CASE PRESENTATION
History…
Mrs.V, 49 yr old,Multipara hailing
from cuddalore belonging to
CLASS-III socioeconomic status
came with complaints of Heavy
menstrual bleeding since 1 year
History of presenting illness
Patient was apparently normal 1 year back, following
which she developed prolonged and heavy menstrual
bleeding during her regular cycles which lasted for 8-10
days with passage of clots Changes 6-7 pads per day
and 2 pads per night fully soaked.
Associated with lower abdominal pain that appears 3-4
days before menstruation aggravated during the 1st day
of menses and subsides after menstruation.
Pain is continuous dull aching not radiating and was
relieved on taking medication.
She consulted a gynecologist in the local hospital for
same complaints and was advised to take tranexamic
acid and the bleeding controlled by taking it in last 3-4
cycles, however not controlled in this cycle.
H/o dyspnoea on exertion (+). fatigue(+)
No H/O post coital/intermenstrual bleeding,
No H/O dyspareunia,
No H/O hormonal drugs/ IUCD use
No alteration of bowel and bladder habits,
No H/O loss of weight/appetite,
No H/O White discharge P/V.
Menstrual History-Menarche-14 yrs
LMP-2/2/23.
1 year back, cycles were regular, 3-4/30 day, moderate
flow. Uses 2-3 pads/day, No H/O passage of clots.
Present cycles- regular,8-10/30days, H/O clots
+ ,changes 6-7 pads/day, fully soaked. Associated with
congestive dysmenorrhea
Marital and Obstetric History –
Married life- 32 yrs
Para 2 Live 2,All full term normal vaginal deliveries,
Institutional, No antenatal or post natal complications.
LCB-26 yrs. Puerperal sterilization done-26 yrs back.
Past history-
No past medical illness, major surgeries, blood
transfusions
Personal History-
Mixed diet
Adequate sleep and appetite
No history of substance abuse.
Family History-
Both parents are Hypertensive, No history of
malignancy.
On examination…
Moderately built and nourished
HT:150cm WT:50kg BMI-22kg/m2
pallor (+)
No Lymphadenopathy
Breast and Thyroid-clinically normal.
Spine and gait- normal
PR-80/min
BP-120/80mmhg
CVS-S1 S2 +
RS-NVBS
CNS-NFND
PER ABDOMEN-
Inspection- Midline SWELLING seen in supra pubic
area,no dilated veins.
A scar of 3cm seen 3cm below the umbilicus,
tubectomy scar, scar-healthy.
Hernial orifices free.
Palpation-No local rise of temperature/tenderness.
Midline mass corresponding to the size of 16 weeks
gravid uterus irregularly enlarged arising from pelvis.
Lower border of the mass not felt.
All other borders felt.
Firm in consistency.
Mobile in transverse direction.
No other masses palpable.
Percussion-Dull note over the mass, resonant elsewhere
Auscultation-Bowel sounds +
Local examination-External genitalia-Normal.
Per speculum-Vaginal mucosa healthy,
Rugosities maintained,
Cervix appeared healthy, Bleeding through os +
Bimanual examination:
Uterus irregularly enlarged, firm in consistency, non
tender, mobile.
Transmitted mobility +
All fornices free and non-tender
Per rectal examination: rectal mucosa free.
Summary…
48yr old P2L2, sterilised came with complaints of
increased bleeding during cycles for the past 1year,
associated with congestive dysmennorhoea
Examination revealed an abdominopelvic mass of 16
weeks size gravid uterus, firm in consistency, smooth
surface, irregular borders transmitted mobility +,B/L
fornices free,No forniceal tenderness.
Provisional diagnosis is AUB-L.
Thank You..
