Non-structural Causes Research Articles

Abnormal Uterine Bleeding: A Pictorial Review on Differential Diagnosis and Not-So-Common Cases of Interventional Radiology Management.

Abnormal uterine bleeding (AUB) poses a multifaceted challenge in women's health, necessitating an integrated approach that addresses its diverse etiologies and clinical presentations. The International Federation of Gynecology and Obstetrics PALM-COEIN classification system provides a systematic approach to the diagnosis of AUB in non-pregnant women, based on clinical and imaging-based categorization of causes into structural (Polyps, Adenomyosis, Leiomyomas and Malignancy; PALM), and non-structural causes (Coagulopathies, Ovulatory disorders, primary Endometrial disorders, Iatrogenic and Not otherwise classified; COEIN). On the other hand, placental disorders, uterine rupture, ectopic pregnancy and retained products of conceptions are the main causes of uterine bleeding during pregnancy and in the peripartum period. Ultrasound is usually the first-line imaging technique for the differential diagnosis of causes of AUB. Computed Tomography may be useful if ultrasound findings are unclear, especially in emergency settings. Magnetic resonance imaging, when indicated, is an excellent second-line diagnostic tool for a better non-invasive characterization of the underlying cause of AUB. This pictorial review aims to illustrate the main causes of AUB from the point of view of diagnostic imaging and to show not-so-common cases that can be treated by means of interventional radiology.

Transcatheter Aortic Valve Replacement for Failed Surgical or Transcatheter Bioprosthetic Valves: A Comprehensive Review.

Transcatheter aortic valve replacement (TAVR) has proven to be a safe, effective, and less invasive approach to aortic valve replacement in patients with aortic stenosis. In patients who underwent prior aortic valve replacement, transcatheter and surgical bioprosthetic valve dysfunction may occur as a result of structural deterioration or nonstructural causes such as prosthesis-patient mismatch (PPM) and paravalvular regurgitation. Valve-in-Valve (ViV) TAVR is a procedure that is being increasingly utilized for the replacement of failed transcatheter or surgical bioprosthetic aortic valves. Data regarding long-term outcomes are limited due to the recency of the procedure's approval, but available data regarding the short- and long-term outcomes of ViV TAVR are promising. Studies have shown a reduction in perioperative and 30-day mortality with ViV TAVR procedures compared to redo surgical repair of failed bioprosthetic aortic valves, but 1-year and 5-year mortality rates are more controversial and lack sufficient data. Despite the reduction in 30-day mortality, PPM and rates of coronary obstruction are higher in ViV TAVR as compared to both redo surgical valve repair and native TAVR procedures. New transcatheter heart valve designs and new procedural techniques have been developed to reduce the risk of PPM and coronary obstruction. Newer generation valves, new procedural techniques, and increased operator experience with ViV TAVR may improve patient outcomes; however, further studies are needed to better understand the safety, efficacy, and durability of ViV TAVR.

Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2.

Abnormal uterine bleeding (AUB) is common, often debilitating, and may affect over 50% of reproductive-aged women and girls. Whereas AUB is a collection of symptoms that include intermenstrual bleeding and abnormalities in period duration, cycle length, and regularity, it is heavy menstrual bleeding (HMB) that is most contributory to iron deficiency and related anemia. It is apparent that AUB, in general, and HMB, in particular, remain underrecognized and underreported. FIGO created two systems for assessing and classifying AUB. FIGO System 1 defines the bleeding pattern using four primary descriptors: frequency, duration, regularity, and flow volume. FIGO System 2 provides a structured classification system of possible causes of AUB, using the acronym PALM-COEIN. "PALM" refers to structural causes of AUB (Polyp, Adenomyosis, Leiomyoma, Malignancy), and "COEI" refers to nonstructural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, and Iatrogenic). The "N" is reserved for those entities that are currently not otherwise classified. Using FIGO System 1 as a gateway to FIGO System 2 streamlines the investigation of reproductive-aged women and girls with AUB. Understanding the pathogenesis of the FIGO System 2 "PALM-COEIN" causes helps interpret investigations and the onward management of AUB. Numerous evidence gaps exist concerning AUB; however, if researchers and trialists universally adopt FIGO Systems 1 and 2 for the assessment and diagnosis of AUB, clear translatable research findings can be applied globally.

