagica • Anovulatory AUB- 40-45years • Continuous painless vaginal bleeding preceded by 6-8weeks of amenorrhoea • Uterus slightly bulky • Myohyperplasia- Uterine wall measurements upto 25mm • Endometrium thick , polypoidal, thin slender polypi project into Uterine cavity • Cystic glandular hyperplasia- Swiss cheese pattern
DL 16-AUB.pptx
DL 16-AUB.pptx
Investigation • Hb, thyroid function test, coagulation profile • Ultrasound • Curettage, uterine aspiration, hysteroscopic biopsy • Doppler ultrasound- endometrial vascularity • Hysterosalpingography and saline salpingography
Treatment • Correct anemia • Treat the cause • Combined oral contraceptives • Progestogens • Gestrinone • Danazol • GnRH analogues- 4weekly inj • Tranexemic acid • NSAIDs, ethamsylate , mirena iucd • SERM- ormeloxifene, centchroman
Minimal invasive surgery • Ablative techniques • 1st generation- hysteroscopic ablation endometrium resectoscope, roller ball laser • 2nd generation- radio frequency induced thermal ablation, balloon therapy, microwave ablation • Uterine tamponade- • Bilateral uterine artery embolisation • If no response- hysterectomy
DL 16-AUB.pptx
Thank you

