{"paper_id":"4d74c854-1860-4866-b083-b91883ea2b9f","body_text":"~ 99 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2022; 6(1): 99-102 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2022; 6(1): 99-102 \nReceived: 19-11-2021 \nAccepted: 21-12-2021 \n \nDr. Silpa Parvathaneni \nAssociate Professor, Department of \nGynaecology and Obstetrics, SVS \nMedical College, Mahabubnagar, \nTelangana, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Silpa Parvathaneni \nAssociate Professor, Department of \nGynaecology and Obstetrics, SVS \nMedical College, Mahabubnagar, \nTelangana, India \n \nStudy of clinical and pathological correlation of AUB \npatients undergoing hysterectomy \n \nDr. Silpa Parvathaneni \n \nDOI: https://doi.org/10.33545/gynae.2022.v6.i1b.1120 \n \nAbstract \nBackground: Abnormal uterine bleeding (AUB) is most common in the perimenopausal  and \npostmenopausal age groups. FIGO's acronym (PALM -COEIN) describes the causes of AUB . Polyps, \nadenomyosis, leiomyoma, mal ignancy, hyperplasia, coagulopathy, Ovulatory dysfunction, endometrial, \niatrogenic, and not yet classified are among them.  \nAim: To determine the preval ence and distribution of various uterine pathologies in hysterectomy \nspecimens as a function of age, parity, and clinical characteristics.  \nMethods: 500 women with AUB who are having a hysterectomy between December 2017 and November \n2019 will be chosen for the study. All AUB patients undergoing hysterectomy were included in the study.  \nResults: In the pre sent study, majority of patients were in the age group range of 41 -50 years (37%) \nfollowed by 30% in the age group range of 31 -40 years. Majority of patien ts were in the 2 nd parity which \nconstituted 58% and minimum number of cases (2%) in unmarried cases. HMB was seen (47.6%) followed \nby dysmenorrhoea (14%) and irregular bleeding (13.4%) cases.  The most common diagnoses were fibroid \nuterus in 40% of cases, A denomyosis in 17% of cases, both fibroid and Adenomyosis in 8.2% of cases, \npolyp in 5% of cases , normal uterus in 14.6 percent of cases, endometrial hyperplasia in 1.6 percent of \ncases, endometrial carcinoma in 1.2 percent of cases. The  most common surgica l approach is abdominal \n(66.2%), followed by vaginal (18.6%), and laparoscopically  (15.2 perce nt). In 102 cases, \ncomplications were discovered (19.25 percent). Pyrexia in 28 instances (5.6%), abdominal distension in 17 \ncases (3.4%), wou nd dehiscence in 15 cases (3%), RTI in 11 cases (2.6%), and UTI in 13 cases are the \nmost common complications (2.6 percent ). Malaria, thrombophlebitis, urinary retention, and subsequent \nhaemorrhage have all been reported in a small number of patients.  \nConclusion: The majority of the patients were in the perimenopausal age bracket and were multiparous. \nHMB was a common AUB symptom. Leiomyoma was a common diagnosis. USG and histology confirmed \nthe diagnosis. Proliferative endometrial patterns were common. Si mple endometrial hyp erplasia in \nperimenopausal women and complicated hyperplasia in postmenopausal women were the most common \nfindings. In AUB patients, hysterectomy is still the only option. \n \nKeywords: abnormal uterine bleeding, dysmenorrhea, heavy menstrual bleeding, hysterectomy \n \nIntroduction  \nThe essence of womanhood, the uterus, is controlled by cyclical hormonal changes caused by \nalterations in the hypothalamus -pituitary-ovary axis  [1]. All women of reproductive age have \nmenstruation, which is cyclic uterine bleeding. Normal menstruation is defined as bleeding from \nthe secretory endometrium that occurs during an ovulatory cycle that lasts no longer than seven \ndays. Abnormal uterine bleeding is defined as any bleeding that does not meet these criteria  [2, 3]. \nBleeding is considered abnormal when the pattern i s irregular or the length exceeds seven days. \nAbnormal uterine bleeding refers to any bleeding that does not meet these criteria. When the \npattern of bleeding is irregular