Patient satisfaction, sexual function and decision regret in use of levonorgestrel intrauterine device

Aim: Abnormal uterine bleeding is a common condition. The etiological cause and treatments are diverse. LNG-IUD can be used to treat abnormal uterine bleeding.It has been shown to reduce the amount of bleeding in patients with menorrhagia and increase hemoglobin and hematocrit (Hct) values. The aim is to investigate the effects of LNG-IUD on hemoglobin, Hct, bleeding pattern, and its effect on sexual function, decision regret, and menorrhagia effects according to the etiologic cause.
 Material and Method: Our study included patients who underwent LNG-IUD implantation and had been using it for over six months. Patients with a history of postmenopausal or adolescent bleeding, hematologic or oncologic diseases, and a history of drug use that may cause coagulation disorders were excluded. Patients were grouped according to their indications as polyp (n=26), adenomyosis (n=16), leiomyoma (n=27), hyperplasia (n=18), and non-structural causes (n=81). Hemoglobin (Hb) and Hct values were examined before and after the application, and bleeding patterns were questioned. Participants were administered Menorrhagia Impact Questionnaire (MIQ), Arizona Sexual Experience Scale and Decision Regret Scale. 
 Results: 168 patients were included in our study. The average duration of LNG-IUD use was 627.0±319 days and the average age was 43.4±6.1 years. The frequency of bleeding (number of bleedings per year) was 18.0±8.0 before LNG-IUD application and 7.8±8.0 after treatment (p

Patient-Friendly Summary of the ACR Appropriateness Criteria: Abnormal UterineBleeding.

One-third of women experience abnormal uterine bleeding (AUB) in their lifetimes. AUB is bleeding from the uterus that is irregular, is more than normal, happens more frequently than normal, or lasts longer than normal in women who are not pregnant. Causes of AUB can be either structural or nonstructural. Nonstructural causes, such as blood coagulation disorders and dysfunction of the ovaries, cannot be diagnosed with imaging.

CLINICO-HISTOPATHOLOGICAL STUDY OF ENDOMETRIUM WITH AND WITHOUT HORMONE THERAPY IN PATIENTS WITHABNORMAL UTERINE BLEEDING

Background: Abnormal uterine bleeding (AUB) is one of the most common problem for the patients and the gynecologists. Histological characteristics of endometrial biopsy material as assessed by light microscopy remains the diagnostic standard for the diagnosis of endometrial pathology. Material and Methods: In our prospective study of 100 patients of the age between 24-75 years, clinical characteristics and the pattern of endometrial histopathology and their association with hormone therapy administration were studied. Results: Total of 100 patients were divided into two subgroups one that received hormone therapy prior to endometrial biopsy and Group II in which hormone therapy was not administered prior to the said procedure. In both groups proliferative phase was the commonest followed by secretory endometrium in both groups. Pill change, Arias Stella reaction, tubercular endometritis, endometrial carcinoma was exclusively noted in the group in hormone therapy was administered prior to endometrial biopsy. Pill change endometrium was only significantly correlated with Group I (p=0.05). Simple hyperplasia, endometrial polyp, chronic endometritis, endocervical polyp, atrophic endometrium was noted in Group II of which simple hyperplasia (p=0.10) was not found to be clinically significant. Conclusions: The study of the endometrium in AUB revealed many structural and non-structural causes manifest in the form of different endometrial histopathological patterns in two groups with or without hormone therapy. Endometrial study gives significant etiological information in AUB when interpreted with relevance to age and other clinical data, thus guiding the appropriate management.

