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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. |
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