BAITI Investigation and Management

8/18/2019 BAITI Investigation and Management

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DYSFUNCTIONAL UTERINE BLEEDING

INVESTIGATION AND MANAGEMENT

SITI NUR BAITI BINTI SHAIK

KHAMARUDIN

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OUTLINE

Dysfunction! ut"#in" $!""%in& 'DUB(

Ai) of in*"sti&tion

In*"sti&tions• Histo#y• Int"#n! "+)intion• S,"ci! in*"sti&tion

Mn&")"nt

• M"%ic!• Non-.o#)on!• Su#&ic!

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DYSFUNCTIONAL UTERINE

BLEEDING

• D"0n"% s

A stt" of $no#)! ut"#in" $!""%in&WITHOUT ny c!inic!!y %"t"ct$!"o#&nic2 syst")ic n% it#o&"nic cus"3

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ANOVULAR BLEEDING

No ovulation occur

Absence ofprogesterone

Endometrial growthunder inuence

estrogen through theccle

Inade!uate structuralstromal support

"emain fragile

Alteration ofprostaglandin

production

Increase #$E% and#$I%

&asodilate'increase

(brinoltic activit

)*EE+IN$

•

H*"

%"*"!o,in&fo!!ic!"

• No )tu#"

fo!!ic!"• No co#,us

!ut"u)

• On!y .*""st#o&"n2 $utno ,#o&"st#on"

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OVULAR BLEEDING

I##"&u!# #i,"nin& of

"n%o)"t#iu)

I##"&u!# s."%%in& of"n%o)"t#iu)

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OVULAR BLEEDING

I""E$U*A" "I#ENN$ O,EN+O-ET"IU-

• In%":ut" fo#)tionn% function of co#,us!ut"u)

• Lut"! ,.s" is s.o#t

• In%":ut" s"c#"tionof ,#o&"st"#on" n%"st#o&"n

• C!inic! ,#"s"nttion ,o!y)"no##."

I""E$U*A" .HE++IN$ O,EN+O-ET"IU-

• Inco),!"t" ;it.%#;! of LHinco),!"t" t#o,.y ofCo#,us Lut"u) ,"#sist"nt

s"c#"tion of


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AIMS OF INVESTIGATION

• To con0#) t." )"nst#u! $no#)!itys stt"% $y ,ti"nt

• To "+c!u%" t." syst")ic2 it#o&"nicn% o#&nic ,"!*ic ,t.o!o&y

• To i%"ntify ,ossi$!" "tio!o&y of DUB

• To ;o#>out %"0nit" t."#,y ,#otoco!

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HISTORY

13 Fi#st!y to con0#) t."$!""%in& is t.#ou&.*&in2 not t." u#"t.#o# #"ctu)3

/3 E+c"ssi*" $!""%in&ss"ss)"nt@

• Nu)$"# of ,%s us"%

•


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INTERNAL EAMINATION

• To "+c!u%" ,!,$!" ,"!*ic ,t.o!o&y3

• Bi)nu! "+)intion inc!u%in& s,"cu!u)"+)intion s.ou!% $" %on" in !! cs"s

"+c",t in *i#&ins3 – R"ct! "+)intion

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S


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S•


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43 Co!o# Do,,!"#• In "n%o)"t#i! .y,"#,!si2 ET

1/))2 .y,"#"c.oic n% #"&u!#out!in"2 n&io&"n"sis n% n"o*scu!#

si&n! stu%y83 S!in" Infusion Sono,.y 'SIS(

• To %+ "n%o)"t#i! ,o!y,s2 su$)ucous

0$#oi%s n% ut"#in" $no#)!ity's",tt"su$s",tt" ut"#us(

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53 Hyst"#osco,y•

B"tt"# "*!ution of "n%o)"t#i! !"sionn% to t>" $io,sy f#o) o"n%in& sit"3

93 En%o)"t#i! s),!in&• As out,ti"nt $sis

•


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?3 Di&nostic ut"#in" cu#"tt&" 'D C(

• Is in%ict"% in DUB

• To "+c!u%" o#&nic !"sions in"n%o)"t#iu) 'inco),!"t" $o#tion2"n%o)"t#i! ,o!y,2 tu$"#cu!#"n%o)"t#itis o# "n%o)"t#i! c#cino)(

• To %"t"#)in" function! stt" of"n%o)"t#iu)

• Inci%"nt! t."#,"utic ""ct

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M"%ic!Mn&")"nt

O#!!ycti*"

,#o&"stins

Est#o&"n

IU,#o&"sto&"n

Dno!

Mif",#iston"

GnRH&onist


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ORALLYACTIVE


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MEDICAL MANAGEMENT

ORALLY ACTIVE


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CYCLIC THERA


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• M"c.nis) H"!,s o#&ni"%"n%o)"t#i! s."%%in& u,to $s!