Abnormal uterine bleeding in adolescents

Abnormal uterine bleeding (AUB) is a common diagnosis in the adolescent female population. In recent years, changes have been made to standardize nomenclature, evaluation and management of AUB in adolescents. The terms "abnormal uterine bleeding" and "heavy menstrual bleeding" have replaced terms including "dysfunctional uterine bleeding," "menorrhagia," "metrorrhagia", and "menometrorrhagia." Due to a high prevalence of these diagnoses in this population and resulting effects on quality of life, clinicians should understand and practice current evidence-based care, yet variability continues to exist. Evaluation should be focused on common etiologies of AUB in adolescents, namely non-structural causes, rather than those etiologies more common in adult females. The aim of this article is to review the existing definition, etiologies, pathophysiology, evaluation and management of AUB in adolescent females, with an emphasis on current universally accepted nomenclature and guidelines for use in clinical care.

Abnormal Uterine Bleeding in Adolescent

Abnormal uterine bleeding (AUB) is defined as the abnormal bleeding from the uterine corpus in term of duration, volume, frequency and/or regularity. This condition occurs in 37% of adolescents and may affect the quality of life and increased hospitalization. Etiology is divided into structural and non-structural causes, known as PALM-COEIN. The most common etiology in adolescents is anovulatory menstruation due to immature hypothalamus-hypophysis axis. Diagnostic evaluation should include investigation in the etiology of AUB, anemia signs, and hemodynamic status. Treatment of AUB consists of hormonal and non-hormonal therapy. Therapy in adolescent is given based on the severity of bleeding, grading of anemia, and hemodynamic stability. Follow-up is required after therapy. Understanding AUB in adolescents can help clinicians deliver appropriate and comprehensive treatment. This review was aimed to explain about definition, epidemiology, etiology, pathophysiology, diagnosis, and treatment of abnormal uterine bleeding in adolescent.

Downbeat nystagmus: a clinical review of diagnosis and management.

This review will extensively cover the clinical manifestations, causes, diagnostic evaluation, and management strategies of downbeat nystagmus (DBN). Historically, MRI to assess for structural lesions at the cervicomedullary junction has been the primary diagnostic test in the evaluation of DBN since the 1980s. In recent years, there is increasing awareness of nonstructural causes of DBN including gluten ataxia, nutritional deficiencies, and paraneoplastic syndromes, among others. Medical management with aminopyridines has become first-line therapy in addition to disease-specific therapies. DBN is a common form of acquired nystagmus and the differential diagnosis remains broad, including both benign and potentially fatal causes. For practical purposes, the causes can be categorized as structural vs. nonstructural with MRI as the ideal, initial diagnostic study to differentiate the two. General therapeutic options include pharmacotherapy to enhance Purkinje cell function, strabismus surgery or prisms to shift null points, and behavioural changes. Disease-specific treatment is necessarily broad, though a significant proportion of patients will be idiopathic.

Hyperspectral remote sensing for detecting geotechnical problems at Ray mine

While many or most geotechnical problems at open-pit mines are related to geological structures or discontinuities, highwall movement and failure can also occur as a consequence of nonstructural geological factors. Nonstructural causes of movement are not amenable to detection by conventional geotechnical sensing techniques such as LiDAR. In this case study, we applied hyperspectral remote sensing for large-scale mapping and detection of minerals at a non-structure-related ground instability in the highwalls of the Ray mine near Tucson, Arizona. The spectral images, obtained and integrated with radar images and the geological map, show that the dominant spectrally active mineral underlying the unstable area is the swelling clay montmorillonite, whereas kaolinite and white mica are more common in more stable parts of the highwall. The montmorillonite is concentrated in an outcropping altered diabase and conglomerate that underlie more competent rocks, providing a potential lift and slip surface. This study shows that hyperspectral remote sensing can aid in geotechnical slope characterization, particularly for nonstructural causes of failure. We provide a brief overview of best practices for hyperspectral remote sensing in geotechnical applications (combining drone- and tripod-mounted sensors, integrating hyperspectral with LiDAR and radar data, and using an iteratively refined spectral library based on site-specific sampling supported by ground truth).

