Aub2ACUTE ABNORMAL UTERINE BLEEDING

1. M A H M O O D A L H A D D A B I R 2
MANAGEMENT OF
ACUTE AUB

3. INTRODUCTION
• Abnormal Uterine bleeding (AUB)
bleeding from the uterus that is abnormal in:
• Regularity
• Volume
• Frequency
• Duration
In the absence of pregnancy

4. • Acute AUB ; episode of heavy bleeding that
require immediate intervention to prevent
further blood loss.
• Can be spontaneous or on top of chronic AUB.

5. APPROACH
• the general process for evaluating patients who
present with AUB:
1. Determine patient acuity.
2. Determine the most likely etiology.
3. Choosing the most appropriate treatment

6. ASSESSMENT OF THE PATIENT
• Assessment for signs of hypovolemia and vital signs.

7. ETIOLOGIES
History:
Details of the current bleeding episode + related symptoms.
Past menstrual, gynecologic and medical history.
Systemic disease such as: leukemia, liver diseases
Medications.

8. PHYSICAL EXAMINATION
Signs of hypovolemia.
Pelvic examination (speculum and bimanual)

11. TREATMENT
• to control the current episode of heavy
bleeding.
• To reduce menstrual blood loss in subsequent
cycles

12. ACUTE AUB MANAGMENT
• IV conjugated estrogen:
• In one RCT shown to stop bleeding by 72% within 8 hours
compared 38% who receive placebo.
• The only medication approved by FDA for acute AUB.
• Intrauterine tamponade :
• With 26F infused with 30 mL saline

13. • COC and oral progestins commonly used in acute
AUB.
• One study compared (TID dose for one week) COC
Vs medroxyprogestrone acetate.
• Study found bleeding stopped in 88% who took COC
compared to 76% who took medroxyprogestrone
acetate within median time of 3 days.

14. • Antifibrinolytic:
Such as Tranexamic acid.
Prevent fibrin degradation.
Effective for chronic AUB.
Reduce bleeding by 30-55%

15. LONG TERM TREATMENT FOR CHRONIC AUB
• Levonorgestrel intrauterine system.
• OCO (monthly or extended cycles).
• Progestin therapy (oral or IM)
• Tranexamic acid.
• NSAIDS

16. • Patients with known or suspected bleeding disorder
may responds to the hormonal and non-hormonal
management.
• Consultation with hematologiest is recommended.
• Desmopressin may help treat acute AUB in patients
with von Willebrand disease.

17. • Factor VIII and von Willebrand factor may reqiured
to control severe hemorrhage.
• Patients with bleeding disorders or platelet function
abnormalities should avoid NSAIDs

18. SURGICAL MANAGEMENT
• based on the clinical stability of the patient, severity of
bleeding, contra-indication to medical management.
• Includes:
• Dilation and curettage (D&C).
• Endometrial ablation.
• Uterine artery embolization.
• Hysterectomy.