Dysfunction Uterine Bleeding (DUB)

It affects 22-30%of women and common in day to day clinical practice.
Diagnosis of DUB is usually made by exclusion of organic disease of the genital tract or systemic organic disease.
DUB is a groups of disorders characterized by dusfunction of any part of the reproductive system (uterus, ovary) or pituitary, hypothalamus, higher centres .
Definition- It is regular excessive bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, pregnancy.
It is caused by hormonal imbalance and most commonly occurs during puberty and menopause.No abnormality detected on pelvic examination is suggestive of the diagnosis.
Classification-
On the basis of age=
1)Pubertal or adolescent DUB- usually women less than 20yrs, incidence-4%
2) Reproductive DUB-Seen in women from 20 to 40 yrs, incidence-57%
3) Perimenopausal DUB- women aged above 40yrs, incidence-39%
4) Postmenopausal DUB- incidence around 10%
On the basis of pathology
Primary DUB:
  There is no detectable disease in the genital tract or elsewhere in the body.
   It is dus to dysfunction in the menstrual or ovarian cycle or uterine-ovarian-pituitary-hypothalamic axis.
Secondary DUB:
   Disorder outside the genital tract
   The cause of uterine bleeding like hypothyroidism, IUCD, Hormones for contraception etc.
On the basis of mentrual cycle
Anovulatory DUB:
   Cause is continuous estradiol production without corpus luteum formation and progesterone productions.
Ovulatory DUB:
Occurs most commonly after the adolescent years and before the perimenopausal years.
Occurs in 10%ovulatory women
Cause is prolonged life of the corpus luteum 
Association with a normal appearing secretary endometrium
Causes
Ovulatory disorder
Other cause:  
    Hormonal abnormalities
    Medication-Antiplatelet drugs
    Excessive exercise or weight loss
    Obesity
     Stress or illness
Clinical features
Irregular, abnormally frequent, prolonged,or excessive of uterine bleeding
Pale skin -Iron deficiency anaemia
Dizziness, fainting, weakness
Low Blood pressure, Tachycardia
Pain
Passing of clots
Diagnosis-
It is helpful to exclude others disease and find out the cause of DUB
Menstrual history
Symptomatic history
Exinatioon
Investigation
Treatment: 


       

टिप्पणियाँ

एक टिप्पणी भेजें

इस ब्लॉग से लोकप्रिय पोस्ट

Third Complications of labor

चित्र
All women who deliver are at risk of complications in third stage of labor.These complications include Post partum Hemorrahege Retention of placenta (Retained placenta) Inversion of uterus Plumonary embolism Obsteric shock Injurier of birth canal     Retained placenta Management 1) Fundal pressure 2) Controll word traction 3) Manual remove of placenta under Genearl Anesthesia 1) Fundal pressure After seperation of placenta Pressure=Dounword and backward pressure on funda part and pull out the umblical word 2) Controll card traction  placenta separate Pressure on symphysis punia upword and backward Pull out with umblical word 3) Manual remove of placenta under general anesthesia Placent not seperat Female=General Anesthesia (Thiopentel sodiyam 4 to 5 mg/kg) Wear the gloves and insert hand in cone shape manner And reach hoti placenta margin Slicing movemen
और पढ़ें

Anatomy and physiology of Vagina to prevent infection

चित्र
In adult female ,vagina is lined by stratified squamous epithelium.In newborn female,it is lined by transitional epithelium.squamous epithelium is resistant to gonococcal infection.Thus , gonococal vaginitis cannot occur in adult female. Vagina has local inhabitant bacteria called Doderlein's bacillus Which breaks down the glycogen present in vaginal epithelium into lactic acid resulting in acidic pH(4-5.5, average 4.5) of vagina.The acidic pH of vagina acts as a barrier for external organism and protect from infection. Physiological vaginal discharge..... Clear, white and flocculent odourless discharge. Smear contains epithelial cells, lactobacillus pH ranges from 3.8 to 4.2 pH increase with increased oestrogen States:in pregnancy,OCP,mid-cycle,PCOS or premenarchal If pH increase in primenopausal woman, investigation for other effects of excess oestrogen. This area is subject to both primary and secondary infection.Ascending infection can occur from the vagina and c
और पढ़ें

Antepartum Heamorrhage APH

चित्र
Antepartum haemorrhage APH APH is usually define as bleeding form the birth canal after the 24 to 28 weeks of  pregnancy.It can occur at any time until the second stage of lobour is complete; bleeding following the birth of the baby is postpartum haemorrhage=Miscarriage Or  Any ammount of bleeding from genital tract after 28 weeks to before of bleeding 28wk ..... Delivery time....6wk APH_________IPH_________PPH ETIOLOGY  --- Idiopathic/unknown 2types    1) Placenta previa (pp) 2) Abrupto previa (AP) Placenta previa=in lower uterin segement Implantation posterior wall of bady of uterus near the fundus Abrupto precisa=premature separation of placenta Most common risk of APH Dropping down theory= Drop down in lower uterine segments Implantation Due to less endometrial reactions Increase that cilliary active of fallopian tube A)Types of placenta previa 1)Types 1 (PP)  low lying place
और पढ़ें