Severe Uterine Bleeding Research Articles

Clinicopathological association of Uterine Fibroids with SOX4 gene overexpression

Uterine fibroids represent the major public problem and the commonest benign tumors. This study.was intended to determine the role of SOX4 gene in induction uterine fibroids, for these purpose 25 patients aged 37-70 years with severe uterine bleeding followed hysterectomy were included in this study. Histopathological of biopsies findings confirm the incidence of uterine fibroids. According the body mass index, the SOX4 gene expression recorded a high significant increase (p> 0.01) :Normal weight =1.74, Overweight =2.94 and Obese=3.81 when compared to control group that recorded in Normal weight =1.08, Overweight =1.04 and Obese=1.04 respectively. On the other hand; the effect of age in SOX4 gene expression folding revealed there was a highly significant increase on (p> 0.01) in group aged less than 45 years (2.6209) when compared to control group (1.0769). In more than 45 years mean folding of SOX4 gene recorded (3.443) when compared to control group (1.020).

Indications of Peripartum Hysterectomy

Introduction: Peripartum hysterectomy has to be done repeatedly as the last resort in saving a woman's existence. Currently, several drugs and surgical techniques have been established for the management of postpartum haemorrhages. The foremost indication for peripartum hysterectomy is severe uterine haemorrhage that cannot be controlled by conservative methods. Objectives: This study intended to find out the indication and frequency of peripartum hysterectomy in MAG Osmani Medical College Hospital, Sylhet. Methods: This prospective cross-sectional study on 100 cases of peripartum hysterectomy was carried out at the Department of Obstetrics & Gynaecology at Sylhet M.A.G Osmani Medical College Hospital, Sylhet from January 2004 to June 2005. Verbal consent was taken before recruiting the study population. Data was compiled and analysed manually. Result: The commonest age group involved in peripartum hysterectomy was 31-35 years (38,38.0%). The incidence of peripartum hysterectomy was 0.70%. Rupture uterus (76%) was the most common cause. Other causes are uterine atony (12%), Placenta praevia (2%), placenta accreta (2%) & sepsis in 6% of cases. Maximum patients (82,82.0%) did not get any antenatal care. Of those who got antenatal care, eighteen patients (18,18.0%) were irregularly booked. Conclusion: Emergency peripartum hysterectomy is a vital lifesaving technique and remains to have a high incidence in our community. The choice to implement an emergency peripartum hysterectomy is usually obscure as the obstetrician's paramount wish is to preserve the uterus for future childbearing.

052 Dysfunctional uterine bleeding in girls, including children with special needs

Adolescent menorrhagia is defined as uterine bleeding lasting more than 10 days and/or severe uterine bleeding with a total menstrual blood loss of more than 80ml, causing anemia. Such uterine bleeding episodes might occur up to 5 years after menarche; are characterized by differential time of abnormal bleeding and its severity: from moderate to heavy menstruation. This is the common form of irregular menstruation in adolescent female and is usually functional [ [1] Haamid F. Sass A.E. Dietrich J.E. Heavy menstrual bleeding in adolescents. J Pediatr Adolesc Gynecol. 2017; 30: 335-340 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar ].

The case of perforation of the uterus with a goose feather with its exit into the abdominal cavity

10/VII 1930, a 24-year-old peasant Chuvash woman was admitted to the Cheboksary hospital due to severe uterine bleeding.

Abnormal Uterine Bleeding in Adolescent

Abstract Abnormal uterine bleeding (AUB) is a frequent cause of visits to health care provider during adolescent period. Heavy menstrual bleeding is the most frequent clinical presentation of AUB. This condition particularly worrisome in this group not only when it occurs at menarche, but also anytime afterward when bleeding lasts longer than 7 days, blood loss is greater than 80 mL per cycle, or other warning signs that indicate a history of heavy bleeding such as anemia. Careful history and examination can help elucidate the best next steps for workup and management. The primary goal of treatment is prevention of hemodynamic instability. Therefore, assessing the severity and cause of bleeding is important. Therapeutic approach in the acute period should be established according to the degree of anemia and amount of flow. Treatment options for medical care of AUB generally include hormonal, nonhormonal and surgery. Additionally, long-term management with hormonal therapy in patients with severe uterine bleeding is known to be safe for developing HPO axis. Keyword: Abnormal uterine bleeding, adolescents, heavy menstrual bleeding

