abnormal utrine bleeding

1. 🩺 Dr. Shamima Haque Tanija
Dr.Muaz Ibna Hossain
🎓 Intern Doctor,
💊 Department of Gynae & Obs,
🏥 Tairunnessa Memorial Medical College and Hospital.
Academic case Presentation:

2. Welcome to our presentation😁

3. Particulars of the Patient:
 Name: Poli Ahmed
 Age: 43 years
 Sex: Female.
 Address: College gate, Gazipur.
 Occupation: Housewife.
 Religion: Islam.
 Marital Status: Married
 Date & Time of Admission: 12/08/2023 @ 1.43 PM
 Date & Time of Examination: 12/08/2023 @ 2.00 PM

4. Chief Complaints:
 1.H/O Irregular menstruation for 2-3times in a month for
4months.
 2.Severe lower abdominal pain and excessive bleeding during
menstruation for same duration.
 3.Generalised weakness.

5. History of Present Illness:
According to the statement of the patient, she was
reasonably well 4months back. Then she suddenly developed
irregular menstruation for 2-3times in a month for
4months.She felt severe pain in lower abdomen during
menstruation with excessive bleeding.The pain reached its
peak at 2nd & 3rd day of menstruation.She also developed
generalised weakness since then. Her bowel and bladder
habit is normal. She is normotensive and a newly diagnosed
diabetic patient. Now she is admitted In the hospital for
better management.

6. Continue...
 Past History: Nothing significant.
 Family History: She has total 4 family members and all are
at good health.
 Drugs & Treatment History: She was taking
Tab.Normens,Cap.Sergel,Cap.Xamic and Tab.Rolac.
 Personal History: Nothing significant.

7. Continue...
 Allergy & Immunization History: She has no
allergic history. She has been immunized as per
current EPI schedule of Bangladesh.
 Socioeconomic History: She belongs to a middle
class family & lives with good water supply & well
sanitization.
 Menstrual History: MC/MP -Irregular for the past
4months/ (8-10 days)
L.M.P:26/06/2023

8. Obstetrical history: Married
for:26years.
Para:2(1NVD+1C/S)
Age of last child:22years.

9. General Examination:

10.  Appearance: Ill looking.
 Body Build & Nutrition: Average.
 Decubitus: On choice.
 Cooperation: Cooperative.
 Pulse: 80 beats/min
 Blood Pressure: 120/80 mmHg
 Respiratory Rate: 20 breaths/min
 Temperature: 98°F (at examination time)

11. Continue..
 Anaemia: Present.
 Jaundice: Absent.
 Cyanosis: Absent.
 Clubbing: Absent.
 Koilonychia: Absent
 Leukonychia: Absent
 Oedema: Absent
 Dehydration: Absent.

12. Continue...
 Neck Vein: Not engorged.
 Thyroid Gland: Not enlarged.
 Lymph Nodes: Not palpable.
 Bony Tenderness: No bony-tenderness.
 Pigmentation: No pigmentation were seen.
 Body Hair Distribution: Normal as like female pattern according to
age.

13. SYSTEMIC EXAMINATION:

14.  Abdomen:
A. Inspection: Shape of abdomen is flat, flanks are empty and
there is no visible pulsation, no scar mark is seen.
B. Palpation:
★ Soft & Non-tender.No mass is found.
★Uterus -not palpable.
★ Liver- not palpable.
★ Spleen- not palpable.
★ Kidneys- not Ballotable.
C. Percussion: Tympanic.
D. Auscultation: Bowel sound present.

15. Respiratory system:
 Inspection: Chest shape is normal, chest movement is
symmetrical & intercostal spaces were full.
 Palpation: Trachea is centrally placed, Chest
expandability is normal and symmetrical, vocal fremitus
was normal.
 Percussion: Resonant.
 Auscultation: Breath sound is vesicular and no added
sound is found.

