Complaints Of Abnormal Uterine Bleeding Research Articles

COVID-19 (SARS-CoV-2) mRNA vaccination does not affect basal sex hormone levels (follicle-stimulating hormone, luteinizing hormone, estradiol) in reproductive-age women.

People vaccinated with the coronavirus disease 2019 (COVID-19) (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) mRNA vaccine have reported experiencing various adverse effects. For instance, reproductive-age women have presented with complaints of abnormal uterine bleeding or menstrual cycle changes. We speculated that differences in basal sex hormone levels before and after vaccination may be present in women who experienced irregular bleeding or menstrual cycle changes; thus, this study aimed to investigate the differences in basal sex hormone levels of women before and after two doses of SARS-CoV-2 mRNA vaccination. This retrospective study included patients who received SARS-CoV-2 mRNA vaccines between January 2021 and February 2022 at a single center. In an outpatient setting, patients were queried regarding their menstrual cycle, the date of SARS-CoV-2 mRNA vaccination, vaccination type, and vaccination side effects. Differences in basal hormone levels (menstrual cycle days 2-3, follicle-stimulating hormone [FSH], luteinizing hormone [LH], and estradiol) before and after vaccination were compared. Among the 326 patients, patients with no laboratory records of the hormones were excluded. The median time interval between SARS-CoV-2 mRNA vaccination and the laboratory test day was 79 days (interquartile range, 44 to 127). A comparative analysis of these hormones before and after vaccination revealed no significant differences. Subgroup analyses based on age and reported adverse events also found no statistically significant differences. This study showed no significant differences in basal hormone levels (FSH, LH, and estradiol) before and after SARS-CoV-2 mRNA vaccination.

Uncommon Metachronicity: Breast and Endometrial Carcinomas in a Young Woman with No Familial Cancer History - A Case Report

Background: Worldwide, breast and endometrial carcinomas are the two most common cancers of women, but their coexistence in a woman <40 years of age is a rare event. The risk of developing a new second primary cancer is higher in cancer survivors compared to those without a history of cancer. The exact pathogenesis of two different primary malignancies is not clear. Still, the coexistence of breast and endometrial carcinoma may be due to germline mutations of p53, BRCA 1, and BRCA 2 genes, environmental, hereditary, and immune-mediated factors. Case Presentation: The present case report briefs the finding of a 37-year-old woman who presented to the Gynecological outpatient department with complaints of abnormal uterine bleeding and a solid irregular lump in the upper outer quadrant of the right breast and the right axilla. She had a history of modified radical mastectomy for left breast ductal carcinoma five years back. She was diagnosed as a case of metachronous endometrial carcinoma (stage IA) with a recurrence of invasive ductal carcinoma in the right breast with metastasis to the right axillary lymph node. Conclusion: The metachronous development of breast and endometrial carcinoma in young women is relatively rare. In young patients <40 years of age with gynecological or breast carcinoma, a thorough work-up, including genetic testing and follow-up, should be done for early diagnosis of metachronous or synchronous primary malignancies of other organs.

Evaluation of Endometrial Histopathology of Patients Presenting with Abnormal Uterine Bleeding

Objective: Abnormal uterine bleeding is an important symptom frequently encountered in the gynecology outpatient clinic. In our study, it was aimed to determine the endometrial pathologies that cause abnormal uterine bleeding. Material and methods: The pathology results of patients who applied to our clinic with the complaint of abnormal uterine bleeding and underwent endometrial sampling were retrospectively analyzed. Findings were classified and compared according to whether the patients were in the postmenopausal or premenopausal period. Results: A total of 878 patients were included in the study. The mean age of the patients was 47.59±7.91/year. The most common symptom was menometrorrhagia 58.1%. The most common pathological finding was endometrial polyp in both premenopausal and postmenopausal patients (29.69% and 24.31%). The incidence of premalignant and malignant lesions was 2.7% in premenopausal patients and 8.25% in postmenopausal patients. Conclusion: Abnormal uterine bleeding may be associated with malignancies in both postmenopausal and premenopausal patients. Performing endometrial sampling in patients presenting with this symptom is of great importance in providing early diagnosis and treatment of malignant and premalignant lesions.

