Assessing a cut-off point for the diagnosis of abnormal uterine bleeding using the Menstrual Bleeding Questionnaire (MBQ): a validation and cultural translation study with Brazilian women

ABSTRACT BACKGROUND: Abnormal uterine bleeding (AUB) is a common condition, and the Menstrual Bleeding Questionnaire (MBQ) is used for its assessment. OBJECTIVES: To translate, assess the cut-off point for diagnosis, and explore psychometric properties of the MBQ for use in Brazilian Portuguese. DESIGN AND SETTING: Prospective cohort study including 200 women (100 with and 100 without AUB) at a tertiary referral center. METHODS: MBQ translation involved a pilot-testing phase, instrument adjustment, data collection, and back-translation. Cut-off point was obtained using receiver operating curve analysis. Menstrual patterns, impact on quality of life due to AUB, internal consistency, test-retest, responsiveness, and discriminant validity were assessed. For construct validity, the Pictorial Blood Assessment Chart (PBAC) and World Health Organization Quality of Life - abbreviated version (WHOQOL-BREF) were applied. RESULTS: Women with AUB were older, had higher body mass indices, and had a worse quality of life during menstruation. Regarding the MBQ's psychometric variables, Cronbach's alpha coefficient was > 0.70 in all analyses, high intraclass correlation coefficient was found in both groups; no ceiling and floor effects were observed, and construct validity was demonstrated (correlation between MBQ score, PBAC score, and clinical menstrual cycle data). No difference between MBQ and PBAC scores were perceived after the test-retest. Significant differences were found between MBQ and PBAC scores before and after treatment. An MBQ score ≥ 24 was associated with a high probability of AUB; accuracy of 98%. CONCLUSION: The MBQ is a reliable questionnaire for Brazilian women. The cut-off ≥ 24 shows high accuracy to discriminate AUB.

Manejo das irregularidades menstruais secundárias ao uso de contraceptivos ­ análise das recomendações atuais / Management of menstrual irregularities secondary to contraceptive use ­ analysis of current recommendations

As irregularidades menstruais representam uma série de desordens na quantida- de, duração, frequência ou regularidade do sangramento uterino. Entre suas cau- sas destaca-se o sangramento secundário ao uso de anticoncepcionais, uma razão frequente de descontinuidade dos contraceptivos, podendo aumentar as taxas de gestações não planejadas. Boa parte dos contraceptivos pode levar a mudanças no padrão de sangramento uterino, e a abordagem inicial do sangramentos irregula- res inclui a avaliação de outras possíveis causas, o reforço do uso correto da medi- cação, a tranquilização da paciente quanto à benignidade do quadro e à tendência a melhora com a continuidade do uso. Os anti-inflamatórios podem ser usados como estratégia inicial, e, não havendo resposta satisfatória, há alternativas espe- cíficas para cada método. Este trabalho visa identificar as recomendações atuais sobre o manejo do sangramento anormal decorrente de contraceptivos, por meio de revisão narrativa de estudos publicados sobre o tema nos últimos vinte anos.

Abnormal uterine bleeding represents a series of disorders in the amount, du- ration, frequency and or regularity of uterine bleeding. Among its causes, uterine bleeding secondary to the use of contraceptives stands out as a frequent reason for contraceptive discontinuity, which could lead to unplanned pregnancies. Most contraceptives can cause changes in the pattern of uterine bleeding, and the ini- tial approach of the abnormal bleeding includes assessing other possible cau- ses, reinforcing the correct use of medication, and reassuring the patient about the benignity of the condition and the tendency to improve with the continuity of the treatment. Anti-inflammatory drugs can be used as an initial strategy, and, if there is no satisfactory answer, there are specific alternatives for each contracep- tive method. This work aims to identify them current recommendations on the management of abnormal bleeding resulting from contraceptives use, through a narrative review of studies published on the subject in the last twenty years.

