Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya.
Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya.
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肯尼亚西部的一家教学和转诊医院的临床出血模式和治疗技术异常出血。
DOI：
10.1371/journal.pone.0243166
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Kirwa P
中科院分区：
文献类型：
--
作者：
Mutakha GS;Mwaliko E;Kirwa P
异常子宫出血（AUB）影响全球30%的育龄妇女。然而，对这些妇女的管理进行评估的地方研究有限。使用AUB的结构和功能原因的诊断指南采用PALM-COEIN标准，即：息肉;子宫腺肌病;平滑肌瘤;子宫内膜异位症和增生;凝血病;排卵功能障碍;子宫内膜;医源性;和尚未分类。本研究旨在确定育龄妇女AUB的临床出血模式、对PALM-COEIN诊断指南的依从性和管理。这是一项在108名年龄在18-45岁之间的AUB女性中进行的横断面研究，于2018年4月至2019年4月在肯尼亚西部Moi教学和转诊医院的妇科进行。他们的社会人口统计学和临床特征收集使用访谈管理的结构式问卷和图表审查。使用PALM COEIN分类评估对诊断建议的依从性。以95%置信区间进行描述性和推断性数据分析。中位年龄为30岁（IQR：22、41），其中长期出血是最主要的模式，占41.7%。出血模式与年龄显著相关（p = 0.04）。仅16.7%的患者符合PALM-COEIN标准，其中PALM和COEIN分别占60%和40%。子宫肌瘤（44.5%）是AUB的常见病因。实验室评价包括：妊娠试验、全血象、激素谱和活检。大多数（79.6%）的妇女做了腹盆腔超声检查。为78.7%的妇女提供了医疗管理。持续出血是最常见的模式，首选药物治疗。需要医院内算法来确保遵守PALM-COEIN指南。
Abnormal uterine bleeding (AUB) affects 30% of reproductive age women globally. However, there are limited local studies evaluating the management of these women. The diagnostic guideline using structural and functional causes of AUB adopts the PALM-COEIN criteria, namely: Polyp; Adenomyosis; Leiomyoma; Malignancy and Hyperplasia; Coagulopathy; Ovulatory dysfunction; Endometrial; Iatrogenic; and Not yet classified. This study aimed to determine the clinical bleeding patterns, adherence to PALM-COEIN diagnosis guidelines and management of AUB among women in their reproductive age. This was a cross-sectional study among 108 women with AUB aged 18–45 years was conducted at the gynaecology department of Moi Teaching and Referral Hospital in Western Kenya between April 2018 and April 2019. Their sociodemographic and clinical characteristics were collected using interviewer administered structured questionnaire and chart reviews. Adherence to diagnosis recommendations was assessed using PALM COEIN classification. Descriptive and inferential data analysis was conducted at 95% confidence interval. The median age was 30 (IQR: 22, 41) years with prolonged bleeding as the most predominant pattern at 41.7%. Bleeding patterns were significantly associated with age (p = 0.04). Only 16.7% were diagnosed as per the PALM-COEIN criteria with PALM and COEIN accounting for 60% and 40% respectively. Leiomyoma (44.5%) was the common cause of AUB. Laboratory evaluation included: pregnancy tests, full haemogram, hormonal profile and biopsy. Most (79.6%) of the women had abdominopelvic ultrasound done. Medical management was provided for 78.7% of women. Prolonged bleeding was the most common pattern with medical management preferred. There is need for in-hospital algorithms to ensure adherence to PALM-COEIN guidelines.
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