CLINICOPATHOLOGICAL EVALUATION OF ABNORMAL UTERINE BLEEDING IN PERIMENOPAUSAL WOMEN

Objective: Abnormal uterine bleeding (AUB) is defined as any bleeding from the uterus that is deviated from normal in terms of regularity, duration, frequency, and amount of blood loss. It interferes with the woman’s physical, emotional, social, and material quality of life. The prevalence of AUB ranges between 11% and 13% rising to 24% in perimenopausal women. The aim of this study is to analyze the demographic profile and risk factors of AUB in perimenopausal women, to classify the causes of AUB based on PALM-COEIN classification, and to correlate the clinical and sonological findings with post-operative histopathology findings. Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynecology at GIMSR hospital, Visakhapatnam, for 1 year from September 2022 to September 2023. A total of 151 perimenopausal women with complaints of AUB in the age group of 41–50 years who underwent hysterectomy were included in the study. Results: The most common clinical presentation was heavy menstrual bleeding (HMB) seen in 96 cases (63.5%). Clinically, the PALM component accounted for 61% of cases and the COEIN component accounted for 39% of cases. Ultrasonographically, the PALM component was detected in 76.8% of cases. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detection of PALM lesions. Conclusion: Leiomyoma was the most common cause clinically, sonologically, and pathologically. Correlation was good for leiomyoma. USG has good specificity for diagnosis of AUB-A and AUB-P but low sensitivity.

A Retrospective Study Of 20 Cases Of Uterine Sarcoma In A Single Institute Over 10 Year Period

Objective: Uterine sarcomas are rare tumors arising from mesenchyme of uterus and th are diagnosed late because of confusing clinical and radiological presentation as urerine fibroids .In post hysterectomy pateints uterine sarcomas can present as pelvic or abdominal tumors causing confusion with tumors of bladder , bowel or other abdominal/pelvic malignancies. Histopathological examination and immuno histochemistry aids in diagnosis of uterine sarcoma and proper management of pateints. Hence 20 cases are studied in detail for better understanding of this rare entity. Methods: A retrospective study of 20 cases of uterine sarcoma was done. Details of patient are collected from departments of surgical oncology, medical oncology, pathology, radiology and outpatient records. Results: Uterine sarcomas are rare tumors and are usually diagnosed late. Most common types of uterine sarcoma are endometrial stromal sarcoma. leimyosarcoma, undifferentiated uterine sarcoma and adenosarcoma Abnormal uterine bleeding is the most common complaint and there are no specific complaints or radiological findings.Endometrial stromal sarcomas are known for their indolent course,in our study 6 pateints had hysterectomy in the past and years later presented as pelvic or abdominal masses causing diagnostic dilemma .Histopathology and immunohistochemistry aids in diagnosis and timely management of uterine sarcomas. Conclusion: In 20 cases of uterine sarcoma, patients presented with complaints of abnormal uterine bleeding, pain abdomen, mass per abdomen, hematuria and constipation, radiological findings revealed either fibroid uterus or degenerated fibroid or ovarian cyst or bladder tumor or bowel tumor or retroperitoneal tumor in none of the cases uterine sarcoma was in list of differential diagnosis. Diagnosis was made only after histopathological examination and immuno histochemistry. Cases of Uterine sarcomas diagnosed at early stage through proper suspicion for this rare tumor and confirmation with histopathology and immunohistochemistry have better survival and quality of life compared to cases which are mis managed. Hence study was done.

Uterine Malignancy: Pathological Pattern and Changing Incidence in a Teaching Hospital in Jeddah, Saudi Arabia.