Histopathological changes in the uterus in women with abnormal uterine bleeding – A 2-year hospital-based retrospective study in a tertiary care center in Assam, India

Background: Abnormal uterine bleeding (AUB) or menstrual bleeding of abnormal amount, duration, or schedule is a common gynecological condition occurring in up to 50% of women of all age groups. Chronic, heavy, prolonged, or irregular uterine bleeding can lead to anemia, and raise a concern about severe underlying malignancy. Therefore, histopathological examination of the endometrium is critical in evaluating the cause of AUB. Aims and Objectives: The aims of this study were to study the various histomorphological patterns in endometrial biopsies in cases of AUB. Materials and Methods: This is a retrospective study done on 212 endometrial tissues in women presenting with AUB. The study is aimed at analyzing the histopathological changes occurring in the endometrium by identifying the cause of bleeding and recording the incidence of various histopathological findings in different age groups. Results: Proliferative endometrium, the most common histopathological finding, accounted for 51.9% of cases, followed by secretory endometrium (24.5%). Eight cases of disordered proliferative endometrium were found in the present study. Eight cases, accounting for 3.8% of endometrial hyperplasia, were associated with AUB, out of which two cases were found to be complex hyperplasia with atypia. Endometrial carcinoma was seen in two cases associated with AUB. Pregnancy-related changes were found in 7 (3.3%) cases, retained product of conception was the leading cause of bleeding (3 cases). Conclusion: Histopathological evaluation of endometrium in women presenting with AUB is of paramount importance not only to diagnose various benign conditions but also to detect some highly malignant lesions and precancerous conditions so that early interventions can be started.

Hyperprolactinemia among the patients of menstrual disorders in a tertiary care hospital

Background: Menstrual disorders are a common clinical problem due to multiple causes. Hyperprolactinemia, is disorders of hypothalamic-pituitary axis in young women, is usually associated with amenorrhea, oligomenorrhea, anovulation, and ovulatory cycles with short or inadequate luteal phase, and galactorrhoea. Menstrual disorder affects physical and mental health of every woman. Aims and Objectives: The aim of the study was to know hyperprolactinemia among the patients of menstrual disorders in a tertiary care hospital. Materials and Methods: Women with menstrual irregularities attending Gynae outpatient department and admitted initially checked clinically and their serum prolactin level were measured. Women in reproductive age group (15–45 years) with complain of abnormal uterine bleeding were included in the study. Menopausal women, women with organic diseases in uterus and cervix, and pregnant women were excluded from the study. Results: Prolactin level is statistically significant with age (P = 0.011). The patients from age group of 20 to 35 years had high proportion (14.4%) of hyperprolactinemia followed by age group <20 years. (12.9%) and >35 years (12.9%). The women presenting with menstrual disorders enlisted in the study were evaluated on the basis of their sociodemographic parameters. About (15.5%) were below 20 years. About (27%) were above 35 years and majority of the women (57.5%) enrolled in the study were from age group of 2035 years of age. Serum prolactin level was observed in 15.4% in patients with frequent menses, 9.1% in patients with metrorrhagia and 7.7% in patients with heavy menstrual bleeding. That result was statistically significant with P = 0.039. Conclusion: Serum prolactin level should be evaluated in every patient of menstrual disorders.

Prevalence of abnormal uterine bleeding according to the International Federation of Gynecology and Obstetrics Classification (PALM-COEIN) among reproductive-aged women admitted in a tertiary hospital in Las Piñas

Objective@#To determine the prevalence of the causes of abnormal uterine bleeding based on the FIGO (PALM-COEIN) Classification, among patients admitted at a tertiary hospital in Las Pinas City@*Methods@#A cross sectional (retrospective) study was done. Patients aged 15-50 years old who were admitted due to abnormal uterine bleeding from January 2017 to December 2019 were included. Patients with AUB due to pregnancy, vaginitis, bleeding before menarche, and bleeding after menopause were excluded from the study. Patient’s data as to age, obstetrical score, co-morbidity, bleeding patterns were tabulated.@*Results@#A total of 455 subjects were included in the study. Results showed that the most common causes of abnormal uterine bleeding among admitted patients in Perpetual Help Medical Center Las Piñas from January 2017 – December 2019 were due to structural causes (91%). Most prevalent was bleeding due to polyps (50.5%), followed by adenomyosis (18.8%), leiomyoma (16.04%), and malignancy (6.2%). Prevalence of non-structural causes of bleeding was 0.4% for coagulopathy, 3.3% due to ovulatory dysfunction, 4.6% due to endometrial dysfunction, and 0.2% for AUB-N.@*Conclusion@#Based on this 3-year retrospective study, structural causes are the most common causes of AUB, comprising about 91% of all patients admitted for AUB. The most common structural causes are AUB-P (50.5%), followed by AUB-A, AUB-L and AUB-M. Prompt recognition of the causes of AUB is very important, to prevent complications such as severe anemia and shock. Proper treatment, be it surgical or medical, also depends on the exact cause of AUB.