More Related Content

DL 16-AUB.pptx

  • 2. SLO 1.Discuss about the definition, incidence, pathogenesis and PALM- COEIN classification of AUB. 2. Discuss the etiology, clinical features, investigations and treatment of puberty menorrhagia. 3. Discuss about the Metropathica hemorrhagica, irregular ripening and Halban’s disease.
  • 3. Objectives • Normal uterine bleeding • Common terminologies • Classification • Pathogenesis • Investigation • Management
  • 4. Normal uterine bleeding • Normal duration – 3-7 days • Normal cycle frequency – 21- 35 days • Normal amount – 30- 80ml • Normal control of menstrual bleeding Menstrual bleeding- Platelet aggregation forms clot Prostaglandin F2alpha- myometrial contraction, constricts Endometrial vessels
  • 5. Common terminologies • Menorrhagia – Cyclical bleeding Excessive In amount or duration . Polymenorrhea – frequent cycles <21 days . Epimenorrhagia- frequent cycles + excessive bleeding . Metrorrhagia – intermenstrual bleeding . Oligomenorrhea- cycles frequency > 35days Hypomenorrhea- Scanty bleeding, cycle duration less than 2 days . Menometrorrhagia- Bleeding irregular and excessive
  • 6. Abnormal uterine bleeding • Excessive bleeding forom the uterus through the gental tract with palpable pelvic organ pathology or macroscopic / microscopic pathology.
  • 7. Menorrhagia- causes • Pelvic • Fibroid uterus • Adenomyosis • Endometriosis • IUCD in utero • Chronic tubo ovarian mass • Tubercular endometritis • Retroverted uterus • Granulosa cell tumour
  • 8. Continued…… • Systemic Liver dysfunction . Congestive cardiac failure . Severe hypertension Endocrine hypothyroidism . Hyperthyroidism Hematological Idiopathic thrombocytopenic purpura . Leukemia . Von willebrand disease . Platelet deficiency
  • 10. Polymenorrhea - causes • Dysfunctional –during adolescence • - preceding menopause • - following delivery and abortion • Ovarian hyperemia • PID and ovarian endometriosis
  • 11. Metrorrhagia - causes • Causes of acyclic bleeding • DUB • Submucous fibroid • Uterine polyp • Carcinoma cervix • causes of contact bleeding • Ca cervix • Mucous polyp of cervix • Vascular ectopy of cervix • Cervicitis • Cervical endometriosis
  • 12. • Causes of Intermenstrual bleeding • Urethral caruncle • Decubitus ulcer • Breakthrough bleeding • Iucd in utero • Ovular bleeding
  • 13. Oligomenorrhea • Causes • Age related – adolescence and menopause • Obesity • Stress related and exercise related • Endocrine –Pcos, hyperthyroidism, hyperprolactinemia • Androgen producing tumours – ovarian , adrenal tumours • Tubercular endometritis • Drugs – phenothiazine, cimetidine, methyldopa
  • 14. Hypomenorrhea • Causes • Uterine synechiae • Tubercular endometritis- late cases • Oral contraceptive • Thyroid dysfunction • Malnutrition
  • 15. FIGO classification • PALM COEIN • Polyp • Adenomyosis • Leiomyoma • Malignancies • Coagulopathy • Ovulatory dysfunction • Endometrial causes • Iatrogenic • Not yet classified
  • 18. Dysfunctional uterine bleeding • Abnormal uterine bleeding without any palpable pelvic organ pathology either macroscopic or microscopic. • Common during extremes of reproductive life, following pregnancy during lactation • Immature hypothalamic pituitary ovarian axis- anovulatory cycle • Types • Anovulatory cycles- • Ovulatory cycles
  • 19. Pathogenesis • PGE2 and PGI2- vasodilators antiplatelet aggregates • PGF2alpha and Thromboxane A2- vasoconstriction and platelet aggregates • Progesterone- secretes PGF2alpha • Anovulatory cycles- absence of progesterone- reduced PGF2alpha- vasodilatation- menorrhagia • Tissue plasminogen activator - fibrinolytic enzyme- increased- menorrhagia • Low endothelin(vasoconstrictor)- vasodilatation- menorrhagia
  • 20. Puberty menorrhagia • Causes • Hypothalamic pituitary ovarian dysfunction • Blood dyscrasia- coagulation disorders, thrombocytopenic purpura, von willebrand disease, leukemia • Hypothyroidism • Genital tuberculosis • Liver disorders • Feminising ovarian tumour, adrenal hyperplasia
  • 21. Clinical features • Often Initial cycles regular • Heavy regular cycles or • Normal bleeding for several days • Investigations • Hb, bleeding time, clotting time, coagulation factors, blood film • Xraychest - tb • Thyroid function test • Ultrasound • D &C - tb endometrium
  • 22. Management • Treat cause, anemia • Anovulatory cycles-acute - IV premarin 25mg 6-8hrly Estrogen for 21days Progesterone- for 10 days for 3-6cycles • Chronic - oral combined pills or cyclical progesterone • NSAIDs- mefenemic acid ,naproxen, ponstan, ibuprofen • Mirena IUCD, Arterial embolisation, Uterine tamponade- foley catheter for 24hrs • Anti tb treatment • Iv tranexemic acid with oestrogen • Desmopressin analogue of arginine vasopressin iv or nasal spray- von willebrand disease
  • 23. Reproductive age • Causes • PALM COEIN classification • PALM- structural abnormaties- studied by imaging and histopathological study • COEIN- non structural- coagulation disorders and hormonal dysfunction
  • 24. Investigation • Ultrasound- polypus, adenomyosis, leiomyoma, malignancy • Saline sonography- polypus • Hysteroscopy- polypus • Dilitaion and curettage • Papsmear
  • 25. Childbearing and premenopausal women • Metropathia hemorrhagica • Anovulatory AUB- 40-45years • Continuous painless vaginal bleeding preceded by 6-8weeks of amenorrhoea • Uterus slightly bulky • Myohyperplasia- Uterine wall measurements upto 25mm • Endometrium thick , polypoidal, thin slender polypi project into Uterine cavity • Cystic glandular hyperplasia- Swiss cheese pattern
  • 28. Investigation • Hb, thyroid function test, coagulation profile • Ultrasound • Curettage, uterine aspiration, hysteroscopic biopsy • Doppler ultrasound- endometrial vascularity • Hysterosalpingography and saline salpingography
  • 29. Treatment • Correct anemia • Treat the cause • Combined oral contraceptives • Progestogens • Gestrinone • Danazol • GnRH analogues- 4weekly inj • Tranexemic acid • NSAIDs, ethamsylate , mirena iucd • SERM- ormeloxifene, centchroman
  • 30. Minimal invasive surgery • Ablative techniques • 1st generation- hysteroscopic ablation endometrium resectoscope, roller ball laser • 2nd generation- radio frequency induced thermal ablation, balloon therapy, microwave ablation • Uterine tamponade- • Bilateral uterine artery embolisation • If no response- hysterectomy