Distribution of causes of abnormal uterine bleeding according to PALM COEIN classification in tertiary health centre and its histopathological correlation

AUB is a common problem among women of all ages, accounting for 20-30% of outpatient visits in the reproductive age group and 69 percent in the peri or postmenopausal age group. It has a major effect on women's personal, social, physical, and psychological well-being.

This prospective observational research was performed at J K Lone Mother and Child Hospital and Government Medical College, Kota, Rajasthan, from date January 2018 to July 2019, in the department of obstetrics and gynecology. The researchers looked at all women in the 40-year-old age group who had AUB and were not responding to nonsurgical care. Several causes of PALM and COEIN were investigated, and a histo-pathological association was calculated.

Total 60 women with AUB not responding to medical management were taken. Majority (53.3%) women were between 40-50 years of age. Majority (63%) were para 2.Most common associated structural cause was leiomyoma (31%) followed by adenomyosis (25%) followed by ovulatory dysfunction (18%) followed by malignancy and polyp (10%).Most common histopathological finding was secretory phase (31.7%) followed by proliferative phase (28.3%) and then by hyperplasia (21.7%).ROC curve analysis showed that AUB-PALMCOEIN can predict diagnosis up to 95.8%. P value analysis for polyp, fibroid, ovulatory, endometrial was not significant showing that AUB-PALMCOEIN can predict diagnosis as much as histopathological examination. P value analysis for adenomyosis and malignancy was significant showing histopathology to be more accurate in giving diagnosis.

The PALM-COEIN classification aids in determining the cause of AUB and, as a result, efficiently adopting and planning for patient care. The structural cause of AUB played a larger role in the development of AUB. The major causes of AUB were divided into structural and non-structural causes in this research. The COEIN part of the classification needs to be improved further through in-depth analysis. Metrics

Practice bulletin number 128:diagnosis of abnormal uterine bleeding in reproductive-aged women.Obstet Gynecol.2012;120(1):197-206. American College of Obstetricians and Gynecologists.Management of anovulatory bleeding. ACOG Practice Bulletin No. Washington DC:ACOG:2000. Munro MG, Critchley HO, Broder MS, Fraser IS. For the FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet. 2011;113(1):3-13. Munro MG, Critchley HO, Fraser IS. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? Am J Obstet Gynecol. 2012;207(4):259-65. Betha K, Malavatu L. Distribution of causes of abnormal uterine bleeding using new FIGO classification system-PALM COEIN: a rural tertiary hospital based study in Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3523-7. Anupamasuresh Y, Suresh YV. Abnormal uterine bleeding: a clinicohistopathological analysis. Int J Reprod Contracept Obstet Gynecol. 2014;3(3):656-661. Mahapatra M, Mishra P. Clinicopathological evaluation of abnormal uterine bleeding. J Health Res Review. 2015;2(2). Byna P, Siddula S. Histopathological correlation of abnormal uterine bleeding in perimenopausal women. Int J Reprod Contracept Obstet Gynecol. 2015;4(6):1875-8. Doraiswami S, Johnson T, Rao S, Rajkumar A, Vijayaraghavan J, Panicker VK. Study of endometrial pathology in abnormal uterine bleeding. J Obstet Gynaecol India. 2011;61(4):426-30. Gouri SRS, Lakshmi PV, Rani NG, Kumar NA. Categorization of causes of Abnormal Uterine bleeding According to PALM-COEIN Classification. Int J Sci Stud. 2016;4(2):104-7. Ahmed SB, Mogri S. Application of PALM-COEIN FIGO classification in diagnosis of abnormal uterine bleeding(AUB) patients. Indian J Obstetr Gynecol Res. 2018;5(2):278-281. Yadav DP, Yadav R. Abdominal hysterectomy: analysis of clinical-histopathological correlation in Western Rajasthan, India. Int J ReprodContraceptObstet Gynecol. 2017;6(3):1012-5. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia: a long term study of “untreated” hyperplasia in 170 patients. Cancer. 1985;56:403-12. Mishra D, Sultan S. FIGO’s PALM-COEIN Classification of Abnormal Uterine Bleeding: A Clinico-histopathological Correlation in Indian setting. The J Obstetr Gynecol India. 2017;67(2):119-25. Shukla M, Fonseca MN, Kharat D, Tekale P. A study to correlate histopathological findings in patients with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2017;6:654-7. Abdulla LS. Histopathological Pattern of Endometrial Sampling Performed for Abnormal Uterine Bleeding in Bahrain Medical Bulletin. 2011;33(4). Mohammed N, Prejisha B. A study of correlation of etiological and histopathological findings in females undergoing hysterectomy for abnormal uterine bleeding - in accordance with palmcoein classification. Indian J Res. 2014;3(11):76-9.