The efficacy of oral Micronized Progesterone versus Medroxyprogesterone Acetate in the control of mild to moderate abnormal uterine bleeding - ovulatory Dysfunction (AUB-O) in adolescents: An open label randomized controlled trial

Objectives@#To determine the efficacy of micronized oral progesterone (OMP) versus Medroxyprogesterone Acetate (MPA) in the control and regulation of mild to moderate abnormal uterine bleeding in adolescents with ovulatory dysfunction.@*Materials and Methods@#This is an open labelled Randomized Controlled Trial. Fifty patients with mild to moderate abnormal uterine bleeding were randomized to treatment with Medroxyprogesterone Acetate or Oral Micronized Progesterone.

International Endometrial Tumor Analysis (IETA) terminology for the evaluation of endometrial color flow and vascular pattern in women with abnormal uterine bleeding – a reproducibility study among ob-gyn ultrasound subspecialists in a tertiary training hospital / Philippine Journal of Obstetrics and Gynecology

Background@#The International Endometrial Tumor Analysis (IETA) group developed a catalog of standardized terms to describe findings that may be associated with uterine pathology. However, there is a lack of reliability studies for these descriptors in the literature.@*Objective@#The objective of this study was to estimate interobserver and intraobserver reliability with regard to the IETA group descriptors for endometrial vascular characteristics in women with abnormal uterine bleeding.@*Materials and Methods@#Five nonexpert and five expert raters assessed stored still images of transvaginal ultrasound examinations obtained from 68 women with abnormal uterine bleeding and endometrial thickening. Endometrial vascularity was evaluated using the IETA group descriptors for color flow and vascular pattern. Interobserver agreement was estimated by comparing the assessments of the nonexpert and expert raters. Intraobserver agreement was estimated by repeating the raters’ assessment after 4 weeks. Interrater agreement to the subjective assessment of an expert investigator was also computed.@*Results and Conclusion@#The reproducibility of assigning IETA color score is good regardless of the degree of expertise of the rater, although the experts displayed better interobserver reliability (κ = 0.74 vs. 0.57) and intraobserver reliability (κ = 0.84 vs. 0.63). However, the reproducibility of describing IETA vascular patterns is significantly worse for both expert and nonexpert raters in both interobserver reliability (experts κ = 0.49 vs. 0.34) and intraobserver reliability (experts κ = 0.65 vs. 0.42). Both expert and nonexpert raters exhibited acceptable agreement with the reference standard, with experts performing better for both color score (κ = 0.79 vs. 0.70) and vascular pattern (κ = 0.63 vs. 0.44).

Predictive Analysis of Quality Markers of Anticoagulant Activity of Kunning Granules Based on UHPLC-Q-TOF-MS/MS and Spectral Efficacy / 中国实验方剂学杂志

ObjectiveTo perform a predictive analysis of the quality marker（Q-Marker） for the anticoagulant activity of Kunning granules. MethodThe chemical components of Kunning granules were analyzed by ultra high performance liquid chromatography-quadrupole-time of flight tandem mass spectrometry（UHPLC-Q-TOF-MS/MS） on a Waters ACQUITY UPLC HSS T3 column（2.1 mm×100 mm， 1.8 μm） with the mobile phase of acetonitrile（A）-25 mmol∙L-1 ammonium acetate aqueous solution（B） for gradient elution （0-5 min， 5%-22%A； 5-10 min， 22%-30%A； 10-15 min， 30%-95%A； 15-20 min， 95%-5%A； 20-30 min， 5%A）， flow rate of 0.2 mL∙min-1， column temperature at 30 ℃， injection volume of 1 μL， electrospray ionization（ESI）， positive and negative ion detection modes. Interaction analysis between the targets of chemical components and the targets of abnormal uterine bleeding（AUB） was performed by network pharmacology， and the key components were screened through network topology analysis. The fingerprints of 10 batches of Kunning granules were established by high performance liquid chromatography（HPLC）， the anticoagulant activity of the granules was determined by blood coagulation method and fibrinogen plate method， and the spectrum-effective relationship was established. The components co-occurring in the topological analysis and spectrum-effective relationship were selected as Q-Markers， and their anticoagulant activities were verified and confirmed. ResultA total of 475 chemical components were identified from Kunning Granule， of which 22 key components such as salvianolic acid B， paeoniflorin， naringin and neohesperidin， were the potential material basis for the treatment of AUB. The spectrum-effective analysis showed that peaks 7（paeoniflorin）， 9（naringin）， 10（neohesperidin） and 11（salvianolic acid B） were the optimal principal components， and in vitro activity test showed that these four components could better characterize their anticoagulant activity. ConclusionSalvianolic acid B， paeoniflorin， neohesperidin and naringin may be Q-Markers for the anticoagulant activity of Kunning granules.