Extra-motor manifestations in post-polio syndrome (PPS): fatigue, cognitive symptoms and radiological features.

There is a paucity of cerebral neuroimaging studies in post-polio syndrome (PPS), despite the severity of neurological and neuropsychological sequelae associated with the condition. Fatigue, poor concentration, limited exercise tolerance, paraesthesia and progressive weakness are frequently reported, but the radiological underpinnings of these symptoms are poorly characterised. The aim of this study is to evaluate cortical and subcortical alterations in a cohort of adult polio survivors to explore the anatomical substrate of extra-motor manifestations. Thirty-six patients with post-polio syndrome, a disease-control group with amyotrophic lateral sclerosispatients and a cohort of healthy individuals were included in a prospective neuroimaging study with a standardised clinical and radiological protocol. Validated clinical instruments were utilised to assess mood, cognitive and behavioural domains and specific aspects of fatigue. Cortical thickness analyses, subcortical volumetry, brainstem segmentation and region-of-interest(ROI) white matter analyses were undertaken to assess regional grey and white matter alterations. A high proportion of PPS patients exhibited apathy, verbal fluency deficits and reported self-perceived fatigue. On ROI analyses, cortical atrophy was limited to the cingulate gyrus, and the temporal pole and subcortical atrophy were only detected in the left nucleus accumbens. No FA reductions were noted to indicate white matter degeneration in any of the lobes. Despite the high incidence of extra-motor manifestations in PPS, only limited cortical, subcortical and white matter degeneration was identified. Our findings suggest that non-structural causes, such as polypharmacy and poor sleep, may contribute to the complex symptomatology of post-polio syndrome.

Physiology of the Endometrium and Regulation of Menstruation.

The physiological functions of the uterine endometrium (uterine lining) are preparation for implantation, maintenance of pregnancy if implantation occurs, and menstruation in the absence of pregnancy. The endometrium thus plays a pivotal role in reproduction and continuation of our species. Menstruation is a steroid-regulated event, and there are alternatives for a progesterone-primed endometrium, i.e., pregnancy or menstruation. Progesterone withdrawal is the trigger for menstruation. The menstruating endometrium is a physiological example of an injured or "wounded" surface that is required to rapidly repair each month. The physiological events of menstruation and endometrial repair provide an accessible in vivo human model of inflammation and tissue repair. Progress in our understanding of endometrial pathophysiology has been facilitated by modern cellular and molecular discovery tools, along with animal models of simulated menses. Abnormal uterine bleeding (AUB), including heavy menstrual bleeding (HMB), imposes a massive burden on society, affecting one in four women of reproductive age. Understanding structural and nonstructural causes underpinning AUB is essential to optimize and provide precision in patient management. This is facilitated by careful classification of causes of bleeding. We highlight the crucial need for understanding mechanisms underpinning menstruation and its aberrations. The endometrium is a prime target tissue for selective progesterone receptor modulators (SPRMs). This class of compounds has therapeutic potential for the clinical unmet need of HMB. SPRMs reduce menstrual bleeding by mechanisms still largely unknown. Human menstruation remains a taboo topic, and many questions concerning endometrial physiology that pertain to menstrual bleeding are yet to be answered.

