scholarly journals Disorders of hemostasis as the main pathogenetic mechanism in the development of menopausal abnormal uterine bleeding

2019 ◽  
Vol 100 (4) ◽  
pp. 589-594
Author(s):  
O V Chechulina ◽  
T E Kurmanbaev ◽  
L M Tukhvatullina ◽  
E A Khairullina ◽  
I G Mustafin
Keyword(s):  
Postmenopausal Women ◽  
Late Onset ◽  
Abnormal Uterine Bleeding ◽  
Chronic Viral Hepatitis ◽  
Reproductive Period ◽  
Uterine Bleeding ◽  
Coagulation System ◽  
Clinical Observations ◽  
Viral Hepatitis C ◽  
Abnormal Bleeding

The article presents our own clinical observations of cases of abnormal uterine bleeding in postmenopausal women, where the main cause was the pathology of hemostasis: a patient after liver transplantation for cirrhosis with chronic viral hepatitis C, and a patient with primary idiopathic thrombocytopenic purpura which manifested at a later age. Among the most common causes of abnormal uterine bleeding in postmenopausal women are hyperplasia and endometrial cancer, leiomyoma, are adenomyosis are distinguished. Pathology of the hemostasis system as the main cause of abnormal uterine bleeding, prevails in the pubertal and reproductive period. In the literature available we did not find any publications concerning uterine bleeding in postmenopausal patients against the background of the pathology of the blood coagulation system. This article illustrates the significance of hemostasis disorders both secondary and primary in the origin of abnormal bleeding in postmenopausal period. Careful collection of anamnesis, an indication of the occurrence of petechial rash, gingival bleeding should alert the doctor. It should also be remembered that “suddenly arisen” immune cytopenias and late-onset thrombosis are often manifestations of the hematological paraneoplastic syndrome and require the exclusion of neoplasia, first of all, of the hematopoietic system. These clinical observations allow recommending a mandatory examination of the hemostatic system in patients with postmenopausal bleeding.

scholarly journals Unsolved issues of pregnancy in liver cirrhosis

2019 ◽  
Vol 91 (4) ◽  
pp. 114-117
Author(s):  
A Iskrenov Kotzev ◽  
L Stoyanov Tanchev ◽  
Ch Savov Pavlov ◽  
S Yotov Tanchev
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Vital Signs ◽  
Abnormal Uterine Bleeding ◽  
Chronic Viral Hepatitis ◽  
Uterine Bleeding ◽  
Variceal Hemorrhage ◽  
Decompensated Liver Cirrhosis ◽  
Viral Hepatitis C ◽  
Life Threatening

Pregnancy in patients with liver cirrhosis and portal hypertension occurs very rare, because of their significantly derailed reproductive functions. Тhe risks for the mother and the fetus are connected with worsening of the portal hypertension, progression of decompensated liver cirrhosis and development of its complications: liver failure, ascites, hepatorenal syndrome, hepatic encephalopathy and variceal hemorrhage, and with increased incidence of spontaneous abortions and abnormal uterine bleeding. The decision for continuation of the pregnancy in cirrhotic patients must be based on individual approach and a multidisciplinary team consisting of obstetricians, hepatologists, anesthesiologists, surgeons and hematologists must participate in the therapy. We are presenting a clinical case with 34 years old pregnant woman with Child-Pugh class C cirrhosis and untreated chronic viral hepatitis C. The patient was admitted in emergency with abortus imminens, vaginal bleeding, anemia, thrombocytopenia and impaired hemostasis. The pregnancy was interrupted in the Department of obstetrics and gynecology due to the high risk for mother’s life. Later the patient developed severe disseminated intravascular coagulation (DIC) syndrome with life-threatening uterine bleeding. The DIC syndrome and the bleeding were resolved after therapy in intensive care unit and the patient was discharged from the hospital with stable vital signs.

scholarly journals Histo-Pathological Study of Endometrial Biopsies in Patients With Abnormal Uterine Bleeding

2017 ◽  
Vol 15 (2) ◽  
pp. 26-31
Author(s):  
Sharmila Parajuli ◽  
Binita Thapa
Keyword(s):  
Endometrial Carcinoma ◽  
Postmenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
The Elderly ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Common Cause ◽  
Histopathological Findings ◽  
Common Sign ◽  
Work Up

Introduction: Abnormal uterine bleeding is a common sign of a number of different uterine disorders ranging from dysfunctional (non organic) abnormalities or complications of pregnancy to organic lesions such as polyps, hyperplasia or carcinoma. Methods: This is a retrospective study conducted at Hospital of 2nd author during a period of 5 years (Jan 2008-Dec 2013).  Histopathology records were retrieved and searched for cases of abnormal uterine bleeding. Relevant histopathological findings and clinical data were recorded and analyzed. The aim of the study was to determine the causes for abnormal uterine bleeding in women presenting to the hospital and to compare the histopathological findings at various age groups.Results: The age of patients ranged from 17 to 71 years with an average of 43 years. The most common cause of uterine bleeding was found to be proliferative phase endometrium; that were 649 cases (56.43%). Out of the pathological causes, the most common cause was found to be endometrial hyperplasia- 44 cases (3.82%). Endometrial carcinoma was found to be more common in the elderly postmenopausal women. A total of 6 cases (0.5%) of endometrial carcinoma were present.Conclusion: Endometrial hyperplasias and malignancies are common in increasing age group, especially in perimenopausal and postmenopausal women. So, a thorough work-up and diagnostic endometrial biopsy is therefore mandatory without delay in these patients to rule out malignancies. 