Leiomioma uterino gigante en adolescente mexicana de 14 años, un caso raro de sangrado uterino anormal. Reporte de caso / Giant uterine leiomyoma in a 14-year-old Mexican adolescent, a rare case of abnormal uterine bleeding. Case Report

Resumen ANTECEDENTES: Los leiomiomas son neoplasias benignas comunes durante la edad reproductiva. Su aparición en adolescentes es excepcional y un reto diagnóstico en menores de 18 años de edad. El caso aquí reportado se integra a los 26 casos asentados en la bibliografía y se trata del tumor más grande en la paciente más joven hasta ahora comunicado. CASO CLÍNICO: Paciente de 14 años, con inicio de sangrado uterino anormal, aumento del perímetro abdominal y tres semanas con hipermenorrea. El reporte inicial de la química sanguínea informó: anemia severa y el ultrasonido pélvico: un gran tumor anexial sólido. Luego de mejorar las condiciones hemodinámicas de la paciente por medio de transfusiones de concentrados eritrocitarios se practicó una laparotomía exploradora y se extirpó un leiomioma gigante, dependiente del útero. El informe histopatológico fue de: leiomioma de 16 cm de diámetro, con degeneración roja. La paciente cursó sin complicaciones posquirúrgicas y hasta la actualidad no ha experimentado datos de recurrencia ni sangrado uterino anormal. CONCLUSIÓN: La fisiopatología de la miomatosis uterina sigue aún sin comprenderse del todo. El tratamiento quirúrgico a una edad temprana debe tomar en consideración el deseo de embarazo y llevar a cabo un seguimiento estrecho para valorar: la fertilidad, recurrencia, atipia celular y trastornos menstruales.

Abstract BACKGROUND: Leiomyomas are common benign neoplasms during reproductive age. Its appearance in adolescents is exceptional and a diagnostic challenge in children under 18 years of age. The case reported here is one of the 26 cases reported in the bibliography and it is the largest tumor reported in the youngest patient to date. CLINICAL CASE: A 14-year-old patient with onset of abnormal uterine bleeding, increased abdominal circumference and three weeks with hypermenorrhea. Initial blood chemistry report: severe anemia and pelvic ultrasound: a large solid adnexal tumor. After improving the patient's hemodynamic conditions through transfusions of erythrocyte concentrates, an exploratory laparotomy was performed and a giant leiomyoma, dependent on the uterus, was removed. The histopathological report was: leiomyoma of 16 cm in diameter, with red degeneration. The patient had no postoperative complications and to date she has not experienced recurrence or abnormal uterine bleeding. CONCLUSION: The pathophysiology of uterine fibroids remains poorly understood. Surgical treatment at an early age should take into account the desire for pregnancy and carry out a close follow-up to assess: fertility, recurrence, cellular atypia and menstrual disorders.