Uterine carcinoma is one of the most common malignancies affecting women globally. It is the second most common gynecologic malignancy in impoverished countries and the most common in industrialized countries. To describe the histopathological patterns of uterine malignancies and their changing incidenceat King Abdulaziz University Hospitalfrom 2011 to 2020. A retrospective study was conducted to analyze female patient record files from 2011 to 2020who underwent uterine resection surgery at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia. A total of 263 patients were included. The age ranged from 30 to 95 years old; median age of 61 years. The majority (71%) presented with the complaint of abnormal uterine bleeding. Themostcommon histopathological diagnosis was endometrioid carcinoma (70%), followed by serous carcinoma (13.7%). The lowest reported uterine cancer diagnoses were in the year of 2011 with (<5%)of the caseswhile the highest were in the year of 2020. These findings demonstrate avariable incidence of endometrial carcinomas in the study population over the study period.With trends of an increasing incidence till 2018 followed by a marginal reduction in 2019 and 2020. The most frequent histopathological diagnosis of uterine cancer was endometrioid carcinoma followed by serous carcinoma, (70%)and (13.7%) respectively. Type 1 endometrial carcinoma was prevalent throughout the decade surpassing the type-2 endometrial carcinoma. The trend also shows a steady increase in the frequency of uterine cancer which is alarming and prompts further research to determine factors associated with and molecular classification of reported uterine cancer cases.

Mixed Epithelial and Stromal Tumor (MEST): Case Report of An Unusual Presentation Causing Diagnostic Dilemma

ABSTRACT Mixed epithelial and stromal tumor (MEST) are rare tumors of kidney accounting to approximately 0.2 percent of all renal tumors. They have striking female predominance seen in peri-menopausal females. They present as clinically palpable masses hematuria with few being diagnosed incidentally. Most of them are benign with few cases reported with its malignant transformation. We present a case of 41-year-old female who came with the complaints of abnormal uterine bleeding since one and a half years, for which she was further evaluated. Radiology revealed a multiloculated solid-cystic mass lesion in the right kidney with bilateral ovarian cysts which prompted a clinical suspicion of renal neoplasm with metastasis. Right radical nephrectomy revealed a single capsulated solid-cystic tumor. Microscopy was diagnostic of mixed epithelial and stromal tumor (MEST). Due to its rarity, MEST is least suspected clinically. The benign nature of this tumor and its characteristic histopathology leads to accurate diagnosis and appropriate management of patients.

COMPARISON OF DIAGNOSTIC TECHNIQUES USED IN THE DIFFERENTIAL DIAGNOSIS OF ENDOMETRIAL PATHOLOGIES PRESENTING WITH AN ABNORMAL UTERINE BLEEDING

Introduction: Transvaginal ultrasonography ( TVUSG ) examination, dilatation and curettage ( D&amp;C ) approach and hysteroscopic assesment are frequently used in examination of the abnormal uterine bleeding ( AUB ). The specisific test for detection of the AUB is histopathological evaluation. The study aimed to check the exactness of TVUSG, D&amp;C and hysteroscopy for differential diagnosis of the AUB.&#x0D; Patients and Methodology: Subjects with AUB, who were supposed to have an endometrial pathology on TVUSG, D&amp;C or hysteroscopy, were included in this retrospective study. Our retrospective study was conducted in 160 patients who were admitted to our clinic with complaint of abnormal uterine bleeding. The final pathological diagnosis was accepted as the reference test and sensitivity and specifity of the D&amp;C, hysteroscopy and TVUSG was checked with the pathological diagnosis.&#x0D; Results: Hysteroscopy combined with biopsy provieded highest correlation with the histopathological evaluation. However, the statistical values obtained with TVUSG was comparable to that of the hysteroscopy alone and D&amp;C but lower than that of the hysteroscopy combined with biopsy.&#x0D; Conclusion: Transvaginal ultrasound is a readily available and reproducible imaging technique for the evalution of the endometrial pathologies leading to the AUB. However, the specificity of the TVUSG is quite low. Among the methods used to correctly identify the endometrial pathologies in our study population, the highest sensitivity and specificity was obtained with hysterosopy combined with the biopsy. Nevertheless, TVUSG provides similar statistical values compared to hysteroscopy alone and D&amp;C.