A STUDY OF 70 CASES OF DUB

Background: Abnormal uterine bleeding (AUB) is a phenomenon which refers to menstrual bleeding of abnormal frequency, duration or quantity. It is a common gynaecological complaint caused by wide variety of organic or non-organic causes. The objective of the study was to determine the incidence of dysfunctional uterine bleeding with respect to aetiopathology, demographic variables, treatment options and other medical disorders.
 Methods: A retrospective study of randomly selected 70 cases of dysfunctional uterine bleeding admitted during October 2006 to September 2007, in the Dept. of Obstetrics and Gynaecology, in a tertiary care hospital named SSG Hospital at Vadodara. Only cases of AUB due to non-structural causes were included. Demographic details of each patient were recorded and analysed. Patients were evaluated with menstrual history, physical examination, laboratory tests and histological examinations. Patients were followed up from 3 to 8 months.
 Results: Most common age group presenting with DUB was 40–50 years and mostly belonged to low socioeconomic status. Most of the women were multiparous. Polymenorrhagia and menorrhagia was most common presentation. Size of uterus is normal in 44 patients. Dilatation and curratage was having the cure rate of 65.6% .Maximum number of patients (85%) was treated surgically and 15% got medical treatment.
 Conclusions: Dysfuntional uterine bleeding (DUB) now termed as Abnormal uterine bleeding (AUB) is a common gynaecological manifestation allied with considerable morbidity and significantly affects the patient's family, personal and social life. Perimenopausal women’s health and quality of life can be maintained and improved through preventive care, life style modification, early diagnosis of risk factor and appropriate treatment.
 
 Keywords
 
 Menorrhagia, Dysfunctional uterine bleeding,Abnormal uterine bleeding Perimenopausal women, Endometrium

Correlations between computational fluid dynamics and clinical evaluation of nasal airway obstruction due to septal deviation: An observational study.

The primary objective of this study was to determine how computational fluid dynamics (CFD) could be correlated to clinical evaluation of nasal airway obstruction (NAO) in a population of patients with symptomatic septal deviation (SD). The secondary objective was to determine whether CFD could define which side was the more obstructed. This was an observational study. Few publications have attempted to correlate CFD with clinical evaluation of NAO. This correlation would permit validation and improved interpretation. This study was performed in a university research laboratory specialised in fluid mechanics. We included patients referred for septal surgery at our centre. Age range was 19-58years. Preoperative CT scans were performed. All patients with non-structural causes of NAO such as rhinitis, sinusitis or tumoral/autoimmune processes (ie, not due to anatomic obstruction) were excluded. For each nasal fossa, we compared CFD data (total pressure, heat flux, wall shear stress, temperatures, velocity and nasal resistances) with both patient perception scores and rhinomanometry using the Spearman correlation test (rs ). Perception scores were graded from 0/4 to 4/4 on each side, based on the patient interview. We also compared CFD-derived nasal resistances with rhinomanometry-derived nasal resistances. Twenty-two patients complaining of NAO with SD were analysed, and 44 analyses were performed comparing each side with its CFD data. Regarding correlations with patient perception scores, the best values we found were heat flux measures (rs =0.86). Both rhinomanometry and CFD-calculated nasal resistances had strong correlations with subjective perception scores (rs =0.75, P<0.001 and rs =0.6, P<0.001, respectively). We found a statistically significant difference between RMM-NR and CFD-NR (P=0.003). Heat flux analysis allowed us to distinguish the more obstructed side (MOS) and the less obstructed side (LOS) in 100% of patients. This study aimed to enhance our ability to interpret CFD-calculated data in the nasal airway. It highlights and confirms that heat flux measures are very closely correlated to patient perception in cases of SD. It also helps to distinguish the more obstructed side from the less obstructed side and could contribute to further CFD studies.