Ligadura temporal laparoscópica de arterias uterinas en un caso de vasculatura miometrial aumentada relacionada con el embarazo / Laparoscopic temporary uterine artery ligation in a case of pregnancy-related increased myometrial vasculature

Resumen ANTECEDENTES: La vasculatura miometrial aumentada es una afección poco común, con alto riesgo de hemorragia masiva. Su fisiopatología se relaciona con una remodelación inadecuada del endometrio y miometrio, posterior a un evento obstétrico. El tratamiento convencional, en caso de sangrado masivo, es la histerectomía. En la actualidad, los tratamientos con enfoque conservador que permiten el embarazo espontáneo, ofrecen una opción segura para estas pacientes. CASO CLÍNICO: Paciente de 20 años, primigesta, con deseo gestacional a futuro, llevada a la sala de urgencias debido a una hemorragia uterina profusa, con datos clínicos de bajo gasto, antecedente de aborto completo de 10 semanas de gestación un mes antes. En el ultrasonido Doppler se observó una imagen anecoica irregular en el fondo uterino que interrumpía la interfase endometrio-miometrial asociada con flujo sistólico alto. Para el control vascular se indicó cirugía conservadora de útero, con ligadura temporal laparoscópica de las arterias uterinas; además aspiración uterina. Estos procedimientos trascurrieron sin complicaciones. El reporte histopatológico del material aspirado fue de tejido trofoblástico asociado con ectasia vascular. CONCLUSIÓN: La ligadura temporal laparoscópica de las arterias uterinas es un procedimiento eficaz, en casos seleccionados, de control vascular durante la extracción del tejido trofoblástico remanente, en casos de vasculatura miometrial aumentada, relacionada con el embarazo, con recuperación completa de la irrigación uterina y preservación del útero.

Abstract BACKGROUND: Enlarged myometrial vasculature is a rare condition with a high risk of massive haemorrhage. Its pathophysiology is related to inadequate remodelling of the endometrium and myometrium following an obstetric event. The conventional treatment for massive haemorrhage is hysterectomy. Currently, conservative management approaches that allow spontaneous pregnancy offer a safe option for these patients. CLINICAL CASE: 20-year-old primigravida with future pregnancy aspirations, presented to the emergency department with heavy uterine bleeding, clinical data of low output, history of complete abortion at 10 weeks' gestation one month earlier. Doppler ultrasound showed an irregular anechoic image in the uterine fundus interrupting the endometrial-myometrial interface associated with high systolic flow. For vascular control, uterine-sparing surgery with laparoscopic temporary ligation of the uterine arteries and uterine aspiration was indicated. These procedures were performed without complications. The histopathological report of the aspirated tissue was trophoblastic tissue associated with vascular ectasia. CONCLUSION: Temporary laparoscopic ligation of the uterine arteries is an effective procedure in selected cases for vascular control during removal of the remaining trophoblastic tissue, in cases of pregnancy-related increased myometrial vasculature, with complete recovery of uterine irrigation and preservation of the uterus.

Sangrado Uterino Anormal: hallazgos ecográficos / Abnormal Uterine Bleeding: ultrasound findings

Describir los hallazgos ecográficos de las pacientes que acudieron por sangrado uterino anormal al servicio de Ginecología y Obstetricia del Hospital Dr. Domingo Luciani durante el período enero 2021 a enero 2022. Métodos: Estudio observacional-descriptivo, de tipo retrospectivo. Muestra no probabilística e intencional, integrada por 99 pacientes. Variables involucradas: edad, raza, paridad, antecedentes personales, ciclo menstrual, duración del período menstrual, fecha última de menstruación, uso de algún medicamento, método anticonceptivo y hallazgos ecográficos. Resultados: Los hallazgos ecográficos evidenciaron diferentes causas que explican el sangrado uterino anormal de las pacientes que integraron la muestra de estudio; las tres más frecuentes fueron: miomatosis uterina, sangrado uterino anormal por leiomioma o por endometrio, sangrado uterino anormal tipo L y tipo E(AU)

Objective: To describe the ultrasound findings ofpatients who came for abnormal uterine bleeding to theGynecology and Obstetrics service of the Dr. Domingo LucianiHospital during the period January 2021 to January 2022.Methods: This was an observational-descriptive, retrospectivestudy. The sample was non-probabilistic and intentional,consisting of 99 patients. The data were collected in an Excelsheet for analysis to determine their percentage frequencyaccording to the variables involved: age, ethnicity, parity,personal history, menstrual cycle, duration of menstrual period,last date of menstruation, use of some medication, contraceptivemethod and ultrasound findings. Results: The ultrasoundfindings showed different causes to explain the abnormal uterinebleeding of the patients who made up the study sample; however,the three most frequent were: uterine myomatosis, sangradouterino anormal tipo L y tipo E(AU)