An Extraordinary Location of Sentinel Lymph Nodes in a Patient with Endometrial Cancer

To show dissection of sentinel lymph nodes. A step-by-step demonstration of the technique with narration. Endometrial cancer (EC) is the most common gynecologic malignancy worldwide. Sentinel lymph node biopsy with indocyanine green (ICG) has become more widely used and has been featured in recently published guidelines for EC [1]. Minimally invasive approaches with the sentinel lymph node concept (conventional laparoscopy, laparoscopic-assisted vaginal surgeries or robotic) to EC staging have resulted in lower rates of peri- and postoperative complications than conventional staging procedures [2]. No video article has been published in the literature about high pelvic, para-aortic sentinel lymph node dissection. An informed consent form was obtained from the patient. An institutional review board approval was not required. A 45-year-old female with gravidity 0, parity 0, and body mass index of 23.4 kg/m2 presented with complaints of abnormal uterine bleeding (spotting). Increased endometrial thickness was detected on transvaginal ultrasound (10 mm) in the postmenstrual period. Endometrioid-type endometrial adenocancer with focal squamous differentiation International Federation of Gynecology and Obstetrics grade I was detected on endometrial biopsy. The patient had hepatitis B virus positivity and no other chronic disease. A laparotomic myomectomy had been performed in 2016. Laparoscopic high pelvic, low para-aortic sentinel lymph node dissection with ICG and hysterectomy (without uterine manipulator)+bilateral salpingo-oophorectomy were performed (Supplemental Video 1). The operation time for the procedure was 110 minutes and the estimated blood loss was <20 mL. No major complications occurred during or after the surgery. The patient stayed in the hospital for 1 day. The final pathology result showed an International Federation of Gynecology and Obstetrics grade I, endometrioid-type endometrial adenocancer with focal squamous differentiation, as a 1.5×1 cm tumorous mass invading less than one-half of the myometrium. Neither lymphovascular invasion nor sentinel lymph node metastasis was detected. A multicenter, prospective study showed that sentinel lymph node dissection with ICG in clinical stage 1 EC is feasible and has a high degree of diagnostic accuracy in detecting EC metastases. In that study, isolated para-aortic sentinel lymph node was detected in 3 of 340 patients (<1%) [2]. Another study reported the detection rate of isolated para-aortic sentinel lymph node to be 1.1% in patients with intermediate- and high-risk EC [3]. There are in some cases 2 distinct channels emanating from one side, and it is important to follow each and to acknowledge there may be more than one sentinel, one of which is lower in a typical location and one higher as in this case. This video article is the first video demonstration of bilateral isolated high pelvic, para-aortic sentinel lymph node dissection in EC.

Retrospective examination of endometrial sampling results in women with abnormal uterine bleeding

&lt;b&gt;Background: &lt;/b&gt;Abnormal uterine bleeding (AUB) is among the most significant and frequent causes of admission to the gynecology outpatient clinic. AUBs may manifest as the earliest sign of endometrial cancer. For the early detection and treatment of endometrial cancer, careful examination of AUBs is crucial.&lt;br /&gt; &lt;b&gt;Aim: &lt;/b&gt;The study was conducted to retrospectively evaluate the histopathological results of probe curettage materials applied to women who applied to the gynecology clinic for AUB and were hospitalized with the complaint of AUB.&lt;br /&gt; &lt;b&gt;Material and Methods: &lt;/b&gt;In the retrospective study planned between 2020 and 2021, all endometrial biopsies from 638 women with AUB reported to the gynecology clinic were reviewed and analyzed. The data were obtained from the archives of our hospital's gynecology and obstetrics clinic and pathology clinic.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; 638 cases were analyzed. The mean age of the patients was 47.94±9.53 years. Malignant pathology was detected in 20 cases (3.13%). Nineteen of these cases were seen in postmenopausal women. The most common pathology was found to be benign polyps at a rate of 19.91%. It was the most common benign pathology in women pre- and postmenopausal. Adenocarcinoma was detected in 13 (2.03%) postmenopausal cases while in only 1 (0.16%) of the premenopausal women.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Since more malignant pathologies are observed in postmenopausal women, women with asymptomatic or AUB complaints should be carefully monitored, and endometrial evaluation should not be skipped. Endometrial biopsies are valuable in the early detection of pre-cancerous and cancerous endometrial lesions, especially in postmenopausal women.