!y"# n% inc#"s"s "n%o)"t#i! #tioof


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ESTROGEN – in situtions ;."#" $!""%in& is cut" n% s"*"#"2

conJu&t"% "st#o&"n /5)& IV is &i*"n3• M"c.nis)s

– H"!,s ;it. #,i% o;t. of %"nu%"% "n%o)"t#iu)n% ,#o)ot"s ,!t"!"t %."si*"n"ss3

–

Cont#o!s $!""%in& $y ,#oc"ss of ."!in&3 –


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IU ,#o&"sto&"n

• *evonorgestrel intrauterine sstem 2*N$3

IU.4 in%uc" "n%o)"t#i! &!n%u!# t#o,.y2st#o)! %"ci%u!ition n% "n%o)"t#i! c"!!incti*tion3

• E"cti*" fo# 5 y"#s3• R"%uction of $!oo% !oss is u,to =73

Dno! 'synt."tic st"#oi%(

• Suit$!" in cs"s ;it. #"cu##"nt sy),to)s n%,ti"nt ;itin& fo# .yst"#"cto)y3

• Dos" *#i"s /66-866)& %i!y in 8 %i*i%"% %os"cont3 fo# 4 )ont.s3

• S)!! %os" t"n%s to )ini)i" $!oo% !oss2 .i&."#%os" ,#o%uc" )"no##."3

•

R"%uc"s $!oo% !oss $y 9673 /5


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Mif",#iston"• An nti,#o&"st"#on"3• In.i$its o*u!tion n% in%uc" )"no##."3

GnRH &onists

• Su$t."#,"utic %os"s #"%uc" $!oo% !oss2t."#,"utic %os"s ,#o%uc" )"no##."3

• V!u$!" s s.o#t-t"#) us" in s"*"#" DUB

'inf"#ti!" ;nts ,#"&nncy(3• SC o# int#ns!• I),#o*"s n")i ."!,fu! ;."n us"% $"fo#"

$!tion3

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-MANAGEMENT

– It count"#cts "n%o)"t#i! 0$#ino!ytic syst")3 – GI si%" ""cts #" co))on3

– Cn $" us"% s s"con% !in" t."#,y3

– M"f"n)ic ci% is ""cti*" in ;o)"n 45y"#s o!% n% in cs"s of o*u!to#y DUB3

–

Dos"s 156-966)& o#!!y %i*i%"% %os"s %u#in&$!""%in& ,.s"3

– NSAIDS #"%uc"s $!o%% !oss /5-8673

– I),#o*")"nt of %ys)"no##."2 ."%c." o#

nus" #" %%"% $"n"0ts3

Anti-0$#ino!ytic &"nts 'T#n"+)ic ci%(


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–

A synt."tic n!o&u" of #&inin"-*so,#"ssin

– Es,"ci!!y in%ict"% in cs"s ;it. *oni!!"$#n%s %is"s" n% fcto# VIII

%"0ci"ncy3 – Gi*"n IV 634&>& o# int#ns!!y3

D"s)o,#"ssin

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SURGICAL MANAGEMENT

• H")osttic n% t."#,"utic ""ct $y #")o*in&n"c#os"% n% un."!t.y "n%o)"t#iu)3

• Don" fo!!o;in& USG3• In%iction U#&"nt2 cyc!ic $!""%in& "n%o)"t#i!

,t.o!o&y is sus,"ct"%3

Ut"#in" cu#"tt&"

• In%ictions '( fi!"% )"%ic! t+ '$( ;o)"n ;.o %o not ;is. to ,#"s"#*"

)"nst#u! o# #",#o%ucti*" function'c( no#)! si" ut"#us'%( s)!! ut"#in" 0$#oi%s '4c)('"( ;o)"n ;.o ;nts to *oi% !on&"#

su#&"#y'f( ,#"s"#*" ut"#us

En%o)"t#i! $!tion

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• Not #"co))"n%"% s 0#st !in" t."#,y fo# ."*y

)"nst#u! $!""%in& 'HMB( o# DUB3

• In%iction ;."n cons"#*ti*" t#"t)"nt fi!s o#

cont#in%ict"%2 n% $!oo% !oss i),i#s ."!t. n%

!if" :u!ity2 ,#"s"nc" of "n%o)"t#i! .y,"#,!si

n% ty,i3

• Rout"s of ,#oc"%u#"s *&in!2 $%o)in! o#

!,#osco,ic ssist"% *&in! )"t.o% '!"ss in*si*"(

• D","n%in& on ut"#in" si"2 )o$i!ity2 %"sc"nt2

,#"*ious su#&"#y n% co#)o$i%iti"s 'o$"sity2

%i$"t"s2 ."#t %is"s" o# .y,"#t"nsion(3

Hsterectom

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REFERENCE

• Dutts T"+t$oo> of Gyn"co!o&y2 9t. E%ition

• Gyn"co!o&y $y T"n T"c."#s

• .tt,;;;3co&3o#&

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BAITI Investigation and Management