Increased risk of severe abnormal uterine bleeding associated with rivaroxaban

Increased risk of severe abnormal uterine bleeding associated with rivaroxaban

Severe uterine haemorrhage requiring a blood transfusion in a dog with ovarian remnant syndrome and secondary pyometra

AbstractAn 18‐month‐old female German Shepherd dog, previously reported to be spayed, presented to a referral clinic with a history of progressive haemorrhagic vulvar discharge resulting in clinical anaemia. An abdominal ultrasound showed an enlarged uterus and a retained right ovary; vaginoscopy revealed no obvious haemorrhage from the vagina or cervix, so the dog underwent exploratory laparotomy for ovariectomy and hysterectomy. Prior to surgery, the dog received a 15 ml/kg packed red blood cell transfusion and post‐operatively was given fresh frozen plasma due to significant blood loss into the uterus. Histopathology was consistent with cystic endometrial hyperplasia, suppurative metritis and pyometra. A uterine culture grew Escherichia coli. The dog ultimately made a full recovery.

Comparative Risk Assessment of Severe Uterine Bleeding Following Exposure to Direct Oral Anticoagulants: A Network Study Across Four Observational Databases in the USA.

BackgroundAntithrombotic therapies are associated with an increased bleeding risk. Abnormal uterine bleeding data have been reported in clinical trials of patients with venous thromboembolism (VTE), but data are limited for patients with atrial fibrillation (AF).ObjectiveUsing real-world data from four US healthcare databases (October 2010 to December 2018), we compared the occurrence of severe uterine bleeding among women newly exposed to rivaroxaban, apixaban, dabigatran, and warfarin stratified by indication.MethodsTo reduce potential confounding, patients in comparative cohorts were matched on propensity scores. Treatment effect estimates were generated using Cox proportional hazard models for each indication, in each database, and only for pairwise comparisons that met a priori study diagnostics. If estimates were homogeneous (I2 < 40%), a meta-analysis across databases was performed and pooled hazard ratios reported.ResultsData from 363,919 women newly exposed to a direct oral anticoagulant or warfarin with a prior diagnosis of AF (60.8%) or VTE (39.2%) were analyzed. Overall incidence of severe uterine bleeding was low in the populations exposed to direct oral anticoagulants, although relatively higher in the younger VTE population vs the AF population (unadjusted incidence rates: 2.8–33.7 vs 1.9–10.0 events/1000 person-years). In the propensity score-matched AF population, a suggestive, moderately increased risk of severe uterine bleeding was observed for rivaroxaban relative to warfarin [hazard ratios and 95% confidence intervals from 0.83 (0.27–2.48) to 2.84 (1.32–6.23) across databases with significant heterogeneity], apixaban [pooled hazard ratio 1.45 (0.91–2.28)], and dabigatran [2.12 (1.01–4.43)], which were sensitive to the time-at-risk period. In the propensity score-matched VTE population, a consistent increased risk of severe uterine bleeding was observed for rivaroxaban relative to warfarin [2.03 (1.19–3.27)] and apixaban [2.25 (1.45–3.41)], which were insensitive to the time-at-risk period.ConclusionsFor women who need antithrombotic therapy, personalized management strategies with careful evaluation of benefits and risks are required.ClinicalTrials.gov RegistrationNCT04394234; registered in May 2020.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40264-021-01060-4.

Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment

Obstetrician-gynecologists frequently are consulted either before the initiation of cancer treatment to request menstrual suppression or during an episode of severe heavy bleeding to stop bleeding emergently. Adolescents presenting emergently with severe uterine bleeding usually require only medical management; surgical management rarely is required. Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management. When used continuously, combined hormonal contraceptives are effective for producing amenorrhea, although complete amenorrhea cannot be guaranteed. The risk of venous thromboembolism in patients with cancer is compounded by multiple factors, including presence of metastatic or fast-growing, biologically aggressive cancers; hematologic cancers; treatment-related factors such as surgery or central venous catheters; and the number and type of comorbid conditions. Although as a group, patients undergoing cancer treatment are at elevated risk of venous thromboembolism compared with the general population, this risk may be extremely elevated for certain patients and existing guidance on risk stratification should be consulted. The decision to use estrogen in patients with cancer should be tailored to the individual patient after collaborative consideration of the risk-benefit ratio with the patient and the health care team; the patient should be closely monitored for known adverse effects such as liver toxicity and venous thromboembolism.

Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment: ACOG Committee Opinion, Number 817.

Obstetrician-gynecologists frequently are consulted either before the initiation of cancer treatment to request menstrual suppression or during an episode of severe heavy bleeding to stop bleeding emergently. Adolescents presenting emergently with severe uterine bleeding usually require only medical management; surgical management rarely is required. Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management. When used continuously, combined hormonal contraceptives are effective for producing amenorrhea, although complete amenorrhea cannot be guaranteed. The risk of venous thromboembolism in patients with cancer is compounded by multiple factors, including presence of metastatic or fast-growing, biologically aggressive cancers; hematologic cancers; treatment-related factors such as surgery or central venous catheters; and the number and type of comorbid conditions. Although as a group, patients undergoing cancer treatment are at elevated risk of venous thromboembolism compared with the general population, this risk may be extremely elevated for certain patients and existing guidance on risk stratification should be consulted. The decision to use estrogen in patients with cancer should be tailored to the individual patient after collaborative consideration of the risk-benefit ratio with the patient and the health care team; the patient should be closely monitored for known adverse effects such as liver toxicity and venous thromboembolism.

Stepwise Treatment of Uterine Arteriovenous Malformation Complicated by a Giant Aneurysm: A Case Report

Uterine arteriovenous malformation (AVM) is a rare condition that threatens severe uterine bleeding. We present a patient with this pathology, who was hospitalized twice within 5 months in serious condition, because she refused a hysterectomy. Ultrasonography of the uterus detected a vascular formation, the nature of which could be identified only on computed tomography (CT) angiography. Afferent vessels were embolized twice, and after the condition was stabilized, we performed a hysterectomy. For a long time, there was no recurrence of bleeding. The foregoing allows us to recommend the described tactics for the diagnosis and treatment of uterine AVM in women in similar clinical situations.

H. Gaertig. Ueber Erythem im Wochenbett. (Centralbl. F. Gynäk., 1894, no. 30). About erythema in the postpartum period

Patient 26 years old. I have never suffered from skin diseases. The first pregnancy was uneventful. The birth is correct. After delivery, delayed placenta and severe uterine bleeding.

Transvaginal ultrasound‐guided direct thrombin injection for the treatment of intramyometrial pseudoaneurysm in a young female with uterine hemorrhage after failed uterine artery embolization

Uterine artery pseudoaneurysm is an uncommon but important cause of severe uterine bleeding in the postpartum or postsurgical setting. The standard treatment options are endovascular uterine artery embolization and bilateral surgical internal iliac artery ligation for uterus conservation or hysterectomy. We report the case of a young female with hemorrhage from an intramyometrial pseudoaneurysm following repeated curettage and hysteroscopic excision of retained products of conception. Uterus preservation was of priority, and the patient underwent uterine artery embolization; however, the pseudoaneurysm persisted due to ovarian artery collaterals. The pseudoaneurysm was subsequently treated with transvaginal ultrasound-guided direct thrombin injection. The case highlights the advantages and disadvantages of the treatment options in such clinically challenging cases emphasizing the seldom employed direct injection of thrombin for the treatment of pseudoaneurysms.