A descriptive study on clinical histopathological and ultrasonological characteristics of women with perimenopausal bleeding in a tertiary referral hospital

Background: Perimenopause is a crucial point in the life of a woman when she faces a lot of changes in her body and menstrual pattern. Abnormal bleeding patterns which can be heavy and erratic are experienced by a significant number of women in the perimenopausal transition abnormal uterine bleeding (AUB) is one of the most common gynecological problems and it affects her quality of life of a woman as well. For managing this problem, it is important to understand the clinical picture of AUB aided with imaging by ultrasound and histopathology. Aims and Objectives: The aim of this study was to study the clinical features and the ultrasonography of the uterus and histopathology of endometrium in patients with perimenopausal bleeding and to correlate with histopathology. Materials and Methods: A descriptive study was conducted over a duration of 12 months. All perimenopausal women who attended the outpatient department with complaints of AUB who fit the inclusion criteria were recruited in the study. Based on the clinical features, sonological profile, and histopathology report, data was analyzed to meet the aims and objectives of the study. Results: In the study population of 105 patients, 72 patients had normal endometrium (68.5%) which was constituted by proliferative and secretory endometrium while 31.5% had abnormal endometrium constituted by disordered proliferative endometrium. For the 105 patients in the study, proliferative endometrium was seen in 41 patients and the thickness ranged between 8 mm and 10 mm. Secretory endometrium was seen in 31 patients and the thickness is ranged between 10 mm and 12 mm. Disordered proliferative endometrium was seen in 33 patients and the endometrial thickness ranged between 12 mm and 14 mm. Menorrhagia (heavy menstrual bleeding) was present in 23 patients with secretory endometrium. Menorrhagia (heavy menstrual bleeding) was present in 23 patients with secretory endometrium. Conclusion: There is a significant association between the clinical pattern of bleeding with ultrasound profile and histopathology in women with perimenopausal AUB.

Comparison between Pipelle Sampling and Hysteroscopy Guided Biopsy in Histologic Evaluation of Endometrium in Tertiary Care Hospital in Pakistan

Introduction: Abnormal uterine bleeding is one of the commonest issues in perimenopausal age group. The proportion is 9-30% in reproductive age group. This extent rises to 70% in perimenopausal and postmenopausal women’s. Irregular uterine dying (AUB) warrants an intensive assessment in perimenopausal females and subsequently it’s vital to perform it in a cost-effective way with available resources. Objective: To compare the efficacy of Hysteroscopic guided biopsy and endometrial cytology To find out the efficacy of endometrial cytology in detecting different normal and abnormal endometrial patterns Study design &amp; Settings: It is a prospective comparative study conducted at Social Security Hospital, Multan Road, Lahore included patients 30 years and above with the chief complaints of abnormal uterine bleeding. Study Duration: 01 year January 2020 to December 2020 Sample: 100 patients Inclusion Exclusion Criteria: Females having symptoms of abnormal uterine bleeding and age above than 30 years are included in the study. The females who are pregnant and having infection or malignancy are excluded from the research Results: This Planned comparative hospital-based study was done in one hundred patients with abnormal uterine bleeding taken after the informed consent, inclusion and exclusion criteria. Endometrial thickness was assessed and all cases with &lt;5 mm thickness will be avoided from the study. Mean age of the patient was found 45 and standard deviation 7.43. Practical implication Conclusion: To get the endometrial sample by pipelle technique is a safe procedure. It has high specificity, sensitivity, positive and negative predictive values when compared to hysteroscopy. In this way, to obtain adequate endometrial sample, Pipelle biopsy should be considered as important way of investigation. Keywords: Abnormal uterine bleeding, Pipelle, Endometerial sampling, FIGO

Histopathological evaluation of uterine lesions in women with AUB in Vindhya region of Madhya Pradesh

: Females over 20 years of age come frequently to gynecological clinics, with the complaint of Abnormal Uterine Bleeding (AUB). It has a direct impact on the physical and mental health of females. This research aims to detect the frequency of different uterine causes of AUB and determine the relationship between histopathological lesions associated with AUB and their age groups of presentation.: Endometrial biopsies / hysterectomy specimens were collected from 235 patients who presented with AUB to Department of Obstetrics &amp; Gynecology SSMC, Rewa, M. P. (India), and HPE was carried out on all biopsies/specimens. Frequency of all findings was recorded and divided into organic and functional causes. Statistical analysis was done between histopathological lesions associated with AUB and their age groups of presentation.: Majority of cases (40%) belonged to 41-50 years of age. HPE revealed prolife rative pattern of endometrium, which was the most common presentation (24.68%) amongst functional causes, while the most common organic cause was uterine leiomyoma (12.76%). Cases of endometrial polyp and endometrial hyperplasia without atypia were found frequently in women of 41-50 years of age. The frequency of endometrial carcinoma was 1.27%, which commonly affected elderly females. : We conclude that AUB most commonly affects women in the perimenopausal age group. Histopathological study of uterine lesions aids the early diagnosis of premalignant and malignant lesions and thus saves the patient from having an unnecessary hysterectomy in premalignant lesions.

