A clinicopathological study of correlation of clinical, sonological and histopathological findings following hysterectomy for abnormal uterine bleeding based on PALM-COEIN Classification

Dr Maharani Maharani,Dr Meerabai V,Dr Sudhakaran R,Dr Divya B.V,Dr Prema N

doi:10.17511/joog.2016.i04.04

Abstract

Background: To identify the proportion of different causes of Abnormal Uterine Bleeding in women undergoing hysterectomy according to the PALM COEIN classification proposed by FIGO. Methods: Collection of data was done from the medical records of women who underwent hysterectomy for Abnormal Uterine Bleeding in the study period from January 2015 to June 2016. Women who underwent planned abdominal hysterectomy and laparoscopy assisted vaginal hysterectomy for Abnormal Uterine Bleeding were included in the study. The clinical, sonological and histopathologic findings were analyzed so as to identify the proportion of different causes of Abnormal Uterine Bleeding in women undergoing hysterectomy. Causes of Abnormal Uterine Bleeding were categorized by calculating the percentage according to the PALM-COEIN classification. Results: A total of 214 women with Abnormal Uterine Bleeding underwent hysterectomy out of which 148 had planned abdominal hysterectomy and 66 had planned laparoscopy assisted vaginal hysterectomy, in the study period. AUB-L was the commonest histopathology (38.3%cases) followed by AUB-O(22%cases) and about 21.5% had adenomyosis. Heavy menstrual bleeding was the commonest presenting symptom (24.3% cases) while 40% and 36% had irregular and frequent menstrual bleeding respectively. Conclusion: FIGO has proposed this new standardized terminology to provide uniform conduct of research as data could be compared both nationally and internationally without any confusion and classify the causes of Abnormal Uterine Bleeding according to PALMCOEIN and identify the relative proportions of each cause. This will help in further research for comparative and epidemiological studies in various populations. More research is needed to identify the riskfactors for leiomyoma in our region as it more prevalent here.

Highlights

Abnormal uterine bleeding (AUB) is defined as any change in the frequency of menstruation, duration of flow or amount of blood loss [1, 2, 3]
Our objective is to conduct a clinicopathological study of correlation of clinical, sonological and histopathological findings following hysterectomy for AUB based on PALM-COEIN classification as hysterectomy still remains the widely accepted and practiced treatment of choice for AUB in spite of the availability of a number of minimally invasive promising surgical alternatives for hysterectomy like endometrial ablation, thermal balloon therapy and uterine artery embolisation as restricted availability and cost factor limit them from being used widely
Table-1: Age wise distribution of women undergone hysterectomy for AUB (n=214)

Summary

Introduction

Abnormal uterine bleeding (AUB) is defined as any change in the frequency of menstruation, duration of flow or amount of blood loss [1, 2, 3]. To identify the proportion of different causes of Abnormal Uterine Bleeding in women undergoing hysterectomy according to the PALM COEIN classification proposed by FIGO. Conclusion: FIGO has proposed this new standardized terminology to provide uniform conduct of research as data could be compared both nationally and internationally without any confusion and classify the causes of Abnormal Uterine Bleeding according to PALMCOEIN and identify the relative proportions of each cause. This will help in further research for comparative and epidemiological studies in various populations. More research is needed to identify the riskfactors for leiomyoma in our region as it more prevalent here

Objectives

Results

Discussion

Conclusion