Approach to Abnormal Uterine Bleeding in Adolescents

This article reviews the current understanding and management of abnormal uterine bleeding (AUB) in adolescents. It is hoped that this review will provide readers with an approach to the evaluation and treatment of mild to severe uterine bleeding. AUB is a common problem which has significantly adverse effects on an affected adolescent’s quality of life. The most common underlying condition in AUB in adolescence is anovulation. During the evaluation, pregnancy, trauma and sexually transmitted diseases must be ruled out, regardless of history. It should be kept in mind that AUB during this period may be the first sign of underlying bleeding disorders. Although observation is sufficient in the mild form of AUB, at the other end of the spectrum life-threatening bleeding may necessitate the use of high doses of combined oral contraceptives, intravenous estrogen and/or interventional procedures.

Retroperitoneal Approach to Laparoscopic Hysterectomy in Patient with Complete Uterus Didelphys

Video Objective Demonstrate how a retroperitoneal dissection can facilitate hysterectomy in cases of uterine anomalies Setting University affiliated hospital Interventions 55 year old patient presented with severe abnormal uterine bleeding and dysmenorrhea. Imaging was suspicious for a Mullerian anomaly. A laparoscopic hysterectomy was planned. On entry into the abdomen, complete uterine didelphys was noticed. Using a retroperitoneal dissection we were able to identify all critical structures and maintain adequate hemostasis during the case, resulting in a satisfactory outcome for the patient. Conclusion Developing the retroperitoneal space is paramount in order to successfully perform surgery in a uterus with distorted anatomy

The Use of Norethisterone for the Treatment of Severe Uterine Bleeding in Adolescents: An Audit of Our Experience.

The purpose of this prospective study was to assess the effectiveness of norethisterone (NET) in the management of abnormal uterine bleeding (AUB) in adolescents in a tertiary care center. This was a prospective audit focused on administering high doses of NET in female adolescents with complaints of AUB. We included female adolescents who presented to our Emergency Gynecological Department or Adolescent Gynecological Outpatient Department from October 2016 to January2019. The study included 29 female adolescents aged 11-17 (mean, 13.14) years. Patients were administered a daily dose of 10-30mg, depending on the severity of the condition, bleeding duration, and patient weight. Cessation of vaginal bleeding. Mean age at menarche of our patient sample was 11.4years (range, 10.7-14years). AUB presented at a mean time of 24.6months after menarche (range, 0-79months). Blood transfusion was deemed necessary in 9 patients. Bleeding stopped at a mean of 46.1 (range, 8-120) hours after onset of treatment with NET. No serious adverse events were reported with NET administration, with only 3 cases of minor side effects. The use of NET is an effective and reliable treatment option among adolescents for whom control of AUB is desired in the acute setting.

ACTA2 mutation and postpartum hemorrhage: a case report

BackgroundACTA2 encodes smooth muscle specific α-actin, a critical component or the contractile complex of vascular smooth muscle. Mutations in ACTA2 are the most common genetic cause of thoracic aortic aneurysm, and are also the cause of other disorders, including Moyamoya disease, coronary artery disease and stroke as well as Multisystemic Smooth Muscle Dysfunction Syndrome. We note that ACTA2 is also expressed in uterine smooth muscle, and this raises the possibility that women harboring ACTA2 mutations might exhibit uterine smooth muscle dysfunction.Case presentationWe present a young woman whose ACTA2 mutation was ascertained during pregnancy because of her father’s history of dissecting aneurysms. She was delivered at full term by cesarean section and subsequently had severe uterine hemorrhage due to uterine atony. Although her atony was successfully treated with uterotonic medications, she required blood transfusion.ConclusionsThis case raises the possibility that women with ACTA2 mutations may be at risk of uterine muscle dysfunction and hemorrhage. Obstetricians should be alerted to and prepared for this possibility.

