Evaluating management of patients with abnormal uterine bleeding at Moi Teaching and Referral Hospital Eldoret Kenya

Abstract

Background: Abnormal uterine bleeding (AUB) affects 3% to 30% of women in their reproductive age globally. The condition further interferes with the socioeconomic status and overall quality of life of the affected women. Despite this, there are limited studies evaluating the management of women with abnormal uterine bleeding in resource limited settings. PALM-COEIN (Polyp; Adenomyosis; Leiomyoma; Malignancy and Hyperplasia; Coagulopathy; Ovulatory dysfunction; Endometrial; Iatrogenic; and Not yet classified) guideline for structural and functional causes of AUB gives a consistent and universally accepted nomenclature as well standardises clinical care and research. Objective: To evaluate proportion, patterns of presentation, management methods and cost of treatment of women with abnormal uterine bleeding at Moi Teaching and Referral Hospital (MTRH). Methods: This was a cross sectional study conducted at the gynaecology department of MTRH between April 2nd, 2018 and April 1st, 2019. A census of 108 women aged between 18 to 45 years with confirmed abnormal uterine bleeding was done. Their sociodemographic and clinical characteristics were collected using a structured questionnaire through interviews and chart reviews. PALM COEIN was used to assess adherence to diagnosis. Data analysis was performed using SPSS version and variables with a p-value of <0.05 considered statistically significant. Results: The participants median age was 30 (IQR: 22, 41) years. The proportion of women seeking gynecological care at MTRH with AUB was 3.96% (n=231) of whom 108 were enrolled into the study. Prolonged bleeding was the most predominant pattern at 41.7% (n=45), followed by heavy bleeding at 35.2% (n=38). Bleeding patterns were associated with age (p=0.04). PALM-COEIN diagnosis guidelines were adhered to among 16.7% (n=18) of all the participants. Initial laboratory evaluation included thyroid stimulating hormone, complete blood count and pregnancy tests; followed by hormonal profiling. Abdominopelvic ultrasound was done for 79.6% (n=86) while only 8.3% (n=3) of women older than 35 years had a biopsy. Leiomyoma was the common cause of AUB 48(44.5%), followed by endometrial causes (17.6%). PALM and COEIN accounted for 60% and 40% respectively. Medical management was provided for 78.7% of women. Cost for surgical management was higher than medical management with a cost difference of KSh.19, 000. Length of hospitalization was associated (p<0.001) with high cost of treatment. Conclusion: Proportion of women with abnormal uterine bleeding was within known ranges but generally lower than those reported in previous studies. Prolonged bleeding was the commonest bleeding pattern. Less than one third of the women were diagnosed as per the PALM-COEIN criteria. Medical management was more commonly used due to its low cost in the short term. Recommendation: Women presenting with prolonged uterine bleeding should be assessed for AUB. There is need for in-hospital algorithms to ensure AUB diagnosis in accordance to PALM-COEIN guidelines. Surgery should be recommended over medical management due to its long-term cost effectiveness.