Abnormal Uterine Bleeding due to Retention of Fetal Bones after Abortion: A Case Report

Background: Retention of fetal bones is a rare cause of abnormal uterine bleeding. Others may present as subfertility, chronic pelvic pain, abnormal vaginal discharge, menometrorrhagia, dysmenorrhea and spontaneous expulsion of bony fragments. Incidence is 0.26% among patients undergoing hysteroscopy. Aim: To document a pattern of presentation of retained fetal bone and its management. Case Presentation: Our patient is an 18-year old who presented with vaginal bleeding of four weeks duration and managed for abnormal uterine bleeding due to retained fetal bone following second trimester abortion. Conclusion: The use of transvaginal ultrasound in making diagnosis of retained fetal bone is effective. Treatment by removal of bones through evacuation by dilatation and curettage or hysteroscopy brings about resolution of symptoms. Use of pelvic ultrasonography to confirm complete evacuation of the uterus after abortion especially second trimester abortion could aid in early diagnosis and management of incomplete abortion.

A Comparative Observational Study of the Use Transvaginal Ultrasound and Hysteroscopy for the Detection of Uterine Cavity Pathologies in Women with Abnormal Uterine Bleeding

Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 - 49 yrs. 81.2% of patients have body mass index above 25 kg/m2. Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS);they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.

Epidemiological Profile of Abnormal Uterine Bleeding at the Gyneco-Obstetric and Pediatric Hospital of Yaounde

Introduction:?Abnormal uterine bleeding (AUB) is one of the most commonly encountered symptoms in gynecological consultations. The prognosis is rarely endangered but the impact on the quality of life is sometimes important. Objective:?Our objective was to assess the epidemiological profiles of patients consulting for AUB at the Yaounde Gyneco-Obstetrics and Pediatrics Hospital.?Methodology:?We carried out a descriptive cross-sectional study at the Yaounde Gyneco-Obstetrics and Pediatrics Hospital. We included all women with acute or chronic per vaginal bleeding and we excluded all cases of bleeding in pregnancy, bleeding due to infection, pre pubertal bleeding and the incomplete files. Data were?collected from January to May 2019, using a questionnaire, and analyzed using Epi Info version 3.5.4 and SPSS version 7. softwares. Results:?A total of 163 patient files were exploited and analyzed. The frequency of AUB in outpatient gynaecology clinics was 3.7%. AUB patients had a mean age of 36 ± 12.27 years and the most represented age group was 30 to 35 years, with 17.1% cases. Sixty-seven representing 41.1% patients were married, 23.9% were civil servants, 23.1% were tertiary employees, and 40.3% had secondary level of education. Almost 44.1% were nulliparous and 53.9% had unknown HIV status an 83.4% have never used contraception. Conclusion:?The frequency of AUB during gynecological consultations is 3.7%. Those women have an average age of 36 years, most of them are nulliparous and have never use contraception.

Comparison of Transvaginal Ultrasound, Saline Infusion Sonohysterography versus Diagnostic Hysteroscopy in Evaluation of Endometrial Cavity Pathology amongst Women with Abnormal Uterine Bleeding in Low Resource Setting

Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.

Research progress in the treatment of perimenopausal abnormal uterine bleeding with traditional Chinese and western medicine

In order to fully understand the research progress of Chinese and Western medicine in the treatment of perimenopausal abnormal uterine bleeding,this paper reviews all kinds of research by referring to related literature reports at home and abroad.The results showed that western medicine mainly used hormone drugs,supplemented by surgery,but the clinical adverse reactions were more and the recurrence rate was higher;traditional Chinese medicine often obtained satisfactory results through the treatment of traditional Chinese medicine,syndrome differentiation,stage treatment,acupuncture and other treatment methods,with fewer adverse reactions and low recurrence rate,but the effect of sudden collapse and hemostasis was slower;the combination of Chinese and Western medicine can learn from each other and become The research focus in recent years is worthy of further discussion.

