This essay will focus on a 40-year-old female teacher who presented to the emergency room complaining of heavy bleeding for over six months throughout her menstrual cycle. The patient's method of contraception is condoms. Six months ago, the patient was normal until she became long and bled heavily for an average of six months. She used to use less than two pads every day, but now she uses more than four. Her medical chart revealed no history of pain while bleeding, no complaints of pain, white discharge PV, or pain during coitus. There is no history of IUCD or OCP use. Absence of any bleeding disorders was present on her chart. No mass on her abdomen was detected and a laparoscopic tubectomy was performed six years ago. TB history was absent. No history of intake of any drugs other than toxin and anemia in the family is also absent.
The patient started her period while she was 13 years and has a monthly cycle of 28 days. She has been married for ten years to Mr. Mark Warner, and they have three children. The patient also says she had an abortion while she was16 years old. There is no medical history of cervical cancer in her family, no history of excessive bleeding and also no history of TB.The patient has ever suffered from diseases such as asthma, epilepsy, and TB.The patient had no medical history of the cardiac disease. The patient is very healthy. She says she eats a balanced diet, sleeps well, exercises each morning a good appetite and her bowel and bladder are normal. An RS, CVs, CNs regular examinations were conducted on her. Her physical appearance seems to be fine since she is sitting upright she is alert, conscious and cooperative. Lab tests were done later on. Abdominal, palpation and percussion tests were also performed, and a provisional diagnosis was found claiming she had Dysfunctioning Uterine Bleeding (DUB).A treatment method was administered where she was givenNSAIDs and tranexamic acid drugs which reduce bleeding. The patient was advised to keep a calendar of her menstrual cycle, and a follow-up care given to her was to take iron supplement drugs to avoid anemia and to take contraceptives to reduce bleeding.
Lastly, a patient assessment was conducted to determine the first evaluation that is needed for a patient with acute AUB includes the following; a quick assessment for signs of potential hemodynamic and hypovolemia instability. If the patient is hemodynamically unbalanced or has symptoms of hypovolemia, intravenous admission directly with a syringe on the veins but the single is important to be started rapidly as should the and clotting factor replacements and the preparation for blood transfusion. For the most proper and accurate treatment management selected, the first stabilization and assessment method to be used as the next step is to assess for the most likely etiology of acute AUB.
INTRODUCTION
Women gynecological health is the study of the female reproductive system. There are many issues women face in the reproduction department from birth to diseases that may affect the reproductive health. This essay will mainly focus on a patient called Grace Warner who came in with a complaint of prolonged and excessive bleeding for almost six months. Her history will be looked at from family, medical to personal history to determine the cause of the problem she is undergoing, and also further tests will be conducted to determine the diseases she is suffering from.
Name: Grace Warner
Age: 40
Race/Ethnicity: Caucasian
Occupation: Teacher
Admission Date: 19/2/2017
Partner’s Name: Mark Warner
Age: 45
Race/Ethnicity: Caucasian
Occupation: Lawyer
Date of Examination: 19/2/2017
Current Health Status; Persistent &and excessive bleeding from the vagina during menses for almost six months.
Contraception Method: The patient uses condoms.
Sexual activity status; the patient is sexually active with her partner.
Satisfaction with sexual relation; Yes
Medical History
The patient bled excessively for an average of six months. She used less than two pads per day but now uses more than four in a day
No history of missed periods before this episode. (metriopatheia hemorrhagic)
No history of pain during bleeding. (anovulatory cycle, endometriosis)
Pain, white discharge PV or pain during coitus is absent. (PID)
No history of use of IUCD or OCP.
Absence of any bleeding disorders. No mass on her abdomen. (Fibroid Uterus)
. laparoscopic tubectomy was undergone six years ago (post ligation syndrome)
TB history absent
No history of intake of any drugs other than toxic. (secondary to drugs)
Anemia in the family is absent. (anemia)
No history of sexually transmitted infections and sexually transmitted diseases
Psychological and Mental health; the patient is psychologically fine as tested by the psychiatrist.
Medications; the patient claims to be using only pain killers for headaches acquired at the pharmacy.