Endometrial blood vessel morphometry in patients presenting with abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is one of the most common problems encountered in gynecological practice. Various benign and malignant disorders of the endometrial tissue show vascular changes such as congestion, dilatation, and vessel wall irregularities. Aim: To evaluate the vascular morphometry of the endometrial tissue in AUB. Materials and Methods: A descriptive cross-sectional study of the endometrial tissue in patients presented with AUB was undertaken for vascular morphometric analysis. Histopathological processing of the endometrial tissue samples was done as per the standard format, and the slides were evaluated for vascular morphometry. Results: Out of 150 cases of endometrial tissue in patients presented with AUB, 80 cases were reported as proliferative phase, 41 as secretory phase, 15 as disordered proliferative endometrium, 6 as atrophic phase endometrium, and 4 each of endometrial hyperplasia without atypia and endometrial carcinoma. An average number of endometrial blood vessels and large-sized blood vessels were more in endometrial carcinoma and endometrial hyperplasia without atypia as compared to proliferative phase, secretory phase, atrophic endometrium, and disordered proliferative endometrium. Vessel shape irregularities and vascular congestion were observed in all the cases of atrophic endometrium, endometrial carcinoma, and endometrial hyperplasia without atypia. Endometrial carcinoma showed severe dilatation of the endometrial blood vessels. Conclusion: Vascular morphometry changes were noted in endometrial hyperplasia, endometrial carcinoma, disordered proliferative endometrium, and atrophic phase endometrium. These findings suggest that studies or trials related to anti-angiogenic therapy may help to plan anti-angiogenic therapy in patients with AUB.

Medical management of abnormal uterine bleeding in a tertiary care hospital – A cross-sectional study

Background: Abnormal uterine bleeding (AUB) is a common gynecological disorder among women of reproductive age, interfering with their day-to-day activity. A better understanding of commonly used drugs in the medical management reduces the need of unnecessary surgical procedures and benefits both the patient and health-care providers. Aims and Objectives: This study aims to study the patient characteristics and prescription pattern in the medical management of AUB and to assess the menstrual blood loss by pictorial blood loss assessment chart (PBAC) and the association between different treatment groups with PBAC score. Materials and Methods: A cross-sectional study was conducted at gynecology OPD, Vanivilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, from January 2019 to January 2020 with approval from the Institutional Ethics Committee, BMCRI, Bengaluru. A total of 200 AUB patients on medical treatment were included for the study, demographic data and relevant data on drug prescription were recorded in the case record form. Menstrual blood loss was assessed using PBAC. Association between PBAC score and different medical treatment groups was determined. Results: AUB was observed mostly in the age group of 21–30 years (35.5%), multiparous women (69.5%) were at higher risk of developing AUB, ovulatory dysfunction (44.5%) was the common cause of AUB in reproductive age group. Medical management included hormonal (36.3%), non-hormonal (21%), combined (9.3%), and concomitant medications (33.4%). Median of PBAC score was 75. There was no significant association among different treatment groups and PBAC score. Conclusion: Majority of AUB patients received hormonal treatment had functional causes with normal PBAC score. This study gives an overview of medical management of AUB in a tertiary care hospital.

Role of Mritika Chikitsha and Yoga Basti in Management of Asrigdar: A Case Report

Asrigdar has been characterised by excessive bleeding per vaginum. Acharya Charaka described Asrigdar as a separate disease along with its treatment in Yoni Vyapada Chikitsha Adhyaya. Acharya Charaka also described it as a Raktaja Vikara. Acharya Sushruta described Asrigdar due to Pitta Samyukt Apana Vayu. It can be correlated with Abnormal Uterine bleeding in modern. Any uterine bleeding other than normal duration, frequency and volume is considered as abnormal uterine bleeding. It affects about 30% of women in reproductive period. It is often associated with backache, pain in lower abdomen and weakness. A 23 years old female patient presented with complaints of Irregular menses with excessive bleeding per vaginum associated with pain lower abdomen. On further enquiry it was found that she had irregular menses since menarche. She took modern treatment but didn’t get significant relief. Due to excessive bleeding she had Anaemia also. Keeping all the aspects in mind a treatment has been planned. Doshas involved in Asrigdar are mainly Pitta and Vata, That is why, for Samprapti vighatan basic treatment divided into three parts i.e. Shaman chikitsha along with Sthanik chkitsha over abdomen with Krishna Mritika and Basti chikitsha. Shaman chikitsha which includes Pitta and Vata shamak, Raktastambhaka and Balya Aushadh. In Bhavprakash Nighantu Krishna Mritika has been kept in Ashtama Dhatwadi Varga and mentioned in Rakta Pradra or Rakt Vikara. The treatment protocol was followed for three cycles with positive outcome as better cycle control and symptomatic improvement in this patient.