ORIGINAL RESEARCH ARTICLE: HISTOPATHOLOGICAL EVALUATION OF ENDOMETRIAL BIOPSIES IN WOMEN WITH GYNECOLOGICAL COMPLAINTS

Objectives: The objectives of the study were to study histopathological evaluation of endometrial biopsies in women with gynecological complaints. Methods: The present study included 100 patients who attended gynecology department of Dhiraj General Hospital, SBKS MI and RC with the complaints of abnormal uterine bleeding. Endometrial biopsy or curettage done by clinician as part of diagnosis and management. Samples sent to the department of pathology for histopathological evaluation. Tissue after appropriate fixation and processing was embedded in paraffin block. After that, 4 micron tissue sections were cut and they were stained with H and E stain. The sections were evaluated on microscopy and an appropriate histopathological diagnosis was made. Results: Out of 100 cases studied, 37% were found out to be secretory endometrium, 20% proliferative endometrium, 6% disordered endometrial glands, 3% simple hyperplasia without atypia, 5% complex hyperplasia without atypia, 1% endometrial hyperplasia with atypia, 2% endometrial polyp, 7% chronic nonspecific endometritis, 1% tuberculous endometritis, 3% Arias-Stella reaction, 6% products of conception, 3% deciduitis, 1% complete hydatidiform mole, 2% endometrial carcinoma, and 3% squamous cell carcinoma of cervix. Conclusion: Abnormal uterine bleeding is a leading cause of morbidity in patients with gynecological complaints. It not just impairing health but psychologically also affects the patients. Endometrial biopsy is a safe, reliable, and less time-consuming outpatient procedure which can be used as an initial diagnostic tool in the patients with abnormal uterine bleeding.

RETROSPECTIVE ANALYSIS OF CHANGING TRENDS IN PRESENTATION AND MANAGEMENT OF ADENOMYOSIS

Background Adenomyosis is a challenging clinical condition, usually diagnosed between 35 to 50 years of age, with prevalence among hysterectomy ranged from 8.8% to 61.5%. Women with adenomyosis have a prole of symptoms which includes abnormal uterine bleeding, dysmenorrhea, dyspareunia, chronic pelvic pain and subfertility. The condition was diagnosed pathologically in hysterectomy specimens by microscopy but now preoperative diagnosis is done by magnetic resonance imaging (MRI) and transvaginal sonography (TVS) and medical or surgical treatments are proposed as per the diagnosis. The diagnosis of adenomyosis as such becomes difcult due to the coexistence with other conditions like endometrial hyperplasia and uterine leiomyomas. Methods This is a retrospective, cross-sectional study done among 100 women admitted in the Gynaecology ward in Chettinad Hospital and Research Institute, Kelambakkam during the period of August 2019 to August 2020. Women with complaints of abnormal uterine bleeding and had hysterectomy were included. The patient's data were retrieved from the subject's case sheets obtained from Medical Records Department. The histopathological examination reports were retrieved from the Department of Pathology. The data collected were listed in Microsoft Excel v365 and interpreted using statistical software SPSS v21. Results Among the subjects, 35% were found to have adenomyosis in the histopathological diagnosis. Out of those, 6% had only adenomyosis followed by 11% with leiomyoma, 13% with endometrial hyperplasia and 5% with both leiomyoma and endometrial hyperplasia. 71.4% of adenomyosis were in 41 -50 years age group and 80% were multiparous. The most common presenting symptom in adenomyosis subjects were Menorrhagia (74.3%) followed by Dysmenorrhoea and Intermenstrual Bleeding with almost 50%. Conclusion Over the few years, a dramatic change has been attained in presentation and management of adenomyosis. It has turned into a clinical diagnosis rather than a histological entity and can be appreciated through imaging techniques, even though a common denition and classication are still in paucity. This will be of maximum concern in the forthcoming years as the disease needs to have a enduring treatment and so it has to be diagnosed earlier to provide better medical or surgical therapies and to avoid hysterectomy.

