AUB case presentation
Dr. Tejaswini J
Dr. Poornima R S
General Hospital Jaynagar
Bangalore
• Name -Mrs X
• Age – 38yrs
• Address – Devarachikanahalli Bangalore
Karnataka
• Occupation – Clerk in a dental clinic
• Marital status – Married ML – 16yrs Non consanguineous marriage
• Husband’s name – Mr. Y
• Husband’s occupation – fruit vendor
• Socio economic status – lower middle class
• Religion – Hindu
• Parity – para 2 living 2
• Date of admission – 5/5/23
• Date of examination – 6/5/23
• Chief complaints –c/o heavy menstrual bleeding
since 6 months.
• History of present illness – Patient was apparently alright 6
months back Later she developed heavy menstrual bleeding
since 6 months lasting for 8 days in a cycle . Her cycles were
regular 24-30 days cycle and she changed 6-8 pads per
day ,she also gives history of changing pads in the
night ,passage of clots measuring about a coin size ,
associated with squeezing type of pain in the lower
abdomen after the onset of menstruation, this pain
subsided after few hours after the onset
This was associated with easy fatigability and tiredness. .She
was on medical line of management for the above mentioned
complaints but her symptoms did not subside .No intrauterine
device was inserted. Patient was not investigated further . Now
she has come to us for further management
No history of dyspareunia , white discharge per vagina ,
intermenstrual bleeding , post coital bleeding , mass per
abdomen , mass per vagina, amenorrhoea followed by bleeding.
• No history suggestive of pressure symptoms like increased
frequency ,urgency of urination or bowel symptoms ,hair
loss ,weight gain , lethargy , palpitation , tremors , loss of
appetite , weight loss , excessive facial hair , acne , intake
of long-term medications , bleeding gums , easy bruisability
,epistaxis ,swelling of knees.
• Menstrual history
Age of menarche – 14 years
Last menstrual period – 15/4/2023
Previous cycles – Regular cycles /24-25days cycle/4-5
days / 3-4pads per day / no clots / dysmenorrhoea +
Present cycles – Regular cycles /24-30 days cycle /7-
8days /6-8pads per day/clots + / dysmenorrhoea +
Obstetric history
Para 2 Living 2
Full term normal vaginal deliveries
Last child birth – 14 yrs back
• She underwent post partum sterilization after 1
month
• Past history
No history of diabetes mellitus ,hypertension ,
tuberculosis ,epilepsy , bronchial asthma
No history of surgeries in the past
No history of blood transfusion in the past
• Family history
No similar complaints in the family
No history of gynaecological malignancies in the family
Marital history / sexual history
Married for 16years , non consanguineous marriage
Sexually active
Personal history
Bowel – Regular Bladder – regular , no urinary
disturbances
Sleep – adequate Diet – mixed
Appetite – good ,No habits , not on any regular
medications like anti- epileptics,anti depressants , anti-
coagulants ,NSAIDs
SUMMARY
• Mrs X aged 38yrs clerk by occupation coming from low socio-
economic status admitted with history of heavy menstrual bleeding
since 6months . Her last menstrual period was 15/4 /23 ,periods are
regular but persisting for 8 days occuring in 21-25days interval . No
significant negative history , family history and past history .Most
probably this is a case of AUB (L)
AUB (A)
AUB (M)
• General physical examination
Patient is conscious, alert and co operative
Moderately built and nourished
Height – 167cms
Weight – 80kgs
BMI – 28.7kg/m2
Spine , thyroid and B/L breast appear normal
Pallor – (+)
Icterus – (-)
Cyanosis – (-)
Clubbing – (-)
Lymphadenopathy - (-)
Edema –(-)
• Pulse rate – 98beats per minute
• Blood pressure – 120/70mmHg
• Respiratory rate – 16cycles per minute
• Temperature – 37°c
Systemic examination
• Respiratory system – Bilateral normal vesicular breath
sounds heard
• Cardiovascular system – S1 and S2 heard , no murmurs
• Central nervous system – conscious, oriented ,higher mental
functions are normal
Per abdomen examination
Inspection –All quadrants of abdomen move equally
with respiration umbilicus is central inverted ,no visible
sinuses , pulsations ,engorged veins
A transverse suprapubic scar measuring about 2cms
seen healed by primary intention
All hernial orifices are intact and normal
Palpation – All inspectory findings confirmed. In the
hypogastric region ,uniformly enlarged mass with a
smooth surface measuring about 16 weeks size gravid
uterus having well defined margins on all sides except
lower margin ,firm in consistency , mobile from side
to side , non – tender.
• Percussion
Dull note over the mass , no free fluid in abdomen
• Auscultation
bowel sounds heard
Local examination
Inspection – Vulva and vagina appear normal
Per speculum examination – Vagina healthy ,cervix
posterior and healthy ,no visible mass , no descent
Bimanual examination - Uterus – mobile ,around -16
weeks size ,all fornices free , no fornicial tenderness ,
no cervical motion tenderness
• Per rectal examination – unremarkable
Summary
• Mrs X aged 38yrs clerk by occupation coming from low
socio-economic status admitted with history of heavy
menstrual bleeding since 6months . Her last menstrual
period was 15/4 /23 ,periods are regular but persisting
for 8 days occuring in 21-25days interval .
• On examination vitals stable and she appears anaemic
On abdominal examination there was a lower abdominal
swelling ,situated midline ,almost globular ,firm in
consistency , margins are well defined except lower
margin which could not be reached ,surface is smooth,
dull on percussion
Bimanual examination shows a pelviabdominal mass
seems to be arisen from the uterus about 16weeks size
gravid uterus
Provisional diagnosis
Mrs.X 38yrs old P2L2 with anaemia with probably
AUB(L)
THANK YOU
