Management of patients with abnormal uterine bleeding puberty in the outpatient setting (experience MCDC “Yuventa”)

Questions of the effectiveness of therapy of abnormal uterine bleeding puberty, prevention of recurrence and restore of normal menstrual and fertility are extremely important in the future. Diagnosis of abnormal uterine bleeding puberty often is an absolute indication for hospitalization. However, the experience Saint Petersburg Municipal consultive and diagnostic center “Juventa” patients can receive medical treatment in a day hospital with good clinical effect, if they haven’t anemia and heavy bleeding. Аccording to Juventa clinic, dysfunctional uterine bleedings of the pubertal period iconsist 4 % in the structure of the gynaecological diseases among the young girls. 75-89 % of young patients with bleedings do not require hospitalization with 24 hour observation and can get medical care in the outpatient settings with good clinical effect. In 2/3 of patients could receive the hemostatic effect when using a non-hormonal therapy. In 1/3 of patients require hormone therapy. All of the patients need further medical supervision and therapy for prevention of recurrent bleeding. The effectiveness of conservative hemostatic therapy conducted in a day hospital was 97.8 %. Important conditions for a good clinical effect were: patient selection, which can be performed outpatient treatment, the use of complex therapy, dynamic assessment of the effectiveness of the therapy, timely correction of the treatment regimen with the addition of hormone hemostatic therapy.

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Preoperative Identification of Synchronous Ovarian and Endometrial Cancers: The Importance of Appropriate Workup

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e3182679119 ◽

2012 ◽

Vol 22 (8) ◽

pp. 1325-1331 ◽

Cited By ~ 4

Author(s):

Fieke M. E. Broeders ◽

Anneke A. M. van der Wurff ◽

Johanna M. A. Pijnenborg ◽

M. Caroline Vos

Keyword(s):

Ovarian Cancer ◽

Adnexal Mass ◽

Young Patients ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Ca 125 ◽

Primary Tumors ◽

Endometrial Cancers ◽

The Right ◽

Postoperative Findings

ObjectiveFor treatment of patients with both endometrial and ovarian cancer, it is important to discriminate between 2 primary tumors and metastatic disease. Currently, criteria are based on postoperative findings. The aim of this study was to determine whether clinical parameters can discriminate between these groups preoperatively and whether a practical guideline could improve appropriate workup and treatment.MethodsA total of 45 patients with a diagnosis of both endometrium and ovarian cancer between 1998 and 2009 and were included for analysis. Clinical and pathological data were obtained, and initial CA-125 was registered; patients had a diagnosis of 2 primary tumors or tumors with metastasis. All patients were reclassified according to workup and treatment.ResultsPatients with synchronous primary tumors were significantly younger, presented more often with abnormal uterine bleeding, and had a lower initial CA-125 than both metastatic groups (P < 0.05). With age and CA-125 included in a polytomic logistic regression model, 83.3% of diagnoses could be classified correctly. In 15 of 17 patients presented with adnexal mass, workup was incomplete owing to lack on information of the endometrial status. In patients presenting with abnormal uterine bleeding, 13 of 21 patients had an incomplete workup leading to staging laparotomy secondary to initial surgical treatment in 2 patients.ConclusionsPatients with synchronous endometrial and ovarian cancers are young, often present with abnormal uterine bleeding and have a low initial CA-125. Adequate workup with attention to both ovarian and endometrial status, especially in young patients with a wish to preserve fertility, is important to make the right decision for treatment.

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Double Approach (Laparoscopy and Hysteroscopy) Repair of Istmochele (Niche)

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v8i4.1268 ◽

2020 ◽

pp. 254-257

Author(s):

Herbert Situmorang ◽

Ribkhi A. Putri ◽

Cepi T. Pramayadi ◽

Riyan H. Kurniawan ◽

Muhammad D. Priangga ◽

...

Keyword(s):

