STUDY OF MEDICAL MANAGEMENT OF AUB CASES IN RESPECT WITH PALM COEIN CLASSIFICATION AT TERTIARY CARE CENTER
European Journal of Molecular & Clinical Medicine,
2021, Volume 8, Issue 4, Pages 193-203
AbstractIntroduction: Abnormal uterine bleeding (AUB) is the most common problem among patients coming to gynaecology outpatient department. There are various pathologies which can lead to AUB. History, blood investigations, ultrasonography, hysteroscopy and endometrial aspiration are the methods to rule out different causes. Later on, they are classified as per PALM-COEIN classification. It helps in better and successful management of AUB patients.
Material and Methods: This prospective interventional study was carried out in the Department of obstetrics and gynaecology, in our institute enrolling 300 consenting subjects having AUB coming to outpatient department and in doored to gynaecology ward of our tertiary care hospital. Subjects with confirmed diagnosis of abnormal uterine bleeding as per “PALM- COEIN” classification and on ultrasonography, fulfilling the criteria and ready to follow up were enrolled in the study. The final medical treatment assigned to the patients depending upon aetiology (PALM-COEIN classification) ,age of the patient ,desire of fertility and options available. Different medical treatment options like LNG-IUS (MIRENA), ormeloxifene (SERM), progesterone only pills, OC pills, tranexamic acid were given to the patients in this study for treatment of AUB.
Results: In our study, out of 300 , total 121 (40.3 %) study participants were given ormeloxifene, 65 (21.7%) were offered OC pills, 60 patients (20.0%) given LNG-IUS(MIRENA), 44 patients (14.7%) were treated with Progesterone and 10 (3.3%) study participants were medically treated with tranexamic acid. Subjects were followed every monthly for initial 3 months of treatment, followed by 6 monthly up to 1 ½ year of treatment. In every follow up PBAC score, Haemoglobin level, endometrial thickness and quality of life (QoL) score was done to assess effectiveness of medical treatment assigned to patients. In our study out of 284 subjects who completed medical treatment for AUB, 72% subjects achieve normal menses, 14.3% subjects had scanty menses & 25(8.3%) subjects developed amenorrhoea. 2.7% subject loss follow up and 2.7% subjects underwent hysterectomy out of which 8 subjects removed LNG-IUS and opted for hysterectomy within 6 months of treatment.
Conclusion: Classification of AUB as per PALM-COEIN helps in better understanding of disease and successful management of patients. Medical management is found very effective in treatment of AUB so that unnecessary hysterectomies and morbidity associated to it can be avoided.
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