Diagnostic Hysteroscopy and Saline Infusion Sonography in Abnormal Uterine Bleeding

One of the commonest reasons for women seeking gynecological advice is Abnormal uterine bleeding (AUB). Most common anatomical causes of abnormal uterine bleeding in women are endometrial polyps, sub mucosal fibroids and endometrial hyperplasia. Hysteroscopy is an effective procedure but is more expensive than Saline Infusion Sonography (SIS). Direct visualization of uterine cavity is possible by hysteroscopy, but it does not give any information about myometrium and adnexa. Saline infusion sonography is effortlessly accepted by most patients as it can be an outpatient procedure. This article present summary of salient features of the procedure which will help the practitioner to take informed decision.

Power Doppler sonography – A supplement to hysteroscopy in abnormal uterine bleeding: Redefining diagnostic strategies

Background: Abnormal Uterine Bleeding (AUB) is a very frequent cause of gynecological visits in women of all age groups. Ultrasound pelvis with or without endometrial sampling have been conventionally used to make diagnosis. Power Doppler is a comparatively recent modality which can be used to screen patients who will need endometrial biopsy/ curretage. We hereby conducted a study to compare the diagnostic accuracy of power Doppler sonography and hysteroscopy with histopathology associated with abnormal uterine bleeding. We also calculated the incidence of uterine pathology in AUB by power Doppler ultrasound and hysteroscopy and compared it with histopathology. Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University. After excluding 42 women, a total of 100 women fulfilling the inclusion criteria contributed to our study. Selected women underwent power Doppler ultrasound and hysteroscopy with guided biopsy. Results were compared with histopathology as per the gold standard. Evaluation of sensitivity, specificity, positive and negative predictive values were performed for each modality. All statistical analyses were performed using the SPSS 11.0 statistical package. P value ?0.05 was considered statistically significant for all tests used. Results: Sensitivity and specificity of power Doppler are 75% and 100% for carcinoma endometrium, 72.72% and 98.9% for endometrial hyperplasia, and 81.81% and 100% for endometrial polyp, respectively. Conclusion: Power Doppler sonography can be used to screen outpatients who do not need an endometrial biopsy for abnormal uterine bleeding. This will avoid unnecessary hysteroscopy in definitive benign cases, and watchful hysteroscopy in suspected premalignant and malignant cases. Irregular branching vessels and color splashes were found to be the best parameters for diagnosing endometrial carcinoma. Power Doppler should be done along with transvaginal sonography in all cases of abnormal uterine bleeding

A Clinical Study to Evaluate Efficacy of KVGAP’S Femicare Syrup on Raktapradara w.s.r to Dysfunctional Uterine Bleeding

Dysfunctional uterine bleeding (Raktapradara) is the commonest gynaecological disorder affecting the quality women’s life of reproductive age group. A clinical study was conducted with KVGAP’S Femicare Syrup on 28 patients of DUB. KVGAP’S Femicare syrup is a polyherbal Ayurvedic formulation prepared from ingredients like Ashoka, Ashwagandha, Gokshura, Guduchi, Shatavari, Manjhistha, Usheera, Kumari, Sariva, Pippali, and Shilajathu. The parameters assessed were number of bleeding episodes, excessive bleeding, investigators global assessment scale, VAS for pain, participants overall assessment scale, clot and interval (number of days of the cycle). Patients were assessed at the beginning of the trail, after 1 month and after 2 months. 56.52%, 73.08%, 77.6%, 85%, 81.93%, 100% improvement were observed in the clinical parameters assessed (number of bleeding episodes, excessive bleeding, investigators global assessment scale, VAS for pain, participants overall assessment scale, clot) respectively. Results were statistically significant. Interval didn’t show any changes. Out of 28 patients in this study, 1 patient shown mild improvement, 11 patients (39%) were shown moderate improvement and 16 patients (57%) had marked improvement. Overall effect of the treatment was 77.31%. This study showed that KVGAP’S Femicare syrup showed promising results in treating DUB. Hence it can be concluded that KVGAP’S Femicare Syrup is effective and safe in the management of dysfunctional uterine bleeding.