Prevalence of Abnormal Uterine Bleeding and its Associated Risk Factors in Women of Perimenopausal Age GroupA Retrospective Study

Introduction: Abnormal Uterine Bleeding (AUB) is defined as any deviation from the normal menstrual cycle that is abnormal in regularity, duration, volume and frequency. AUB may be accompanied by pain and discomfort which presents a substantial burden on patient’s health, quality of life, society and healthcare system. There is also an increased incidence of associated co-morbidities like thyroid disease, diabetes and hypertension in AUB cases. Aim: To estimate the prevalence of AUB according to the PALM-COEIN classification and its associated risk factors in the perimenopausal age group. Materials and Methods: This retrospective study was conducted in the Gynecology Department of Malabar Medical College, Kozhikode, Kerela, India. The data was collected from the medical records and computerised system of the hospital for a period of one year from January 2021 to December 2021. A total of 225 patients in the perimenopausal age group (40 years and above) attending Gynecology Outpatient Department (OPD) and admitted with complaints of AUB was included. Patient’s information such as age, menstrual history, obstetric history, medical and surgical history, laboratory tests, imaging findings, endometrial biopsy results was obtained and analysed. Data was entered in Microsoft excel excel and analysed by using Statistical Package for the Social Science (SPSS) version 24.0. Results: The total number of patients attending the gynecology outpatient department during the study period was 11765. The total number of AUB cases during the study period were 2154, so the prevalence for AUB was 18.3%. For the assosciated risk factors, 255 patients were considered, where maximum number of patients 103 (45.3%) were in the age group of 45- 49 years. Structural causes accounts for 175 (77.6%) cases. Hypertension was the most common risk factor associated with AUB 68 (30.2%), followed by diabetes 32 (14.2%) and thyroid disorders 15 (6.6%). Conclusion: The prevalence of AUB was 18.3% in present study. Abnormal Uterine Bleeding - Ovulatory dysfunction and Abnormal Uterine Bleeding- Endometrial had statistically significant association with thyroid disease.

A Randomized Comparative Study to Compare Karman's Cannula and Pipelle Biopsy for Evaluation of Abnormal Uterine Bleeding.

Objectives:This study aimed to compare the diagnostic accuracy, inadequate sampling, pain during the procedure (Visual Analog Scale [VAS] score), and ease of insertion of the Karman's cannula and Pipelle biopsy for patients with abnormal uterine bleeding (AUB).Methods:This prospective observational randomized comparative study included women of age more than 40 years with complaints of AUB. Two hundred and fifty women were randomly divided into two groups: (1) Group A (n = 125) who underwent endometrial aspiration using Karman's cannula and (2) Group B (n = 125) who underwent Pipelle endometrial sampling. Both the groups were followed by conventional dilation and curettage (D and C) which was considered the gold standard. Sensitivity, specificity, positive predictive value, and negative predictive value for differentiating benign and malignant conditions of endometrium were calculated.Results:Group B had a sensitivity of 89.29% followed by Group A (86.36%); on the other hand, Group A had a specificity of 96.08% followed by Group B (95.74%) (P > 0.05). Inadequacy was comparable among the two groups with 1 inadequate in Group A and 3 inadequate in Group B. Mean VAS score was significantly lesser in Group A than Group B (4.5 ± 2 vs. 5.8 ± 2.1, P < 0.0001). Ease of insertion was similar in Groups A and B (P = 0.345).Conclusion:Both procedures were equivalent in diagnostic accuracy, inadequacy, and ease of insertion. However, the use of Karman cannula resulted in less pain and is a much cheaper option in comparison to Pipelle. Overall, either procedure can be performed on an outpatient basis without cervical dilation and anesthesia and thus may be routinely used for women presenting with AUB.

