A study to correlate clinical with pathological findings in abnormal uterine bleeding (AUB)

Abstract

Introduction: Abnormal uterine bleeding (AUB) poses a significant health and financial burden, especially in perimenopausal women. Despite the PALM-COEIN classification, gaps persist in correlating clinical and histopathological aspects. Our study, utilizing diagnostic modalities like Ultrasonography, Hysteroscopy, and Endometrial sampling, seeks to enhance diagnostic precision in AUB, contributing to improved management strategies and patient outcomes. Materials and Methods: This descriptive study investigated Abnormal Uterine Bleeding (AUB) in 126 women aged 35 and above at our hospital from September 2019 to February 2021. The study utilized the PALM-COEIN classification system for categorizing AUB causes. Inclusion criteria covered various AUB presentations, while exclusion criteria excluded specific conditions. Data collection involved a structured proforma, and diagnostic interventions encompassed Ultrasonography, Hysteroscopy, and Endometrial sampling. Statistical analysis employed various measures, including the concordance index and Chi-square test, utilizing SPSS 21. Results: This hospital-based study enrolled 126 women presenting with abnormal uterine bleeding (AUB), offering comprehensive insights into their demographic, clinical, and histopathological profiles. The mean age of the cohort was 45.96 years, with a notable concentration in the 40-44.99 age group. The majority resided in urban areas (96.83%) and belonged to the upper middle class (65.87%), with housewives constituting 97.62%. AUB patterns, including irregular bleeding (56.35%) and postmenopausal bleeding (15.87%), were meticulously examined. Comorbidities, predominantly hypertension (31 patients) and hypothyroidism (22 patients), were identified in 60 patients. Ultrasonography revealed Leiomyoma in 54.76% and Adenomyosis in 24.6%. Clinical diagnoses, utilizing the PALM-COEIN classification, highlighted AUB-L as the primary cause (54.76%). Diagnostic modalities such as Hysteroscopy, Hysterectomy, and concordance analyses contributed to enhanced diagnostic precision, emphasizing the multidimensional approach imperative for effective AUB management in clinical practice. Conclusion: Our study underscores the efficacy of the PALM-COEIN classification in correlating clinical and histopathological findings for Abnormal Uterine Bleeding (AUB). Leiomyoma emerged as the primary etiology, showcasing the classification's utility in identifying dual pathologies. Histopathological examination significantly complemented clinical diagnoses, emphasizing the system's value in optimizing patient care.