Peripartum Hysterectomy in Misan Province during 2014-2016

Background: Peripartum hysterectomy is the procedure of removing the uterus after vaginal delivery or cesarean birth; it remains a life-saving procedure in cases of severe uterine hemorrhage. Objective: To know the incidence of peripartum hysterectomy in Misan province, what is the main cause of this procedure, and if there is any change in the incidence of this procedure during a 3 year study period. Method: A descriptive cross sectional study was done in Misan province for all cases of peripartum hysterectomy during the period from 2014-2016. All information regarding present pregnancy, previous obstetric history, the cause of peripartum hysterectomy, any complications & infant outcome, were taken from the case sheet & from the patients themselves. 50 patients were enrolled in this study, and only 30 patients needed peripartum hysterectomy and 20 patients’ uterus were saved by repair surgery. Results: During the study period of 3 years, there was 72,720 deliveries, and during that time 30 peripartum hysterectomies were carried out of the 50 cases studied, which gave an incidence of 0.4/1000 deliveries. The patients were diagnosed as: rupture uterus in 30 (60%) cases, adherent placenta in 14 (28%) & 6 (12%) cases had atonic uterus. The major postoperative complication was anemia which complicated 23 (46%) cases, & then bladder injury 5 (10%). Admission to ICU was needed for 24 (48%) cases. There were 32 (64%) cases needed ≥4 units of blood transfusion. There were 38 (76%) cases stayed in hospital for ≥4 days. The most common cause for peripartum hysterectomy was for adherent placenta (28%) & rupture uterus (20%). Conclusion: The incidence of peripartum hysterectomy was 0.4/1000 (0.04%) deliveries. The most common reason behind peripartum hysterectomy was for adherent placenta and next was for uterine rupture. The rate of this procedure was not changed during the study period.

A case of severe uterine bleeding postpartum following manual removal of placenta increta

A case of severe uterine bleeding postpartum following manual removal of placenta increta

Abnormal uterine bleeding

The article describes a clinical case of severe uterine bleeding in a patient with III degree of mitral valve insufficiency after mitral valve replacement, which was placed a clinical diagnosis of abnormal uterine bleeding (AUB). Given the categorical refusal of the patient and her relatives from holding hysteroscopy the conservative haemostatic therapy was appointed.In view of the congenital heart disease and the risks of thrombotic complications the oral contraceptive for patient was contraindicated. Therefore, for the treatment was selected the drug of tranexamic acid Vidanol at dose of 1.5 g every 8 hours for 5 days, as well as non-steroidal anti-inflammatory drug diclofenac sodium in rectal suppositories of 100 mg over 5 days. Considering the moderate secondary anemia and the severity of clinical symptoms, for patient was also appointed anti-anemia drug Ferinzhekt at a dose of 1000 mg intravenously once, followed by the appointment after 1 week Maltofer on 1 tablet 3 times a day for a month.During the first 12 hours of treatment with the combination Vidanol +diclofenac sodium was observed a decrease in the volume of blood loss of patient, the decrease of intensity of pain, and improvement in overall condition. Against the background stabilization of the general condition of the patient under ultrasound was performed the dissection and separation of intrauterine adhesions, which were detected during diagnostic hysteroscopy. In order to prevent recurrence of occurrence of this disease was introduced anti-adhesion gel Defensal in the uterus. Postoperatively, the patient also received antibiotic prophylaxis and complex of anti-inflammatory therapy.In the next two menstrual cycles in order to prevent of AUB the patient took from 1 to 5 day of menstruation on 500 mg of Vidanol 3 times a day, as well as suppositories diclofenac sodium one day before the onset of menstruation and within 5 days of the cycle. After 2 months at the time of the next menstruation for woman was set intrauterine system (IUS), which releasing daily 13.5 mg of levonorgestrel. At the control examination 3 months after IUS installation the patient was no complaints, no bleedings and pain, and her general condition was improved.This clinical case is an example of an effective and safe treatment for severe AUB for patient of reproductive age with severe somatic pathology. Appointment of tranexamic acid in combination with nonsteroidal anti-inflammatory drugs and anti-anemia therapy is effective in the treatment of AUB and can be used for the prevention of uterine bleeding.