Case Report on Management of Abnormal Uterine Bleeding with Anemia

Introduction: The most prevalent condition seen in the gynecology outpatient department is abnormal uterine bleeding (AUB). AUB can be caused by a variety of conditions 1. A 42 year female who have chief complaints of abnormal uterine bleeding is bleeding from the uterus that is longer than usual or that occurs at an irregular time. several characteristics of underlying hereditary or acquired blood disorders increase the "anticipated" hormonal imbalance at this age, hence worsening the morbidity of the underlying condition axis .Despite the fact that blood problems can cause AUB, uterine structural and/or endocrine abnormalities are frequently missed when a blood illness is present [1]. Hematologists and gynecologists, as well as adolescent medicine experts, must work to get her to treat a complex etiology [2,3].&#x0D; Patient History: A 42 year old female was admitted in AVBRH in gynec ward sawangi meghe wardha with chief complaint of abnormal uterine bleeding since 2 month, abdominal pain since 1 week, weakness.&#x0D; Medical Management: Patient treated with anticoagulant, antibiotic, iron supplement.&#x0D; Nursing Management: Administrative IV fluid monitor vital sign, and medication given by doctor’s order.&#x0D; Conclusion: Women should be asked about their previous menstrual cycle, regularity, desire for reproduction, contraception, and sexual health by their primary care providers. If abnormal uterine bleeding is detected at the primary care level, additional history, examination, and testing can be undertaken, and appropriate consultations can be scheduled. Timely treatment and management of abnormal uterine bleeding with anemia.

Localized endometrioid cancer in the abdominal wall with synchronous early-stage endometrial cancer

Presented herein is the only case in literature with the synchronous development of endometrioid-type endometrium cancer and endometrioid carcinoma originating from the endometriosis foci in a scar tissue. A 44-year-old female patient presented with complaints of abnormal uterine bleeding, swelling at the rectus muscle level in the abdominal wall, and cyclic pain close to the old cesarean section incision scar. Pathological findings of the rectus muscle and endometrial biopsies revealed endometrioid adenocarcinoma (grades 2 and 1, respectively). Positron emission tomography, performed for primary focus investigation, revealed pathologic fluorodeoxyglucose uptake in the uterine cavity and biopsy site, consistent with residual tumor without any pathologic uptake elsewhere. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic and para-aortic lymphadenectomy, and the residual tumor in the left rectus muscle was excised. The patient was followed up for 3 years. At a postoperative follow-up in the 4th year, no relapsed tumor or metastasis was seen on imaging.

English

BACKGROUND Abnormal uterine bleeding is an important cause of morbidity in the female population, which can be attributed to several reasons. Trans-vaginal sonography and saline-infusion sonography are the mainstay of diagnosis and govern the further management of this condition. This study was conducted to evaluate the thickness and pattern of endometrium with transvaginal sonography and determine any abnormality in the uterine cavity which can be attributed to saline infusion sonography (SIS) in cases of abnormal uterine bleeding (AUB). METHODS The study was conducted among 122 women with complaints of abnormal uterine bleeding attending Outpatient Department and indoor cases of a tertiary care hospital over a period of twelve months. RESULTS The most common presenting complaint was heavy menstrual bleeding in 27.04 % cases. Maximum (44.26 %) cases had normal finding on transvaginal sonography; most common pathological finding was leiomyoma (22.31 %), and endometrial hyperplasia (15.5 %). More than one third (37.7 %) of patients had no abnormalities on saline infusion sonography; while 62.3 % had one or more pathologies; the most common lesion was fibroid in 25.4 % cases. Normal proliferative and secretary endometrium was found on histopathological examination in 50 % cases, while remaining half cases had one or more pathology, most common pathology detected was endometrial hyperplasia in 25.4 % cases. On trans-vaginal sonography (TVS), 11 cases of endometrial polyp were missed, which were detected after infusion of saline and confirmed by histopathological examination. The diagnostic indices of SIS were superior to TVS in diagnosis of any pathology. Sensitivity of TVS was 86.94 % and SIS was 91.94 %. Specificity of TVS (75.41 %) was greater than SIS (68.33 %). CONCLUSIONS TVS and SIS scanning techniques play a very important role in endometrial disorders in woman with AUB. KEYWORDS SIS, Transvaginal, AUB, Endometrium