Study on Relevance of Endothelin to Abnormal Uterine Bleeding Associated with Long-Term Subdermal Implants Use

ve To investigate the relationship between estradiol, progesterone and endothe-lin (ET) and abnormal uterine bleeding after using sub-dermal contraceptive implant

Study on mechanism of Radix Paeoniae Rubra-Cortex Moutan in treatment of abnormal uterine bleeding based on network pharmacology

Objective:To explore the mechanism of the treatment of abnormal uterine bleeding with Radix Paeoniae Rubra-Cortex Moutan.Methods:To search the effective elements and action targets of paeony peony skin drug pair by searching the pharmacology platform of traditional Chinese medicine system;to select the disease targets of abnormal uterine bleeding by searching the human gene information database;to select the common targets of drugs and diseases by R language,to construct the interaction network of drugs compounds action targets diseases by using the software of Cytoscape;to construct the protein-protein interaction network by using the string platform The interaction network(PPI)was used to visualize the results,and the bio information package of Bioconductor was used to analyze go function enrichment and KEGG pathway.Results:This study included 16 compounds and 67 key targets.After enrichment analysis,87 go functional items and 116 KEGG signaling pathways were obtained.Quercetin,scutellarin,kaempferol and stigmasterol in Radix Paeoniae Rubra-Cortex Moutan directly act on interleukin-6,epidermal growth factor receptor,cystatin 3,mitogen activated protein kinase 8,vascular endothelial growth factor and other related targets,and are mainly enriched in Kaposi sarcoma associated herpesvirus infection and hepatis B.Age-range,TNF and other signal pathways.Conclusion:Radix Paeoniae Rubra-Cortex Moutan may play the role of anti-cell proliferation and apoptosis,protection of vascular endothelium,anti-inflammatory response,regulation of hormone secretion,and improvement of antioxidant activity through multi-component and multi-target,and play the role of treatment of abnormal uterine bleeding.

Research Progress on Treatment of Abnormal Uterine Bleeding during Puberty with Traditional Chinese and Western Medicine

In recent years,the frequency of clinical occurrence of abnormal uterine bleeding in adolescence has gradually increased.In order to fully understand the research progress in the treatment of abnormal uterine bleeding in adolescence,various studies and clinical experience have been reviewed by consulting related literature reports.The results found that currently Western medicine mainly uses hormone drugs in clinical treatment,but there are risks such as more clinical adverse reactions and higher recurrence rate;traditional Chinese medicine(TCM)treatment has achieved satisfactory results,but the advantages of sudden collapse and hemostasis are not obvious.Combined TCM and Western medicine treatment,it can learn from each other and has become a research hotspot in recent years,which is worthy of an in-depth discussion.

Clinical and Demographic Profile of Women with Uterine Fibroids Living in Puerto Rico

Introduction: Uterine leiomyomas, or fibroids, are prevalent benign tumors affecting up to 70% of reproductive-age women in the United States, significantly impacting productivity and quality of life. Despite their commonality, the epidemiology and clinical patterns of leiomyomas in Puerto Rico remain inadequately researched. Methods: This study conducted a secondary data analysis using clinical, menstrual cycle characteristics, and demographic data from self-administered questionnaires of women undergoing diagnostic laparoscopy for endometriosis in Puerto Rico. Chi-square tests and t-tests analyzed categorical and continuous variables, respectively (p Results: Among 1,610 endometriosis cases, 312 included uterine fibroids. Prevalence estimates were 10.3% (40 years). Primiparous women averaged 22.14 years, with 40.71% having 2 - 3 pregnancies and 26.28% experiencing miscarriages. Symptoms included infertility (29.5%), dyspareunia (40.7%), severe pain (50%), and dysmenorrhea (75.6%). Comorbidities included ovarian cysts (52.2%) and abnormal uterine bleeding (37.8%). Conclusions: Advanced age, parity, and comorbidities like diabetes and hypertension were prevalent in our cohort. Understanding the epidemiological profile of women living in Puerto Rico with uterine fibroids is crucial for improving diagnostic awareness and enhancing patient care.