Clinico-pathological evaluation and etiological stratification of chronic AUB patients based on PALM-COEIN classification: A prospective study in tertiary care center of Nalgonda District

Context: Abnormal uterine bleeding (AUB) is a common crippling gynaecological condition with vast financial implications. A structured approach for establishing the cause using the FIGO defined PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and Not otherwise classified) classification system will facilitate accurate diagnosis and inform treatment options. Aims and objectives: 1. Clinico-pathological evaluation of patients presenting with chronic AUB. 2. Etiological stratification of patients with chronic AUB in accordance to PALM-COEIN Classification.3. To determine frequency of various uterine histopathological findings and their associated etiologies in the population of Nalgonda district. Settings and Design:The present study was a cross-sectional prospective study conducted at the Department of pathology and Department of Obstetrics and Gynecology, Kamineni Institute of Medical Sciences, Narketpalli over a period of 2 years starting from June 2016 to June 2018. Methods and Material: The study population included 188 cases of Chronic AUB. Specimens analysed were: 1. endometrial biopsy obtained by dilatation and curettage. 2. Hysteroscopy guided biopsy 3. Hysterectomy specimens. Histopathological evaluation of specimens was done and reported in accordance with PALM-COEIN classification. Results: The commonest Age group involved was perimenopausal group (41-50) constituting (39.4%). Multiparous women most commonly presented with AUB accounting for 44.1% of all cases. Menorrhagia is the most common clinical presentation in reproductive age group (50.6%) and perimenopausal women (39.2%). Post-menopausal bleeding (36.0%) is commonest presentation in Post- menopausal age-group of AUB patients. Proliferative endometrium is the most common histological finding in reproductive age group (44.9%) and perimenopausal women (33.8%). Leiomyomas are the most common presentation is Post-menopausal women (32%). 4 Patients in the Post-menopausal Age group presented with Endometrioid Adenocarcinoma. According to PALM-COEIN classification AUB-E is the most common etiologic factor across all age groups. Non-structural causes account for 54.8% of AUB cases and among 45.2% of structural causes, Simple cystic hyperplasia is the most common histological finding. Conclusions: AUB is a common and debilitating condition with high direct and indirect costs. Histopathological evaluation is the gold standard tool in the evaluation of the patients with Chronic AUB. A structured approach to establishing the cause using the FIGO PALM-COEIN classification system will facilitate accurate diagnosis and inform treatment options.

Study of causes behind abnormal uterine bleeding according to PALM- COEIN classification at a tertiary care hospital.

This descriptive observational study was carried out to determine the frequency of causes behind Abnormal Uterine Bleeding (AUB) amongst patients of reproductive age presenting to gynaecology OPD from January to June 2018 at the Combined Military Hospital Kharian, a tertiary care hospital. All women presenting with complaints of AUB were enrolled for the study, except for those who were pregnant, adolescent and postmenopausal. Detailed history, physical examination and relevant investigations were done and patients were categorised according to FIGO PALM-COEIN classification system and placed in nine main categories. A total of 238 patients were enrolled and the incidence of AUB among them was found to be 11% according to PALM-COEIN classification system. The frequency and percentage of all etiologies was calculated. Frequency of structural causes was Polyp 10 (6.7%), Adenomyosis 35 (23.5%), Leiomyomata 80 (53.7) and Malignancy 24 (16.1%). Nonstructural causes were Coagulation Disorders 5 (5.6%), Ovulatory 56 (37.6%), Endometrial Dysfunction 3 (3.4%), Iatrogenic 14 (15.7%) and Not-yet-classified 11 (12.4%). Development of a universally accepted classification system is a step towards facilitating clinicians, patients and researchers to communicate with each other and make objective management plans.

Performance of Hepatic Artery Velocity in Evaluation of Causes of Markedly Elevated Liver Tests

The purpose of this study was to assess the utility of peak systolic proper hepatic artery velocity (HAV) in differentiating causes of severely elevated liver function tests. HAV, hepatic artery resistive index and portal vein velocity of 41 patients with severely elevated liver function tests were evaluated. In 19 patients (46%), the causes were structural (e.g., cholecystitis, cholangitis), whereas in 22 patients (54%) the causes were non-structural (e.g., rhabdomyolysis, drug-induced liver injury). The average HAV for structural causes was 138 ± 68cm/s, and for non-structural causes, 65 ± 29cm/s (p < 0.0001). An HAV >100cm/s was correlated with structural causes (p = 0.0001). With respect to diagnostic performance, this threshold was 79% sensitive and 86% specific, with a high positive likelihood ratio (5.8) and low negative likelihood ratio (0.24). The resistive index and portal vein velocity were not statistically different. In patients with severely elevated liver function tests, an HAV >100cm/s can help distinguish structural from non-structural causes, which may guide management while awaiting definitive laboratory tests.