Transvaginal Ultrasound ◽

Abnormal Uterine Bleeding ◽

Oral Contraception ◽

Patient Admission ◽

Uterine Bleeding ◽

Day Hospital ◽

Caesarean Scar ◽

Double Approach ◽

Optimal Approach ◽

Caesarean Scar Defect

Objectives: Reported a case demonstrate the double approach repair of niche treatment through the hysteroscopy and laparoscopy technique.Methods: Case report. We reported a case starting from the patient admission untill 3 months postoperative condition.Case: A 33 years old woman came with abnormal uterine bleeding, already got medication and combine oral contraception pill, but the bleeding never stopped. We found a cavity (niche) filled by menstrual blood with thin lower uterine segment (just serous layer) from transvaginal ultrasound. We did hysteroscopy and laparoscopy approach. We illuminated the niche by hysteroscopy, then resected it by laparoscopy. Patient had a day hospital admission and no symptoms anymore after the procedure.Conclusion: Many treatment methods have been described for repair of niche with varies effectivities. Double approach (hysteroscopy and laparoscopy) technique was a minimal access, but optimal approach of niche resection with up to 100% effectivity.Keywords: abnormal uterine bleeding, caesarean scar defect, hysteroscopy, istmochele laparoscopy, niche Abstrak Tujuan: Melaporkan sebuah kasus yang menggambarkan pendekatan ganda dalam memperbaiki niche dengan histeroskopi dan laparoskopi.Metode: Laporan kasus. Kami melaporkan sebuah kasus dimulai dari pasien masuk sampai dengan 3 bulan pascaoperasi.Kasus: Perempuan 33 tahun datang dengan perdarahan uterus abnormal, telah diberikan terapi obat dan pil kombinasi, namun perdarahan tidak berhenti. Dari ultrasonografi ditemukan rongga berisi darah menstrusasi dengan segmen bawah uterus yang tipis (hanya lapisan serosa). Kami melakukan pendekatan histeroskopi dan laparoskopi. Dilakukan iluminasi dengan histeroskopi, kemudian reseksi dengan laparoskopi. Perawatan pasien di rumah sakit selama satu hari, dan tidak terdapat keluhan pada pasien setelah tindakan.Kesimpulan: Terdapat banyak metode dalam tata laksana niche dengan efektivitas yang beragam. Pendekatan ganda dengan histeroskopi dan laparoskopi merupakan tehnik dengan akses minimal namun hasil optimal, dengan efektivitas hingga 100%.Kata Kunci: perdarahan uterus abnormal, defek skar sesar, histeroskopi, istmpchele, laparoskopi, niche

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Pipelle endometrial biopsy for abnormal uterine bleeding: do patient’s pain and anxiety really impact on sampling success rate?

BMC Women s Health ◽

10.1186/s12905-021-01526-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Aiym Kaiyrlykyzy ◽

Faina Linkov ◽

Faye Foster ◽

Gauri Bapayeva ◽

Talshyn Ukybassova ◽

...

Keyword(s):

Severe Pain ◽

Medical Center ◽

Abnormal Uterine Bleeding ◽

Outpatient Setting ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Success Rates ◽

Pain Anxiety ◽

The University

Abstract Background Pipelle endometrial biopsy is vital for the early diagnostics of endometrial pathology and is performed in outpatient setting in minimally invasive manner. One of the reported disadvantages of sampling with Pipelle curette is failure to collect enough tissue for histological analysis. The role of psychological factors such as anxiety and pain sensitivity in obtaining adequate samples is not well known. The study's objective was to explore whether there is relationship between severe pain, anxiety, and the rate of Pipelle failure. Methods Study included 158 women with median age of 42 who underwent Pipelle endometrial biopsy at Clinical Academic Department of Women’s Health of the University Medical Center (UMC), Nur-Sultan City, Kazakhstan with an abnormal uterine bleeding from June 2019 to April 2021. Women were asked to fill survey on pain, anxiety before, during and after the procedure. Results 3.8%, 15.19% and 4.43% of women reported severe pain and 39.24%, 34.18% and 14.56% of women reported severe anxiety prior, during and after procedure, respectively. Women who experienced severe pain during procedure tend to be more anxious during procedure (p = 0.0001) and have higher number of sampling attempts (p = 0.0040). Pain level was higher among patients sampled by the junior OB/GYN specialist (p < 0.0001). We found no differences in Pipelle biopsy success rates in relationship to baseline, during and postprocedural pain and anxiety scores. Conclusion Anxiety during procedure performance was significantly associated with severe pain during the procedure but did not represent a key element for the success of Pipelle biopsy.

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Evaluation of the efficiency of hemostatic therapy with micronized progesterone for abnormal uterine bleeding

Akusherstvo i ginekologiia ◽

10.18565/aig.2016.5.145-148 ◽

2016 ◽

Vol 5_2016 ◽

pp. 145-148

Author(s):

Balan B.E. Balan ◽

Tikhomirova E.V. Tikhomirova ◽

Keyword(s):

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Hemostatic Therapy ◽

Micronized Progesterone

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Endometrial Carcinoma in a 26-Year-Old Patient with Bardet-Biedl Syndrome

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/1952351 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Olga Grechukhina ◽

Gregory M. Gressel ◽

William Munday ◽

Serena Wong ◽

Alessandro Santin ◽

...

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Endometrial Adenocarcinoma ◽

Clinical Signs ◽

Young Patients ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Endometrioid Adenocarcinoma ◽

Bardet Biedl Syndrome ◽

Obesity And Diabetes

Background. Bardet-Biedl Syndrome (BBS) is a rare genetic condition characterized by cognitive impairment, dysmorphism, central obesity, and diabetes mellitus, among other abnormalities. Although some of these characteristics are known independent risk factors for endometrial cancer and its precursors, the association between BBS and endometrial cancer is underreported. Case. We present the case of a 26-year-old patient with BBS and clinical signs of hyperestrogenism who presented with abnormal uterine bleeding and was diagnosed with endometrioid adenocarcinoma. She ultimately underwent definitive surgical treatment with hysterectomy and bilateral salpingectomy. Conclusions. This is one of only a few reports in the literature describing the association of BBS and endometrioid endometrial adenocarcinoma. Given the association of BBS with risk factors for hyperestrogenism such as truncal obesity, hyperinsulinemia, and ovulatory dysfunction, providers should have increased suspicion for endometrial cancer in young patients with BBS and abnormal uterine bleeding.

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