调经止血方对围绝经期AUB 患者Ang-1、Ang-2 水平的影响

目的:探讨调经止血方对围绝经期异常子宫出血(AUB)患者血清Ang-1、Ang-2水平的影响。方法:选取2021年1月~2023年1月收治的78例围绝经期AUB患者,均分为A组和B组,持续治疗6周。比较两组临床疗效、治疗前后各指标差异及不良反应发生率。结果:A组疗效89.74%,明显高于B组71.79%(P<0.05)。治疗后,A组在中医证候、月经失血、内膜厚度等方面均优于B组,多项血清指标也显示A组效果更好(P<0.05)。不良反应率两组无显著差异(P>0.05)。结论:调经止血方辅助治疗可提高围绝经期AUB临床疗效,调节血清Ang-1、Ang-2水平。

Novasure treatment for one case of abnormal uterine bleeding with active systemic lupus erythematosus

Abnormal uterine bleeding（AUB）, especially in the menopausal transition period,is showing a tendency of rising in recent years, and after treatment, high recurrence rate for the treatment of hormone treatment, the endometrial resection and uterine resection. But for patients with severe systemic disease with AUB, it may get worse with the conventional treatment. Novasure provides us with an effective measure for the treatment of AUB with active systemic lupus erythematosus（SLE）.

基于真实世界数据的青春期异常子宫出血用药规律研究

目的:通过对女童青春期异常子宫出血患儿临床实际诊疗病例资料进行数据挖掘分析其中药治疗的用药规律。方法:基于医院信息管理系统提取2020年1月至2022年12月首都医科大学附属北京儿童医院女童青春期异常子宫出血患儿的病历数据,分为止血期和调理期2个阶段,总结归纳其辨治规律。结果:纳入止血期663例患儿,1020例病历;调理期796例患儿,2047例病历。止血期涉及中药169味,排名前5位为侧柏炭、牡丹皮、小蓟、麸炒椿皮和白芍,性味以寒、苦药为最多,归经以肝经为最多,功效以止血、补虚类药物为最多;调理期涉及中药232味,排名前5位为当归、酒女贞子、炙淫羊藿、黄芪和生地黄,性味以温、甘药最多,归经以肝、肾经为最多,功效以补虚类为最多。聚类分析分别获得4类和5类核心药物组合。结论:真实世界临床数据显示肾阴亏虚、血热内扰为青春期异常子宫出血常见证型,治则先以止血为主,待崩漏缓解后,重在调补脾肾以复旧,组方注重止血、补虚、收涩和清热等药物的配伍应用。

腔内三维超声联合临床指标对剖宫产术后子宫切口憩室致子宫异常出血的价值

目的 探讨腔内三维超声联合临床指标在剖宫产术后子宫切口憩室致子宫异常出血的价值。方法 收集2017年1月~2023年4月在石河子市人民医院行阴道超声检查的126例剖宫产术后合并子宫切口憩室的患者资料。根据患者剖宫产术后出血情况分为组1(无异常出血,n=72)、组2(异常出血,n=54),所有患者均行阴道超声(二维超声及三维超声)检查。分析比较两组间临床特征(子宫位置、剖宫产次数以及剖宫产缝线方式等)以及子宫切口憩室超声特征(憩室形态、憩室容积、憩室长度、憩室深度以及残余肌层厚度等)的差异,建立基于临床及超声特征的预测模型,探索剖宫产术后合并子宫切口憩室患者子宫异常出血的独立危险因素,并评价此模型的预测价值。结果 两组间剖宫产次数、子宫位置、子宫内膜厚度、憩室深度、憩室长度、憩室容积、憩室比以及残余肌层厚度的差异均有统计学意义(P<0.05);多因素回归分析显示,子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是子宫异常出血的独立危险因素(OR=0.087、10.385、4.658、12.892、0.001,P<0.05),与各单因素相比,此模型预测子宫异常出血的AUC为0.936,高于各单因素(AUC=0.567、0.705、0.836、0.895、0.870,P<0.05),该联合预测模型以-6.28为截断值时,敏感度为87.04%,特异性为91.67%,准确度为89.68%,且与临床诊断结果有良好一致性(Kappa=0.789,P<0.001)。结论 子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是剖宫产术后子宫切口憩室合并子宫异常出血的独立危险因素,超声及临床特征对预测剖宫产术后子宫切口憩室致子宫异常出血有重要预测价值。