Health maintenance/screenings, including results of patient’s last Pap and mammogram is appropriate, as well as previous vaccinations (HPV, MMR, hepatitis B, last DT, and pneumovax/influenza medical records are appropriate
Menstrual History
Age of Menstrual cycle – 13 years of past Cycles – A regular 28 days cycles with three days flow, no pain or passage of lumps.LMP – 27/01/2015
The patient is also a multipara
History with Obstetric
Married for – 10 years
1st child – 12 years male Immunized. The pregnancy was full term 36 weeks. No complications.
2nd child – 8 years female Immunized. The Pregnancy was also a full term pregnancy.36 weeks no complication,
3rd child – 5 years male Immunized. There was a complication with the pregnancy where by their was a premature rapture of the membrane (PROM). Forcing the baby to be born at 33 weeks.
The patient had an abortion when she was 16 years old.Her last delivery was five years back.
Family History
No medical history of cervical cancer among mother or sister.
No medical history of bleeding disorders among other family members.
No history medical history of exposure to TB.
Past History
.Thyroidectomy was performed six years ago on the patient.
No history of, Tuberculosis, Epilepsy or Asthma.
No history is suggestive of heart disease.
No treatment is taken for excess bleeding on the vagina
Personal/Social History
Appetite – Good
Balanced mixture of food
Good sleep
Bladder &Bowel – Regular
The patient wakes up every morning at 6 A.M to run for an hour before her daily routine.
Systemic Examination
RS – NVBS heard no basal crypts.
CVS – S1 S2 heard, No murmurs.
CNS – NAD.
General Physical Examination
The patient is about 40 years old lady, discreetly built and fed, aware, & compliant, sitting comfortably on the bed.
Lab Test
Pulse – 94/min, steady, good volume
BP – 127/150 mm of Hg
Temperature – Afebrile
RR – 16/min, regular
Cyanosis – Absent
Paleness – Present
Icterus – Absent
Bashing – Absent
Lymphadenopathy – Absent
Thyroid – Scar over thyroid region present, no palpable gland.
Spine – Ordinary
Edema – Lacking
Breasts – Usual
ABDOMINAL EXAMINATION
Inspection:
Umbilicus appears healthy
Shape of abdomen – regular
The respiration movement was quadrant and correct.
No visible mass, sinuses ,dilated veins or scars
Hernia orifices – regular
No noticeable pulsations or peristalsis.
Stretch marks were present in her body
Palpation:
No tenderness and local rise in the temperature
No organomegaly.
Palpable mass was absent
Percussion
Fluids in the abdomen was absent
No note of the Tympanic
Auscultation:
The sound in her stomach-Present.
(I would like to do bimanual examination, a vaginal and per speculum and to approve my diagnosis)
Diagnosis
36 yrs. old P4L4 (in the reproductive age group) with DUB
An Accurate Clinical Screening test for an Underlying Disorder of in the Patient with AUB
Initially, the screening test for an original disorder of patients with AUB also known as excessive menstrual bleeding should be organized by the medical examination history. A confident lab test result comprises of the following;
Some of the conditions include;
Heavy menstrual cycle
Surgery-related bleeding
Bleeding related with dental work
Postpartum hemorrhage
Nose bleeding occurs once or twice in a month.
Family history of bleeding symptom
experience of frequent gum bleeding
Patient Assessment with Acute Abnormal Uterine Bleeding
The first evaluation that is needed for a patient with acute AUB includes the following; a quick assessment for signs of potential hemodynamic and hypovolemia instability. If the patient is hemodynamically unbalanced or has symptoms of hypovolemia, intravenous admission directly with a syringe on the veins but the single is important to be started rapidly as should the and clotting factor replacements and the preparation for blood transfusion. For the most proper and accurate treatment management selected, the first stabilization and assessment method to be used as the next step is to assess for the most likely etiology of acute AUB (Brigham, 2017).
Treatment
Dysfunctional uterine bleeding also known as abnormal uterine bleeding is the abnormal menstrual bleeding without any general medical disease or pregnancy that disrupts the endless menstrual cycle (Agarwal, 2017). Pregnancy is usually the common cause of uterine bleeding, and the others include; fibroids, cervical cancer and thyroid problems of which it is a rare case.Non-hormonal treatments have fewer risks compared to hormonal treatment therapy, which can be administered intermittently when bleeding occurs. The treatment choices usually offered for regular heavy bleeding includes;
NSAIDs which reduces bleeding by 25-35% also relieving dysmenorrhea by reducing the levels of prostaglandin.
Tranexamic acid, a drug used as a plasminogen activator reducing menstrual blood flow by 40-60%.
