A 45-year-old woman presented with irregular menstrual cycles and excessive bleeding during menstruation for the past 3 months. A physical examination revealed pallor and the presence of a cervical polyp. She was admitted with a diagnosis of abnormal uterine bleeding due to a polyp with mild anemia. During her hospital stay, she underwent a cervical polypectomy and endometrial biopsy. Her discharge diagnosis was abnormal uterine bleeding from a cervical polyp.

1. ABNORMAL UTERINE
BLEEDING
CASE PRESENTATION
By Intern:
Prabesh Pokhrel
Pratima Chaulagain
Dept.of Obstetrics/Gynaecology
3/3/2023 1

2. OBJECTIVES
To be able to present a case of AUB
•History
•Physical examination
•Course of treatment in the ward
2

3. PATIENT’S PROFILE
• NAME : Mrs Adhikari
• AGE : 45 years
• ADDRESS (Permanent): Ratna chowk- 7 , Pokhara
• MARITAL STATUS : Married
• OCCUPATION: Homemaker HUSBAND : Retired army
• EDUCATION : SLC HUSBAND: Bachelor
• RELIGION: Hindu
• DATE OF ADMISSION: 2079/09/20 at 2:00 pm from OPD
• DATE OF HISTORY TAKING: 2079/09/20
• INPATIENT NO. 79058471
• BED NO. 7
3

4. CHIEF COMPLAINTS
Irregular menstrual cycle since 2 Years
Excessive per vaginal bleeding during menstruation for 3
months
Lower abdominal pain for 3 months
4

5. HISTORY OF PRESENTING ILLNESS
Excessive bleeding during menstruation since 3 month
Acute in onset
Shortest cycle of 10-15 days
Longest cycle of 30-35 days
Fully soaking 3 pads each day and associated with passage
of clots
No any aggravating and relieving factors
5

6. HISTORY OF PRESENTING ILLNESS
No history of
Trauma
Gum bleeding
Nasal bleeding
Easy bruising
Intake of blood thinner medication
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7. HISTORY OF PRESENTING ILLNESS
Lower abdominal pain for 3 months
Site : lower abdomen
Onset : insidious
Character : dull aching type, continuous
Radiation: no radiation
No any Alleviating and relieving factor
Time /duration : no postural/diurnal variation
Severity :mild
7

8. NO HISTORY OF :
Increase urinary frequency
Difficulty in passing urine
Difficulty in passing stool
Vomiting
Abdominal distension
Shortness of breath
Palpitations
Fever
Past medication history
Weight loss and use of any
medications
8

9. OBSTETRIC HISTORY
 Married for 20 Years
P2L2A1
L1 – 17 years, Female, Home delivery, Weight: Unknown
L2 – 15 years, Male, Normal delivery, hospital, birth
weight -3000 grams
A1- 13 years back, spontaneous at 6 week of gestation
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10. MENSTRUAL HISTORY
Age at menarche: 13 years
Menstrual cycle: Irregular , 15-20 days since 2-3 months
Flow : 5 -7 days
Pads used: 3 per day, fully soaked
Dysmenorrhoea present
Associated with passage of clots
 No Intermenstrual and postcoital bleeding
LMP : 2079/09/05
10

11. CONTRACEPTIVE HISTORY
 Depot medroxy progesterone acetate injection for 10
years
 Last dose on kartik 05 , 2079
11

12. PAST HISTORY
Hypertension (-)
Diabetes Mellitus (-)
Tuberculosis, Epilepsy (-)
Heart disease and Thyroid disorder (-)
Surgical history (-)
Blood Transfusion(-)
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13. FAMILY HISTORY
 No similar history in immediate family member.
No history of malignancy like cervical cancer, endometrium
cancer, breast and colon cancer
13

14. PERSONAL HISTORY
Non vegetarian.
Non- smoker and Non- alcoholic.
Denies history of substance abuse.
No h/o allergy to any drug.
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15. GENERAL CONDITION
Fair , average built, conscious, co-operative, well
oriented to time, place and person, and examined on
day light
Height :157cm
Weight :60 kg
B.M.I : 24.3kg/m2 (Normal)
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16. VITALS
PULSE: 80 BPM, taken on right radial artery, regular in
rhythm , adequate in volume, no radio –radial delay.
RESPIRATORY RATE: 18 breaths Per minute, Thoraco-
abdominal
BLOOD PRESSURE: 110/70 MM OF HG taken over right
arm in supine position
TEMPERATURE: 97 °F over left axilla
16

17. Cardinals
Pallor present on lower palpebral conjunctiva
No signs of icterus, lymphadenopathy, cyanosis, clubbing,
edema
Hydration status adequate
17