超声引导下子宫内膜消融术在异常子宫出血中的疗效及影响因素

目的:探讨超声引导下子宫内膜消融术在异常子宫出血中的疗效及相关影响因素。方法:选取2019年1月—2020年12月梅州市人民医院接受超声引导下子宫内膜消融术的41例异常子宫出血患者,失访2例,根据末次随访结果将39例患者分为三组,痊愈25例、有效10例、无效4例。收集临床资料并进行比较。在彩超引导下,用微波针穿刺宫腔及子宫病灶,对子宫内膜进行消融3~5 min,通过产生热效应使子宫内膜组织凝固性坏死,达到阴道流血显著减少或闭经。治疗41例,随访39例,随访时间1.5年以上。结果:术后1.5年子宫出血治愈率达95.1%,术后感染率4.8%,术后穿刺点皮下血肿率2.4%。结论:超声引导下子宫内膜消融术,方法简便、保护正常组织、术后恢复快、缓解患者症状、减少患者痛苦。患者体重指数、孕次、合并子宫肿物大小是影响子宫内膜消融术疗效的独立因素。

认知干预在宫腔镜治疗子宫异常出血患者中的应用分析

目的探讨在子宫异常出血患者宫腔镜治疗中运用认知干预的效果。方法选取110例接受宫腔镜手术治疗的子宫异常出血患者,以随机数字表法分组,n=55。对照组给予常规护理,观察组在常规护理基础上给予认知干预,对比两组患者对疾病认知度、心理状态、生活质量及术后并发症发生情况。结果观察组患者对疾病认知率为96.36%,高于对照组的81.82%(P<0.05);护理后观察组焦虑与抑郁评分均低于对照组(P<0.05)。观察组生活质量各功能评分均高于对照组(P<0.05)。观察组术后并发症率低于对照组(P<0.05)。结论在子宫异常出血患者宫腔镜治疗护理中运用认知干预,可提高患者认知水平,改善心理不良状态,降低患者并发症发生率,提高生活质量,值得临床推广。

临床特征在术前诊断子宫腺肌病合并子宫内膜癌中的作用

目的分析子宫腺肌病(AM)与合并子宫内膜癌(EC)患者的临床特征及在术前诊断中的作用。方法收集最终经病理检查确定为AM合并EC或子宫内膜非典型增生(EAH)以及同期有异常子宫出血(AUB)的AM患者共142例,根据是否合并EC或EAH分为AM合并EC或EAH组(71例)和对照组(71例),对患者的临床资料进行回顾性分析,探讨AM合并EC患者的临床特征及治疗策略的制定。结果单因素分析结果显示AM合并EC或EAH组患者的年龄、CA125及CA125升高的比例、子宫体积、合并高血压、超声存在内膜异常声像的比例均显著高于对照组,痛经的比例显著低于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,超声的内膜增厚、内膜回声不均、内膜增厚合并回声不均是AM合并EC或EAH的独立危险因素。结论临床上应对超声具有内膜增厚或回声不均声像的AM患者先行宫腔镜诊刮取得病理结果后再进一步制定手术方案,以达到早期诊治EC的目的。

葆宫止血颗粒治疗排卵障碍性异常子宫出血疗效及安全性的系统评价和序贯分析

目的对葆宫止血颗粒治疗排卵障碍性异常子宫出血的临床疗效和安全性进行系统评价和试验序贯分析。方法检索中国知网、万方数据知识服务平台、维普资讯中文期刊服务平台、中国生物医学文献数据库、PubMed、Embase、Cochrane Library建库至2023年1月5日运用葆宫止血颗粒治疗排卵障碍性异常子宫出血的随机对照试验,按照Cochrane系统评价手册进行文献筛选、数据提取,使用RevMan5.4进行Meta分析。结果共纳入文献15篇,涉及患者1425例。Meta分析结果显示,葆宫止血颗粒可有效提高治疗排卵障碍性异常子宫出血的临床疗效(RR=1.17,95%CI[1.13,1.23],P<0.00001),缩短止血时间[出血控制时间(MD=-6.35,95%CI[-8.89,-3.81],P<0.00001),完全止血时间(MD=-12.56,95%CI[-16.22,-8.89],P<0.00001)],减小子宫内膜厚度(MD=-1.26,95%CI[-1.71,-0.80],P<0.00001),减少血红蛋白丢失(MD=13.35,95%CI[11.41,15.29],P<0.00001),改善子宫出血评分(MD=-2.22,95%CI[-2.43,-2.01],P<0.00001),降低复发率(RR=0.37,95%CI[0.19,0.72],P=0.004),不良反应与对照组差异无统计学意义(P=0.82)。对总有效率进行试验序贯分析,累计纳入的研究超过了传统界值和试验序贯分析界值。结论葆宫止血颗粒治疗排卵障碍性异常子宫出血具有一定疗效,但研究可能存在发表偏倚,有待开展更高质量的临床随机对照试验加以验证。

