P15.03: A rare cause of postpartum bleeding: exaggerated placental site reaction and placental site nodule

Abstract

Objectives: Menstrual disorder is the leading cause of diminished quality of life in women of reproductive age group and it accounts for 20% of all referrals to specialist gynaecology service. Ultrasound is the first line diagnostic tool for identifying structural abnormalities in these women. The aim of this study is to analyse scan findings in these group of women. Methods: We did a retrospective analysis of scan findings of 100 women referred to University College London for menstrual problems from January to March 2010. Viewpoint TM data was used to collect the information using a structured proforma. Results: The commonest age group was 40–49 years. Majority (48%) of women were nulliparous. 84% of them did not use any treatment at the time of referral. The most common presenting complaint was heavy regular periods (80%) followed by irregular periods (20%). Dysmenorrhoea was present in 42% of women. 92% of women had transvaginal scans and the acceptability was good. Scan findings: The most common abnormality found was fibroid (43%) followed by adenomyosis (12%). Both fibroid and adenomyosis were found in 9% of patients. Among those patients with fibroids, only one third of them had submucous fibroids (16%). However fibroid distorting uterine cavity was seen in 25% of women. Endometrial appearance was normal in 73% of patients. The rest had either focal abnormality like fibroid and polyp or global abnormality like thickened endometrium. Normal scan findings were seen in 23% of patients and malignancy was not seen in any of these women. Conclusions: Transvaginal scan is very effective in diagnosing abnormalities in women with menstrual disorders. It helps in counselling women appropriately and to tailor the treatment according to the abnormalities found. The most common abnormality found in our study is fibroid uterus.