ABNORMAL
UTERINE BLEEDING
David.A
Final year
Madha medical college and Research
institute
• Mrs.Malar, 50 year old female residing in
Sadhanandhapuram, housekeeper by
occupation,with no formal education and belonging
to lower middle class according to modified
kuppusamy scale visited the OPD of Madha medical
college and research institute,Chennai.
CHIEF COMPLAINTS
• Complaints of 3 months of amenorrhea, followed
by heavy menstrual bleeding for the past 4
days(since 23-Nov-2024)
HISTORY OF PRESENTING
ILLNESS
• The patient was apparantly normal before 5
months.
• H/o 3 months of Amenorrhea , followed by heavy
menstrual bleeding - for the past 4 days .
• Changes fully soaked 8 pads/ day.
• H/o night change of pads.
• H/O presence of clots and not associated with
pain.
• H/O heavy menstrual bleeding on and off for 60
days in previous menstrual cycle (1/June/2024).
• Associated with clots and was evaluated outside
on August 2024. Managed conservatively:1- oral
iron Therapy 2- tranexamic acid.
• -No H/O fatigue ,palpitation & giddiness .
• -No H/O white discharge per vaginum.
• -No H/O intermenstrual bleeding or post coital bleeding.
• -No H/O burning micturition , fever, mass per abdomen.
• -No H/O lower abdominal pain / back pain.
• -No H/O vomiting / loose stools/ constipation.
• -No H/O significant loss/gain of weight.
PAST MENSTRUAL HISTORY
• Attained menarche at 11 years.
• Regular 3/28 day cycle; normal flow.
• Changes 2 pads/ day.
• Not associated with pain/ clots.
MARITAL HISTROY
• married since 31 years.
• non consanguineous marriage.
• No h/o contraceptive use.
OBSTETRIC HISTORY
• P3L3 / previous NVD/ puerperal sterilisation/ Last child
birth; 24 years.
• I ;- female/ full term normal vaginal delivery/28 years/no
antenatal or postnatal complication.
• II ;-Female/ full term normal vaginal delivery/26 years/no
antenatal or postnatal complication.
• III ;-Female/ full term normal vaginal delivery/24
years/no antenatal or postnatal complication.
PAST MEDICAL HISTORY
• H/O 3 units of blood transfusion done 2 years ago ,
due to anaemia.
• H/O hypothyroidism for past 9 years and consumes
Eltroxin 100 mcg OD.
• No h/o Diabetes Mellitus, Hypertension, Tuberculosis,
Epilepsy, Bronchial asthma.
SURGICAL HISTROY
• Puerperal sterilization done 24 years ago.
• No other significant surgical history present.
FAMILY HISTORY
• No significant family history present.
PERSONAL HISTORY
• Consumes mixed diet.
• Normal bowel and bladder habbits.
• Normal sleep and appetite.
• No drug or food allergy.
GENERAL EXAMIATION
• Conscious ,oriented and cooperative.
• Well built and well nourished.
• Mild pallor present.
• No icterus, cyanosis, clubbing, lymhadenopathy and
edema.
• BREAST examination was done and was normal.
• SPINAL examination was found to be normal.
• THYROID examination was done , found to be
normal.
Anthropometry:-
• WEIGHT- 99.75 Kg
• HEIGHT-158 cm
• BMI- 40 Kg/m2
VITALS;-
• Blood pressure- 116/74 mm Hg.
• Respiratory rate- 16 bpm.
• Pulse rate- 90 bpm, regular in rhythm, normal in
volume.
• Temperature- 98 F
SYSTEMIC EXAMINATION
• CVS- S1 S2 heard , no murmurs heard.
• RS- normal vesicular breath sounds heard.
• CNS- no focal neurological deficit.
ABDOMINAL EXAMINATION
Inspection
• Abdomen not distended.
• Umbilicus in midline and everted.
• All quadrants move equally with respiration.
• Sub umbilical transverse scar present .
• No sinus or dilated veins visible.
• No visible pulsations over abdomen seen.
• Hernial orifices free.
PALPATION
• Abdomen was soft.
• No warmth; non tender.
• No organomegaly.
• No mass palpable.
• sterilisation scar is healthy- 4 cm in length.
PERCUSSION
• No shifting dullness/fluid thrill found.
AUSCULTATION
• Bowel sounds heard.
LOCAL EXAMINATION
• External genetalia - Normal.
• pubic hair - Normal in distribution.
• P/S;Cervix hypertrophied
Vagina Healthy
bleeding through os (+ ve)
Bleeding Per vaginum
• Bimanual Pelvic Examination;
Cervix ↓ , anteverted
uterus mobile, 12 weeks.
fornices free, no forniceal tenderness .
SUMMARY
• P3L3.C/O 3 months of amenorrhea followed by
heavy menstrual bleeding for the past 4
days.Puerpral Sterilzation done. H/O blood
transfusion done 2 years ago.
• O/E , mild pallor,uterus 12 weeks, sterilization scar
and bleeding per vaginum .
• patient is now admitted in hospital for further
evaluation.
DIAGNOSIS
Mrs. Malar is diagnosed as a case of abnormal
uterine bleeding under evaluation.
INVESTIGATIONS
• Complete blood count.
• Blood glucose evaluation.( FBS,PPBS,Hba1C)
• Thyroid function test.
• USG pelvis(transabdominal, transvaginal)
• Endometrial biopsy.
MANAGEMENT
• Oral iron Therapy.
• Tranexamic acid Tablets (Antifibrinolytics).
• Progesterone, tapering dose.
THANKYOU