scholarly journals Evaluation of the diagnostic accuracy of transvaginal sonography versus hysteroscopy in detection of submucous myomas in peri and postmenopausal women with abnormal uterine bleeding

2021 ◽  
Vol 10 (10) ◽  
pp. 3885
Author(s):  
Kushla Pathania ◽  
Surbhi Sharma
Keyword(s):  
Diagnostic Accuracy ◽  
Postmenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Transvaginal Sonography ◽  
Cross Sectional ◽  
Predictive Values ◽  
Menopausal Women ◽  
Submucous Fibroid ◽  
Post Menopausal

Background: Abnormal uterine bleeding is a very common gynaecological condition that affects all age groups. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation. Aim was to evaluate the diagnostic accuracy of transvaginal sonography versus hysteroscopy in detection of submucous myomas in peri and postmenopausal women with abnormal uterine bleeding.Methods: The present study was prospective cross sectional study conducted in the Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child Indira Gandhi Medical College Shimla for period of one year w.e.f. 1st May 2018 to 30th April 2019. The study was started after hospital ethical committee approval. 76 patients peri and post-menopausal women were enrolled in the study after taking written consent.Results: On TVS- all the study subjects underwent TVS examination, submucous fibroid was detected in 10 subjects (n= 76) i.e. 13.1% (all perimenopausal). On hysteroscopy submucous fibroid was detected in 11 (14.4%) subjects, on histopathology it was confirmed in 11 subjects (14.4%). Out of 11, 8 patients underwent hysterectomy, 1 myomectomy, 2 patients had hysteroscopic removal of fibroid. 1 subject with AUB-LSM was wrongly diagnosed as AUB-P. Sensitivity, specificity, positive and negative predictive values of transvaginal sonography versus hysteroscopy was 90.09%, 100%, 100%, 98.5% respectively.Conclusions: TVS is an important initial modality for evaluating the patient of AUB. It is quick, simple, painless, least invasive, less expensive and readily available procedure and does not need full bladder like TAS. On the other hand, hysteroscopy has a better diagnostic accuracy as it provides the option of see and treat which is recommended for peri and post-menopausal women with AUB.

scholarly journals Abnormal Uterine Bleeding – A Clinico-pathological Study

2021 ◽  
Vol 8 (1) ◽  
pp. A9-13
Author(s):  
Sarita . ◽  
Nisha J Marla ◽  
Nagarathna . ◽  
Jayaprakash C S
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Cost Effective ◽  
Reproductive Period ◽  
Uterine Bleeding ◽  
Target Organ ◽  
Direct Access ◽  
Age Group ◽  
Morphological Findings ◽  
Dilatation And Curettage ◽  
Proliferative Endometrium

Background: Abnormal Uterine Bleeding (AUB) can occur at any age in a woman`s reproductive period and needs to be assessed very carefully and immediately. When it occurs in the older age group, a more meticulous screening for malignancy is imperative so that treatment can be more radical. Dilatation and curettage is a simple, cost effective, safe and a reliable investigation and it gives us a direct access to the target organ. Methods: Study was conducted prospectively on 162 patients presenting with AUB in reproductive, perimenopausal and postmenopausal age group. All the endometrial samples procured from the endometrial curettage were fixed in 10% buffered formalin for 12-24 hours, processed in the automated tissue processor, cut and stained with Hematoxylin & Eosin (H & E) stain and were finally studied in detail for the morphological findings under light microscopy. Result: In our study Secretory endometrium was most common type, which was followed by Proliferative endometrium. Disordered proliferative endometrium and Endometrial hyperplasia were the commonest histopathological patterns seen in AUB of organic type. Endometrial carcinoma was seen more commonly in postmenopausal age group. Further, in our study Mc Cluggage criteria was applied to all the samples to categorize endometrial samples which were unassessable and inadequate. Conclusion: Evaluation of Endometrial samples is important in all patients with Abnormal Uterine Bleeding (AUB) to find out the Organic Pathology. Histopathological typing of endometrium is crucial for appropriate therapy. Its interpretation is quite challenging and also may show considerable interobserver variability. In AUB, the endometrial samples should be taken during the bleeding episode itself. Dilatation and curettage is a simple, cost effective, safe and reliable investigation and gives us a direct access to the target organ.

scholarly journals Premalignant and malignant lesions in endometrial polyps in patients undergoing hysteroscopic polypectomy