Hysteroscopic Evaluation Of Abnormal Uterine Bleeding In A Tertiary Care Institute — An Observational Study

Objectives:To assess the feasibility of diagnos?c hysteroscopy in the diagnosis of abnormal structure and pathological lesions in the uterine cavi?es of women presen?ng abnormal bleeding of the uterus. Methods: This is a Prospec?ve Cross-sec?onal study conducted in the Department of Gynaecology at Prathima Ins?tute Of Medical Sciences, Karimnagar: one hundred women presen?ng with Abnormal Uterine Bleeding, over a period of one year from December 2020 to November 2021, were subjected to the procedure. Results: The results of our study show that hysteroscopy has high accuracy for detec?ng the pathology in women with abnormal uterine bleeding, especially in benign lesions such as endometrial polyp and submucosal fibroid and it can be used as the first line diagnos?c method for these abnormali?es. Conclusion:Hysteroscopy provides a more accurate diagnosis than dilata?on and cure?age or ultrasonography alone to diagnose pathology in women with abnormal bleeding of the uterus. It is very sensi?ve for diagnosing intracavitary lesions like submucous myoma and endometrial polyp

Prevalence of premalignant and malignant changes in hysteroscopically removed endometrial polyps in reproductive aged women: A 5-year review of cases in a Tertiary Government Hospital in the Philippines

Objective@#To determine the prevalence of premalignant and malignant changes in hysteroscopically removed endometrial polyps in reproductive aged women, and to determine clinical, ultrasonographic and hysteroscopic characteristics of such women. @*Methods@#This is a cross-sectional study of patients diagnosed with endometrial polyp, and underwent hysteroscopy from 2015-2019. A review of the medical records (ultrasound results, intraoperative findings and histopathology results) was done.@*Results@#A total of 117 patient records were included in the analysis. The median age of all patients who underwent hysteroscopy was 38 years old (age range: 19-44 years). The prevalence of endometrial hyperplasia or carcinoma in the 18-44 year old age group was 8.5% (n=10/117). Among patients with endometrial hyperplasia or carcinoma, 70% were nulligravid, 40% had anovulation disorder, and 40% had infertility. Most of the patients were overweight or obese (70%). Co-morbidities were present in only 3 cases, and diabetes mellitus (30%) was the predominant illness seen in these patients. @*Conclusion@#Our findings showed a higher prevalence (8.5%) of endometrial hyperplasia or carcinoma in endometrial polyps among Filipino reproductive-aged women, compared to reports in published literature. Among the different clinical characteristics, ultrasound and hysteroscopic findings, no particular factor had a significant association with endometrial hyperplasia or malignancy.

Rotura uterina: da suspeita ao tratamento / Uterine rupture: from suspicion to treatment

A rotura uterina durante a gravidez ou trabalho de parto é uma grave complicação obstétrica ainda responsável por elevada morbimortalidade materna e perinatal. É importante o diagnóstico diferencial de outras hemorragias da segunda metade da gravidez, como o descolamento prematuro da placenta e a placenta prévia. O diagnóstico é feito baseado em uma associação de sinais bem comuns da rotura uterina. O tratamento sempre é cirúrgico, mas varia de acordo com a classificação da emergência. A prevenção é realizada por meio da atenção obstétrica cuidadosa e com implementação das boas práticas de assistência ao parto.(AU)

Uterine rupture during pregnancy or labor is a serious obstetric complication still responsible for high maternal and perinatal morbidity and mortality. Differential diagnosis of other hemorrhages in the second half of pregnancy, such as placental abruption and placenta previa, is important. The diagnosis is made based on an association of very common signs of uterine rupture. Treatment is always surgical but varies according to the classification of the emergency. Prevention is carried out through careful obstetric care and the implementation of good childbirth care practices.(AU)