宫腔镜下电切术与宫腔镜下刮宫术在围绝经期异常子宫出血患者中的应用

目的:分析宫腔镜下电切术与宫腔镜下刮宫术在围绝经期异常子宫出血患者中的应用。方法:选取2020年1月—2023年1月苏州永鼎医院收治的102例围绝经期异常子宫出血患者作为研究对象。根据计算机随机分组法将其分为对照组及观察组,各51例。对照组实施宫腔镜下刮宫术,观察组实施宫腔镜下电切术。比较两组术前、术后免疫功能,术前、术后3个月月经情况,复发情况。结果:术后7 d,两组免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、补体C3、补体C4水平均降低,但观察组IgG、IgA、IgM、补体C3、补体C4水平均高于对照组,差异有统计学意义(P<0.05)。术后3个月,两组子宫内膜厚度、月经出血量、月经期均改善,且观察组子宫内膜厚度、月经出血量、月经期均优于对照组,差异有统计学意义(P<0.05)。观察组复发率低于对照组,差异有统计学意义(P<0.05)。结论:围绝经期异常子宫出血患者应用宫腔镜下电切术治疗,可改善患者子宫内膜厚度及月经情况,改善免疫功能指标,减少复发。

口服抗凝治疗增加易栓症患者异常子宫出血的发生风险:一项单中心回顾性研究

目的 探讨女性易栓症患者口服抗凝治疗期间异常子宫出血(abnormal uterine bleeding,AUB)的发生率及其不良影响。方法 以2013年1月—2023年5月于北京协和医院血液内科出凝血疾病门诊就诊,并接受口服利伐沙班或华法林抗凝治疗的女性易栓症患者为研究对象。回顾性收集抗凝治疗前及治疗后患者的一般临床资料及AUB情况,并根据抗凝治疗药物不同将患者分为利伐沙班治疗组和华法林治疗组。采用广义估计方程分析女性易栓症患者抗凝治疗前后AUB的发生率,探讨不同抗凝治疗药物对AUB发生率的影响。结果 共入选符合纳入与排除标准的女性易栓症患者106例,相较于用药前,AUB的发生率显著增加(56.6%比26.4%,P<0.001),以月经过多(48.1%)和经期延长(21.7%)为主要临床表现。相较于华法林,利伐沙班更易导致AUB(OR=3.3,95%CI:1.5~7.4,P=0.003)。在发生月经过多和经期延长的54例患者中,72.2%(39/54)采取了干预措施,其中经期暂停服用抗凝药是主要干预措施(37.0%),相较于华法林治疗组,利伐沙班治疗组患者更易在经期停药(OR=10.4,95%CI:1.2~87.2,P=0.019)。结论 口服抗凝治疗可显著增加女性易栓症患者AUB的发生风险,且利伐沙班相关AUB的发生风险明显高于华法林。

延续性精准护理在异常子宫出血患者中的应用效果

目的:观察延续性精准护理在异常子宫出血(AUB)患者中的应用效果。方法:回顾性分析2021年6月至2022年5月该院收治的76例AUB患者的临床资料,按照护理方法不同将其分为观察组和对照组各38例。对照组实施常规护理,观察组在对照组基础上实施延续性精准护理,两组均护理3个月。比较两组护理前后心理弹性[Connor-Davidson心理弹性量表(CD-RISC)]评分、自我效能感[一般自我效能感量表(GSES)]评分、生命质量[生活质量综合评定问卷-74(GQOLI-74)]评分,以及护理满意度。结果:护理后,观察组乐观性、力量性、坚韧性等CD-RISC各维度评分均高于对照组,差异有统计学意义(P<0.05);观察组GSES评分高于对照组,差异有统计学意义(P<0.05);观察组GQOLI-74评分高于对照组,差异有统计学意义(P<0.05);观察组护理满意度为97.37%(37/38),高于对照组的78.95%(30/38),差异有统计学意义(P<0.05)。结论:在常规护理基础上实施延续性精准护理可提高AUB患者心理弹性评分、自我效能感评分、生命质量评分和护理满意度,效果优于单纯常规护理。