2014 ◽  
Vol 12 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Marco Antonio Lenci ◽  
Vanessa Alessandra Lui do Nascimento ◽  
Ana Beatriz Grandini ◽  
Walid Makin Fahmy ◽  
Daniella de Batista Depes ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Histopathological Examination ◽  
Transvaginal Ultrasound ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Premalignant Lesions ◽  
Endometrial Polyps ◽  
Menstrual Status ◽  
Cellular Atypia ◽  
Malignant Lesions

Objective : To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy. Methods : The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm. Results : Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal. Conclusion : Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer.

scholarly journals Relação entre o espessamento endometrial e o sangramento uterino anormal no diagnóstico de câncer de endométrio em pacientes na pós-menopausa / Relationship among endometrial thickening and abnormal uterine bleeding in the diagnosis of endometrial cancer in postmenopausal patients

2019 ◽  
Vol 64 (3) ◽  
pp. 208
Author(s):  
Carmen Mayanna Jamur ◽  
Grace Kelly Rodrigues ◽  
Eduardo Schunemann Junior
Keyword(s):  
Endometrial Cancer ◽  
Gynecological Cancer ◽  
Abnormal Uterine Bleeding ◽  
Total Sample ◽  
Uterine Bleeding ◽  
Incidence Of Cancer ◽  
Endometrial Thickening ◽  
Uterine Curettage ◽  
Abnormal Bleeding ◽  
The Relationship

Introdução: O câncer de endométrio é o terceiro câncer ginecológico mais frequente em mulheres no Brasil. O sangramento uterino anormal e o espessamento endometrial são as apresentações mais comuns da doença. O objetivo desse estudo foi encontrar a relação entre sangramento, espessamento endometrial e  obesidade no diagnóstico do câncer de endométrio na paciente na pós-menopausa. Métodos: Trata-se de um estudo retrospectivo no qual foi realizado o levantamento de dados das pacientes na pós-menopausa submetidas à curetagem uterina de prova (CUP) devido à queixa de sangramento anormal e/ou apresentarem espessamento endometrial, no Hospital de Clínicas da UFPR no período de Janeiro de 2012 a Dezembro de 2014.  Resultados: Das 157 pacientes na pós-menopausa avaliadas, foram diagnosticados 33 casos de câncer de endométrio e dois de sarcoma. Da amostra total (157), 112 apresentavam espessamento endometrial e sangramento, 40 somente espessamento e  5 somente sangramento. Das 112 com sangramento e espessamento, foram encontrados 31 (27,7%) casos de câncer de endométrio. Das 40 que apresentavam apenas espessamento, uma (2,5%) apresentou câncer. Das 5 que apresentavam sangramento isolado, foi diagnosticado um caso de câncer de endométrio (20%). A incidência de câncer de endométrio também mostrou relação com o aumento de IMC (com maior incidência acima de 25) e com o nível de espessamento endometrial a partir de 15mm. Conclusão: O sinal mais importante relacionado ao câncer de endométrio, sem dúvida é o sangramento. Mulher no período da pós-menopausa que apresente sangramento uterino anormal deve ser investigada criteriosamente em busca de exclusão de diagnóstico oncológico, pela alta possibilidade (OR = 14.03) de ter câncer de endométrio.Descritores: Neoplasias do endométrio, Metrorragia, Hemorragia uterina, Pós-menopausa, Obesidade, CuretagemAbstractIntroduction: Endometrial cancer is one of the most common types of gynecological cancer, and it is the fourth leading cause of death by cancer among women in Brazil. Abnormal uterine bleeding and endometrial thickening are the most frequent presentations of this disease. The objective of this study was to find the relationship among abnormal bleeding, thickening and obesity in the diagnosis of endometrial cancer in postmenopausal patients. Methods: This is a retrospective study in which was collect data of patients that underwent uterine curettage (D&C) complaining about abnormal bleeding and/or presenting endometrial thickening, at Hospital de Clínicas from UFPR on the period of January 2012 to December 2014. Results: From all the 157 postmenopausal patients evaluated, 33 cases of endometrial cancer and two of sarcoma were diagnosed. In the total sample (157), 112 presented endometrial thickening and bleeding, and 40 presented thickening and five presented isolated bleeding. Within the 112 patients with abnormal bleeding and endometrial thickening, 31 (27.7%) cases of endometrial cancer were found. From the 40 patients with only thickening, one (2.5%) presented cancer. From the five patient isolated bleeding, one (20%) case of endometrial cancer was diagnosed. The incidence of cancer also showed relationship with BMI increasing (mores incidence of cancer with BMI over 25) and with endometrial thickening starting from 15mm. Conclusion: The most important factor related to endometrial cancer beyond doubt is abnormal bleeding. Postmenopausal women with abnormal uterine bleeding should be carefully investigated for exclusion of an oncological diagnosis, because of the high possibility (OR = 14.03) of having endometrial cancer.Keywords: Endometrial neoplasms, Metrorrhagia, Postmenopause, Uterine hemorrhage, Obesity, Curettage

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