1. Acute abnormal uterine bleeding (AUB) requires immediate intervention to prevent blood loss and is evaluated by assessing patient acuity, determining the likely etiology, and choosing appropriate treatment. 2. Initial assessment involves vital signs and signs of hypovolemia while etiologies consider medical history, medications, physical exam, and lab tests. 3. Treatment options for acute AUB include IV conjugated estrogen, intrauterine tamponade, combined oral contraceptives, antifibrinolytics, and surgery if medical options fail or are contraindicated. Long term options treat underlying causes.

1. M A H M O O D A L H A D D A B I R 2
MANAGEMENT OF
ACUTE AUB

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

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

5. APPROACH
• the general process for evaluating patients who
present with AUB:
1. Determine patient acuity.
2. Determine the most likely etiology.
3. Choosing the most appropriate treatment

6. ASSESSMENT OF THE PATIENT
• Assessment for signs of hypovolemia and vital signs.

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

8. PHYSICAL EXAMINATION
Signs of hypovolemia.
Pelvic examination (speculum and bimanual)

11. TREATMENT
• to control the current episode of heavy
bleeding.
• To reduce menstrual blood loss in subsequent
cycles

12. 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

13. • 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.

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

15. LONG TERM TREATMENT FOR CHRONIC AUB
• Levonorgestrel intrauterine system.
• OCO (monthly or extended cycles).
• Progestin therapy (oral or IM)
• Tranexamic acid.
• NSAIDS

16. • 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.

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

18. 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.