or the duration exceeds se ven days, it is cons idered abnormal. \nPolyp, adenomyosis, l eiomyoma, malignancy and hyperplasia, coagulopathy, Ovulatory \ndysfunction, endometrial, iatrogenic, and not yet classified are the causes of AUB, according to \nFIGO (2011)'s acronym (PALM -COEIN) [4, 5]. Menorrhagia, men orrhagia, dysmenorrhea, \npolymenorrhoea, intermenstrual bleeding, irregular bleeding, and postmenstrual bleeding are the \nmost prevalent symptoms. Heavy Menstrual Bleeding takes the role of menorrhagia (HMB). \nClinically, inquiry, and ultr asonography are used  to treat AUB , although there may be a \ndifference between clinical and sonological and histopathological diagnosis. The histology \nresearch and the final diagnosis were always in sync.  \n \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 100 ~ \nMedical management, minor surgeries such as D an d C, ablative \ntreatments, and finally hysterectomy are all option s. \nHysterectomy can be performed vaginally, abdominally, or \nlaparoscopically, depending on the patient's condition, the size \nof the uterus, including mobility, the institution's resources, an d \nthe surgeon's experience. \n \nMaterials and Methods \n500 women with  AUB who are having a hysterectomy between \nDecember 2017 and November 2019 will be chosen for the \nstudy. All AUB patients undergoing hysterectomy were included \nin the study. All AUB patients not undergoing hysterectomy and \nall the hysterectomy causes other than AUB were excluded from \nthe study. Heavy menstrual bleeding, dysmenorrhea, \nmetrorrhagia, irregular bleeding, postmenopausal bleeding, and \nother symptoms were investigated in all AUB patients. Instances \ninvolving pregnancy were omitted from the s tudy, and the \nremaining cases were investigated further. A complete medical \nhistory was collected, including the patient's age, parity, \neducation, socioeconomic level, clinical symptoms, duration o f \nsymptoms, and blood loss. Information was also gathered on any \ngynaecological complaints, medical conditions, and previous \nhormonal or surgical treatment. A full history was taken, \nfollowed by a thorough physical examination that included a \nthorough gene ral and systemic exa mination, and a tentative \ndiagnosis was  made. After that, all blood tests such as a \ncomplete blood count, renal function test, thyroid function test, \nbleeding time, and clotting time are performed. A Pap smear \nwas also performed. A pelv ic ultrasonographic examination was \nperformed. Endometrial biopsies were kept in 10% formalin \nsaline and forwarded for histological analysis and reporting. The \ncases where a hysterectomy was performed were saved and sent \nfor histological evaluation. The re ports were gathered,  and a \ndefinitive diagnosis was arrived  upon. Clinical and ultrasound \ndiagnoses were compared to the final diagnosis. The study's data \nwas examined with the help of proper statistical tools and \ntechniques. To explore the pattern of dist ribution, explorator y \ndata analysis using graphs and pie charts was performed. \n \nResults \n \nTable 1: Distribution based on age. \n \nAge (Years) No. of cases Percentage \nLess than 30 20 4% \n31-40 150 30% \n41-50 185 37% \n51-60 95 19% \n61-70 30 6% \nGreater than 70 20 4% \n \nTable 1 shows that the majority of patients were in the age group \nrange of 41-50 years (37%). \n \nTable 2: Distribution based on parity. \n \nParity No. of cases Percentage \nUnmarried 10 2% \nNulliparous 26 5.2% \n1 34 6.8% \n2 290 58% \n3 85 17% \n4 35 7% \n5 20 4% \n \n \nTable 2 sh ows that majority of patients were in the 2 nd parity \nwhich constituted 58%. \n \nTable 3: Distribution based on symptoms. \n \nClinical Symptoms No. of cases Percentage \nHMB 238 47.6% \nDysmenorrhea 70 14% \nHMB & Dysmenorrhea 31 6.2% \nHMB & Irregular bleeding 33 6.6% \nIrregular bleeding 67 13.4% \nMetrorrhagia 37 7.4% \nPostmenopausal bleeding 24 4.8% \n \nTable 3 shows that heavy menstrual bleeding was