Rights-holders or refugees? Do gay men need reproductive justice?

A thriving North American industry has emerged designed to help gay men become biological parents through surrogacy and egg donation. Taking as given that gay men have the same ethical right to pursue such reproductive technologies as heterosexual couples or individuals, this article asks whether access to egg donation and surrogacy for gay men specifically could be considered a matter not just of (consumer) rights, but of justice. The idea of shifting discourse about reproduction from the language of ‘rights’ to that of ‘justice’ is most notably articulated by women of colour. Their call for reproductive justice seeks to expand discussion beyond the narrow right to an abortion (as a negative privacy right) to encompass broader, positive rights, such as the rights to bear healthy children and to raise them in safe environments. What, if anything, might we learn from reproductive justice movements about how to frame gay men's desire/demand for access to surrogacy? While I find several productive connections between the two groups, two factors lead me to argue against understanding gay access to surrogacy as a matter of justice: first, the necessary reliance on women's reproductive labour; and second, the largely non-structural causes of gay couples' inability to reproduce. Nevertheless, by considering two driving forces behind gay male assisted reproduction – social norms favouring biological family formation and the need for family security – I ultimately conclude that a basis for solidarity exists between gay men and reproductive justice movements. That basis is a concept like ‘procreative liberty’.

La participación política directa en el proceso constituyente español de 1977-78

In 1978, the Spanish constituent power finally opted for a restrictive regulation of direct political participation, in contrast to the broad acceptance that the first Draft of the Constitution had contemplated. An approach to the debates on this matter during the Spanish constituent process can shed light on what happened in terms of the historical circumstances of the time and the factors related to the dynamics of the constituent process itself. Observed from this historical perspective, the way in which the Constitution contemplated direct political participation was due to transitory and non-structural causes. Consequently, its adaptation to the current Spanish society should definitely be revised. Enviado el (Submission Date): 14/01/2018Aceptado el (Acceptance Date): 16/04/2018

Prevalence of abnormal uterine bleeding according to new International Federation of Gynecology and Obstetrics classification in Chinese women of reproductive age: A cross-sectional study.

The PALM-COEIN classification for causes of abnormal uterine bleeding (AUB) was proposed by the International Federation of Gynecology and Obstetrics (FIGO) in 2011, which has been gradually applied in the diagnosis of AUB in the past 2 years in China. However, there are no reports yet on the causes of chronic AUB among Chinese women with this new classification system.The purpose of this study was to describe the prevalence of the causes of chronic AUB among Chinese women of reproductive age using the PALM-COIEN classification system.This is a cross-sectional study. Beijing Shijitan Hospital, Capital Medical University.A total of 1053 women aged 15 to 55 years with chronic AUB were evaluated between November 2016 and May 2017.Prevalence of the causes of chronic AUB using the PALM-COEIN classification. AUB-O was the most frequent finding in women with chronic AUB, accounting for 608 (57.7%) cases. AUB-P was found in 171 (16.2%) women, AUB-L in 130 (12%) women, AUB-A in 52 (4.94%) women, AUB-E in 28 (2%) women, AUB-I in 23 (2%) women, AUB-M in 20 (1.9%) women, AUB-C in 10 (1%) women, and AUB-N in 10 (0.9%) women.Ovulatory dysfunction (AUB-O) is the most common cause of AUB among the nonstructural causes. Endometrial polyps (AUB-P) are the most common among the structural causes, followed by uterine fibroids (AUB-L) and uterine adenomyosis (AUB-A).