18. THYROID: Normal, no visible mass or pulsation.
BREAST: B/L symmetrical in size, nipple areolar complex
normal, no localized rise in temperature, non tender, with no
palpable mass or lesion
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19. PER ABDOMINAL EXAMINATION
INSPECTION
Abdomen is flat
Umbilicus centrally placed and inverted
All quadrants move equally with respiration.
No scar marks, visible, pulsations, venous prominences
, swelling.
Hernial orifice seems to be intact
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20. PER ABDOMINAL EXAMINATION
PALPATION
On superficial palpation: No localized rise in temperature
,non tender
On deep palpation: No organomegaly
PERCUSSION
Tympanic note heard
AUSCULTATION
Bowel sounds heard (6/min)
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21. SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM
 Bilateral vesicular breath sounds heard
CARDIOVASCULAR SYSTEM
First and second heart sound heard
No murmurs
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22. VULVA,PERINEALAND PERIANAL
AREA
 Normal distribution of pubic hairs
 No active bleeding from external genitalia
 No sign of inflammation or visible swelling, vulval varicosities, no
discharge
 No any perineal tear
 No presence of ulcer or pigmentation
 No bleeding or ulceration in perianal area
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23. PER SPECULUM EXAMINATION
Bleeding (-)
Mild discharge(+), whitish coloured, non foul smelling,
mucoid discharge (+)
Cervix: Smooth, no erosions
Reddish, fleshy mass, around 2*1 cm arising from cervical
os seen at 10 o’clock position
Lateral vaginal wall rugosities intact
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24. Bimanual Examination
Uterus 6 weeks size
 Mobile
Non tender
 Smooth surface
 Regular margin
 Bilateral fornices free
Cervical motion tenderness (-)
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25. Provisional diagnosis
Abnormal uterine bleeding (polyp) with
anemia
25

26. DIFFERENTIAL DIAGNOSIS
LOCAL TRAUMA
FIBROID
ADENOMYOSIS
ENDOMETRIOSIS
COAGULOPATHY
OVULATORY DISORDER
PREGNANCY
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27. INVESTIGATION
Hematology Reference Range
•Hb – 10.5 g/dl 11-16 g/dl
•Platelets – 192000 cells/mm^3 1,50,00-3,00,000
•Blood group – “O” Positive
Serology
•HIV Spot – Non reactive
•HBsAg Spot – Non reactive
•VDRL – Non reactive
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28. RENAL FUNCTION TEST
•Serum Urea – 22 mg/dl 15-40 mg/dl
•Serum Creatinine – 0.9 mg/dl 0.6-1.5 mg/dl
• Sodium – 141 mg/dl 135-150 mmol/L
•Potassium – 3.9 mg/dl 3.5-5.3 mmol/L
PT -14 Control Time :13sec
INR – 1.0 INR : 1.6
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29. URINE R/E
•Color : YELLOW
•Transparency : CLEAR
•pH :ACIDIC
•Protein : NIL
•Sugar: NIL
•Pus cells : 0-2 /HPF
•RBC : NIL
•Epithelial cells : 1-3 /HPF
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30. Biochemistry report Reference range
•TSH : 1.47 0.55 - 4.78 mIU/L
•RBS – 120 mg/dl 70-100 mg/dl
•Urine pregnancy test : NEGATIVE
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31. ULTRASOUND OF ABDOMEN AND
PELVIS
• Uterus anteverted and measures approx. 10.9*5.0*6.7 Cms
• Normal in outline
• Homogenous in echotexture
• Endometrial echo complex is normal ( 7.6mm)
• Empty uterine cavity
• No significant free fluid collection
• Upper abdominal scan normal
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32. FINAL DIAGNOSIS
ABNORMAL UTERINE BLEEDING
(POLYP) WITH MILD ANEMIA
32

33. PLAN
CERVICAL POLYPECTOMY WITH
ENDOMETRIAL BIOPSY
33

34. OT FINDINGS
Cervix was visualized and polyp was noted
Polyp was avulsed
Anterior lip of cervix was held by vulsellum and sent for
HPE
IPAS cannula 4 was inserted, 5 cc of endometrial tissue
was taken and send for histopathological examination.
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35. MEDICATION
INJECTION CEFTRIAXONE 1 GM IV BD
INJECTION METRON 500 MG IV TDS
INJECTION PANTOP 40MG IV BD
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36. Diagnosis at discharge
Cervical polypectomy with endometrial biopsy
for abnormal uterine bleeding (polyp)
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37. Medication on discharge
• TAB CEFIXIME 200MG PO BD FOR 7 DAYS
• TAB METRONIDAZOLE 400MG PO TDS FOR 7 DAYS
• TAB PANTOPRAZOLE 40MG BD FOR 7 DAYS
• TAB FLEXON 1 TAB PO SOS
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38. SUMMARY
45 Years female P2L2A1 , presented with excessive
bleeding during menstruation with irregular cycle and
pain abdomen for 3 months with examination
findings of pallor on lower palpebral conjunctiva and
cervical polyp, admitted with diagnosis of Abnormal
Uterine bleeding (Polyp), with mild anemia. Cervical
polypectomy with endometrial biopsy
38

39. Thank You !!! 
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