Hormonal therapy is usually given when the bleeding has been controlled after a few months. Being overweight is one of the causes of dysfunctional uterine bleeding. Eating a balanced diet and exercising is the most preventive solution (Brigham, 2017).
Patient Education
Instruct the patient and her caregivers about the normal menstrual cycle and the beginning nature of DUB. The patient is recommended to be recording a calendar history of her menstrual cycles, noting the start and end dates of bleeding. Advise the patient to return if bleeding is recurring or does not respond to medical therapy (Schuiling & Likis, 2013).
Management plan
The first line of medical rehabilitation for women suffering from AUB minor bleeding disorder without any reason known is called hormonal management. The treatment method options accessible include combined oral contraceptives (OCs), IV conjugated equine estrogen and oral progestins. In one of the random controlled trial conducted of 34 women, compared with 38% of participants treated with a placebo, the administration of IV clotted the blood of about 60% of participants patients within hours after it was taken patients with cardiovascular or thromboembolic risk factor showed signs of slight data change .Concerning the use of IV estrogen in Acute AUB, a combination of OCs and oral progestins is administered at a high level dosage also are frequently used in hospitals. A study comparing participants who had therapy administered with OCs their recovery was faster compared to the patients administered with medroxyprogesterone. Excessive bleeding stopped in patients who administered OCs was an average of 80% of the of females who administered medroxyprogesterone acetate 3 times daily. The Centers for Disease Control and Prevention’s in hand with World Health Organization assist with the medical care of patients eligible for contraceptive use. This information is helpful in determining whether the patient possibly will be treated with OCs or progestin only. Other OC and progestin preparations and dose timetables may be similarly effective (Agarwal, 2017).
For patients with chronic AUB tranexamic acid, Antifibrinolytic are real medical treatments drugs, working by stopping fibrin degradation bleeding in these patients have been shown to reduce by a percentage of 30–55%. Although it has not been studied for this indication Tranexamic acid competently reduces excessive bleeding. The importance of surgical transfusion in patients is very likely actual for patients with acute AUB. Recommend experts’ advice using either IV tranexamic acid oral treatment for patients suffering from acute AUB.
Surgical Management
The need for surgical action is based on the severity of bleeding, the underlying medical condition of the patient, clinical stability of the patient lack of reply to medical organization, and contraindications to medical management by the patient. Surgical options include uterine artery embolization, hysterectomy, endometrial ablation and dilation and curettage (D&C). The choice of surgical modality an example of (D&C versus hysterectomy) is grounded on the above-mentioned factors. In addition to the patient’s wish for future parenting abilities, exact treatments with hysteroscopy and D&C, polypectomy, or myomectomy, may be compulsory if physical abnormalities are a suspicious cause for acute AUB. Curettage and dilation alone (without hysteroscopy) is an insufficient tool for evaluation of uterine disorders and may offer only a temporary decrease in bleeding (the cycles after the D&C), will not be improved. Suspected patients with infections in their uterine walls, a sample may be required for further examination for curettage and dilation with associated hysteroscopy may be of value for them. Study conducted through these tests indicates that. Although readily available drugs in most centers, endometrial ablation, should be considered only if other treatments have been contraindicated or have been ineffective. It should be when the possibility of endometrial or uterine cancer has been consistently ruled out as the source of the acute AUB is done, only when a woman does not have plans for future childbearing and hysterectomy, as the final treatment for nursing heavy bleeding. It may be essential for patients who do not answer to medical treatment (Schuiling & Likis, 2013).
Follow-Up-Care
Iron supplements should be offered 2-3 times daily to the patient to avoid mild anemia.
Oral contraceptive pills should be offered for the cycle control.
In conclusion, Dysfunctioning Uterine Bleeding is a medical condition that is caused by fibroids, pregnancy or cervical cancer. The medical procedure to go about it is to seek treatment at the hospital where drugs such as NSAIDs and tranexamic acid will be given to the patient, and further medical assistance will be given for treatment.
References
Agarwal, K. (2017). Abnormal Uterine Bleeding. Evidence-Based Clinical Gynecology, 101.
Brigham, K. S. (2017). Abnormal Vaginal Bleeding. In The MassGeneral Hospital for Children Adolescent Medicine Handbook (pp. 153-158). Springer International Publishing.
Schuiling, K. D., & Likis, F. E. (2013). Women's Gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.