16. Cardiovascular System:
 Inspection: There is no visible carotid & epigastric pulsation and
no cardiac impulse were seen.
 Palpation:
★ Apex beat was found at left 5th intercostal space which was
9cm away from mid line.
★ Thrill- Absent.
★ Palpable P2: Found in Pulmonary area.
★ Left Parasternal Heave: Absent.
 Auscultation: 1st & 2nd heart sounds were audible at all
auscultatory area of precordium and there is no murmur present.

17. Continue...
 Other systemic examination reveals no abnormality.

18. Local Examination:
Per abdominal examination:abdomen was soft,non-
tender.No mass was found.Uterus was not palpable.

19. Salient Feature:
 Poli ahmed,43years old female hailing from College
gate,Gazipur, admitted into this hospital with the complaints of
H/O Irregular menstruation for 2-3times in a month,with lower
abdominal pain and excessive bleeding during menstruation and
generalised weakness for 4months...She got medical treatment
but her condition didn't improve. On general examinations,
pulse was 80 beats/min, blood pressure- 120/80 mmHg,
respiratory rate 20 breaths/min, temperature- 98°F and
anemia was present. All other vital parameters were normal.

20. Continue..
On systemic examinations, abdomen was flat in shape and soft &
non-tender, bowel sound was present. Her bowel & bladder habit
is normal. Other systemic examination reveals no abnormalities.

21. Provisional Diagnosis:
 Abnormal uterine bleeding (Dysfunctional
uterine bleeding due to unknown
etiology).

22. Differential Diagnosis:
1.PCOS.

23. Investigations:
 USG of lower abdomen.
 Blood grouping and Rh typing
 CBC
 Urine R/M/E
 Random blood sugar
 Serum creatinine
 RBS
 TSH

24. Investigations:
 CBC-
★ HB%:- 10.3gm/dL
★ ESR:- 54mm (1st hour)
★ Total WBC:- 4,740 /Cumm
★ Platelet count:- 189×103 /uL
 S. Creatinine- 0.92 mg/dL
 RBS:- 15.40 mmol/L
 Urine R/M/E:Pus cell 2-4/HPF, Epi.cell-3-5/HPF
 Blood group:- “B” positive
 TSH:1.75 mcl/ml, ECG:Normal

26. Confirmatory Diagnosis:
 Dysfunctional Uterine Bleeding due to unknown
etiology.

27. Treatment plan
 Total abdominal hysterectomy(TAH)
 On 13/08/2023 @11.00AM
 Surgeon: Associate professor Dr.Rowshon Ara.

28. Contd…
 Procedure : With all aseptic precautions under SAB & after
proper painting & drapping abdomen was opened by
Pfannenstiel incision.Then after proper clamping TAH was
done.Both sided ovaries were healthy and preserved.Before
operation,patient was transfused with 2units of PCV.After
operation,specimen was sent for histopathology.

29. Abnormal Uterine Bleeding
 Any uterine bleeding outside the normal
volume,duration,regularity or frequency is
considered abnormal uterine bleeding.
Classification of AUB:
 Structural causes(PALM)
 Polyp
 Adenomyosis
 Leiomyoma
 Malignancy & hyperplasia.

30. Non structural systemic causes(COIEN)
 Coagulopathy
 Ovulatory dysfunction
 Endometrial
 Iatrogenic
 Not yet identified.

31. Dysfunctional Uterine Bleeding
 It may be defined as a state of abnormal uterine
bleeding without any clinically detectable
organic,systemic & iatrogenic cause.
Classification:
1.ovulatory &
2.Anovulatory

32. Medical conditions associated with DUB
 1.PCOS
 2.Obesity
 3.Hyperandrogenism
 4.Adrenal disease.
 5.Thyroid disease.
 6.Anorexia nervosa.

33. Treatment of DUB
 Medical treatment (Non hormonal):
 Prostaglandin synthetase inhibitors-
Mefenamic acid.
 Antifibrinolytic agents:Tranexamic acid.
 Hormonal:Medroxyprogesterone
acetate,Danazol,GnRH analogues etc.
Surgical management:Hysterectomy.