the most \ncommon symptom for hysterectomy which constituted 47.6%. \n \nTable 4: Clinical Diagnosis. \n \nDiagnosis No. of cases Percentage \nFibroid 205 41% \nAdenomyosis 127 25.4% \nBoth 34 6.8% \nDysfunctional uterine bleeding 66 13.2% \nPolyp 32 6.4% \nEndo CA 24 4.8% \nCervical CA 12 2.4% \n \nTable 4 shows that fibroid was the highest clinical diagnosis \nwhich constituted 41%. \n \nTable 5: USG Diagnosis. \n \nUSG Diagnosis No. of cases Percentage \nFibroid 200 40% \nAdenomyosis 85 17% \nBoth 41 8.2% \nPolyp 25 5% \nNormal 73 14.6% \nEndo hyperplasia 8 1.6% \nCervical CA 6 1.2% \nOvarian Cyst 15 3% \nBulky uterus 17 3.4% \nAtrophic organs 6 1.2% \nMyohyperplasia 4 0.8% \nEndo and \nMyohyperplasia 12 2.4% \nEndometriosis 2 0.4% \nEndo CA 6 1.2% \n \nTable 5 shows that fibroid was the highest USG diagnosis which \nconstituted 40%. \n \nTable 6: Routes of operative procedures \n \nRoute No. of cases Percentage \nAbdominal 331 66.2% \nVaginal 93 18.6% \nLaparoscopy 76 15.2% \n \nTable 6 shows that abdominal was the most common route of \noperating which constituted 66.2%. \n \n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 101 ~ \nTable 7: Complications of hysterectomy \n \nComplications No. of cases Percentage \nWound Sepsis 15 3% \nAbdominal Distension 17 3.4% \nPyrexia 28 5.6% \nRespiratory infection 11 2.2% \nUTI 13 2.6% \nUrinary retention 6 1.2% \nMalaria 7 1.4% \nThrombophlebitis 3 0.6% \nHaemorrhage 2 0.4% \n \nTable 7 shows that pyrexia was the most common complication \n(5.6%), followed by abdominal d istention (3.4%), wound sepsis \n(3%), UTI (2.6%), respiratory infection (2.2%), malaria, urinary \nretention, thrombophlebitis & haemorrhage. \n \nDiscussion \nIn the present study, majority of patients were in the age group \nrange of 41 -50 years (37%) followed by 3 0% in the age group \nrange of 31 -40 years. Similar results were observed in Rizvi et \nal. [6], 44.5 percent of cases are in the fifth decade (41 -50 years). \nIn Bharati Misra et al. [7] study; 41.25 percent of the cases are \nbetween the ages of 41 and 50, while 30 percent are between the \nages of 31 and 40. In Karmakar et al . [8]. study, 87.2% cases \nwere in the age group of 41 -60 years group and rest were above \n60. 35.9% of AUB cases were observed in 41 -50 years in \nJairajpur et al. [9]. study. 48.1% of AUB cases were observed in \n41-50 years  in Muzaffer et al . [10] study. 32.1% and 33.5% of \nAUB cases were observed in 41 -50 years in Abdullah et al. [11] \nand Saraswati et al . [12]. studies respectively. In the present \nstudy, majority of patients we re in the 2 nd parity which \nconstituted 58% and minimum number  of cases (2%) in \nunmarried cases. In Bharati Misra et al.  [7]. study second para \naccounted for 62.5 percent of the instances, with the unmarried \ncases accounting for the smallest number of cases . 1.75 \npercentage. In the Mohammad et al. [13]. study, it was discovered \n(65.9%) cases with a parity of 2, which is similar to the current \nstudy. Lee NC et al. [14] discovered a mean parity of 3 in their \nresearch, which revealed almost identical results. I n present \nstudy, HMB  was seen (47.6%) followed by dysmenorrhoea \n(14%) and irregular bleeding (13.4%) cases.  In Bharati Misra et \nal. [7]. study, similar results were observed as HMB  was seen \n(51.5%) followed by dysmenorrhoea (15%) and irregular \nbleeding (13.75%) cases. In comparison to our study, Rizvi et al. \n[6] discovered that 43.7 percent of subjects presented with HMB \nand irregular bleeding. HMB was discovered in 49.1% of \npatients by Nayar et al.  [15]. study. In Tyagi et al . [16], 41.3 \npercent of cases w ere having HMB, in 5 .75 percent of patients, \nmetrorrhagia is discovered. In 6% of cases, postmenopausal \nhaemorrhage occurs. In present study, fibroid uterus was found \nin 41% cases followed by adenomyosis in 25.4% cases and both \nfibroid uterus  and adenomyos is was found in 6.8 % cases. In \nBharati Misra et al. study, Fibroid uterus found in 48.25 % cases \nfollowed by adenomyosis in 25.75% cases and both \nadenomyosis and fibroid uterus found in 6.25 % cases. In Rizvi \net al. 6 study, it was found fibroi d uterine  in 41 .46% of cases, \nadenomyosis in 46.36 percent of cases, and both fibroid uterus \nand adenomyosis in 19. percent of cases. In 54.1 percent of \npatients, fibroid uterus was detected clinically, polyps were \ndiscovered in 4.25 percent of cases,  according to Begum et al.17 \nstudy. According to Doraswami et al. [18], polyps were accounted \nfor 11.2 percent of cases. Polyps were identified in 12 percent \nand 13 percent of cases, respectively, according to Mirza et al. \n[19] and Cornitescu et al. [20]. In Jairajpuri et al.9 study, incidence \nwas 1.7%, in Purendare et al . [21] it was found that  polyp was \nobserved in 4.8% cases, In  Saraswati et al . [12]. study, \nendometrial carcinoma were found in 2.75 % cases, 4.4% were \nfound for endometrial carcinoma and lower values were \ndocumented in Jairajpuri  et al. 9 study with 0.5% and \nMohammed et al . [13]. Study 0.72 % of endometrial carcinoma \nwas noted . Purendare et al.  [21] found that 0.9% were having \nendometrial carcinoma. Ovulatory dysfunction were found to be \npresent in 11% cases as c ompared to 22.5 % cases found by \nMohammed et al. [13]. In this study, the most common diagnoses \nwere fibroid uterus in 40% of cases, Adenomyosis in 17% of \ncases, both fibroid and Adenomyosis in 8.2% of cases, polyp in \n5% of cases, normal uterus in 14.6 perc ent of cases, endometrial \nhyperplasia in 1.6 percent of cases, endometrial carcinoma in 1.2 \npercent of cases, 3.25 percent of cases ovarian cyst.  \nIn present study, the most common surgical approach is \nabdominal (66.2%), followed by vaginal (18.6%), and \nlaparoscopically (15.2 percent) The most common surgical \napproach is abdominal (76.75%), followed by vaginal (15%), \nand laparoscopically (8 percent) in Bharati Misra et al. [7] study. \nIn Mac Kanzie et al. [22] study, it was observed that abdominal \nmethod was  preferred in 79 % cases and vaginal route in 17 % \ncases. In present study, in 102 cases, complications  were \ndiscovered (19.25 percent ). Pyrexia in 28 instances (5.6%), \nabdominal distension in 17 cases (3.4%), wound dehiscence in \n15 cases (3%), RTI in 11 c ases (2.6%), and UTI i n 13 cases are \nthe most common complications (2.6 percent ). Malaria, \nthrombophlebitis, urinary retention, and subsequent \nhaemorrhage have all been reported in a small number of \npatients. \n \nConclusion \nFIGO developed the PALM – COEIN class ification for AUB. \nThis study concluded that the majority of the patients were \nbetween the ages of 41 and 50 and were multiparous. HMB was \nthe most common AUB symptom, followed by dysmenorrhoea. \nLeiomyoma was the most common  clinical diagnosis, followed \nby adenomyosis. Ovulat ory dysfunction was a common non -\nstructural cause of AUB. USG and histopathological procedures \nwere used to confirm the diagnosis. Proliferative endometrial \npatterns were common. Simple endometrial hyperp lasia was the \nmost common observ ation in perimenopau sal age groups, \nfollowed by complex hyperplasia in postmenopausal age groups. \nDespite the availability of medicinal treatments and conservative \noperations, hysterectomy is still the most common and effect ive \ntreatment option for AUB patients. \n \nReferences \n1. Livingstone M, Fraser IS. Mechanisms of abnormal uterine \nbleeding. Hum Reprod Update. 2002;8:60–67. \n2. Market Opinion and Research International (MORI). \n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 102 ~ \nWomens health in 19 90. Research study con - ducted on \nbehalf of Parke-Davis Laboratories. London: MORI, 1990. \n3. Sarwar A, ul Haque A.  Types and frequencies of \npathologies in endometrial curettings of abnormal uterine \nbleeding. 2005;3(2):65-70. \n4. Kjerulff KH, Erickson BA, Langenb erg PW.  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