Transcript Abnormal Uterine Bleeding

Welcome to Weakly seminar
Dr. Shubha Prasad Das
Intern Doctor
Dept. of Gynaecology and Obstetrics
Particulars of the patient
Name: Marjina
Age:45 years
Registratio no:
Bed No:
Husband’s Name: Md. Akkas
Address:
Village: Makorpara, P.O:Sakrail,
Thana : Modhukhali, District: Faridpur
Date of admission: 17th April,2011
Date of examination: 17th April,2011
Chief complaints:
- Irregular menstruation with excessive
bleeding for 2 years.
- Weakness
History of present illness
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According to the patient statement she
was well 2 years back. Thereafter she
developed irregular menstrual cycle
which persist for 15-16 days. Menstrual
period persist for 2-3 days. There is
excessive bleeding during menstruation
with passage of blood clots. She also
complains generalized weakness with
these symptoms. There is no associated
dysmenorrhoea.
History of past illness

She has no history of liver disease,
thyroid disease, renal disease or
bleeding disorders.
Menstrual History
Menarche: At the age of 13 years
Menstrual period:3-4 days
Menstural cycle: 28 days
Since last 2 years :
Menstrual period:2-2 days
Menstural cycle: 15-20 days
Menstrual flow: excessive
LMP: 14/04/11
Dysmenorrhoea: Absent
Obstetrics History
Married for: 32 years
Para: 5(NVD)+2( IUD)
ALC: 13 years
Family History:
Drug History:
Nothing contributory
Nothing contributory
Socio-economic History:
Contraceptive History:
Poor
She
don’t use any type of contraception.
General Examination
Appearance- Ill Looking
Respiratory rate- 14 breath/min
Body Built- Average
BP- 110/70 mmhg
Anaemia- Moderate
Heart - clear
Jaundice- Absent
Lung- clear
Oedema- Absent
Temperature - Normal
Lymph Node – Not enlarged
Thyroid- not enlarged
Pulse- 84 beat/min
Breast: Normal
Abdominal Examination:

Inspection: No abnormality seen
Palpation:
Non tender
 No mass detected
 Temperature – not raised
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Percussion:
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No fluid thrill or shifting dulness
Per- vaginal examination:
Inspection: vulva- healthy
 Speculum examination: vagina and
cervix looks normal
 Bimanual examination:
- Uterus bulky
- Fornices free
- Ovaries normal
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Investigations:
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CBC
Blood grouping and Rh typing
RBS
Blood urea serum creatinine
Urine R/M/E
X-ray chest P/A view
T3, T4 and TSH
USG of Whole abdomen
Salient feature :

My patient Mrs. Marjina wife of Mr. Akkas aged 45years
Muslim lady from Sakrail Modhukhali admitted in FMCH
with the complaints of irregular menstrual cycle with
excessive bleeding. She also complains generalized
weakness. She has no history of liver, thyroid diseases
or bleeding disorder. She didn’t take any drug related to
such type of symptoms.
On general examination- she was found moderately
anaemic and normotensive. Abdominal examination
reveals no abnormality.
On vaginal examination revealed bulky uterus, free
Fornices. All the investigation normal except HB%.
Diagnosis:

Clinically it appears to be a case of
DUB
Differential Diagnosis:
Adenomyosis
 Fibroid Uterus
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Treatment :
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Total Abdominal hysterectomy with
conservation of both ovaries if they
are look healthy.