Palm-coein classification of abnormal uterine bleeding and clinicohistopathological correlation

Background: The aim was to categorize women with AUB as per the PALM-COEIN classification system as this is a step towards cause based diagnosis and focused management of patients. The acronym PALM-COEIN comes from arranging basic categories of the classification system. The PALM group comprises the structural entities, which can be measured visually or by using imaging techniques and histopathology. The COEIN group comprises the non- organic types which cannot be defined by imaging or histopathology.Methods: The study comprised 350 women of reproductive age with AUB for minimum 3 month time span. It describes and observes AUB in amount, interval and frequency for women attending out-patient Gynaecology department of C. U. Shah Medical College and Hospital, Surendranagar (Gujrat) over a period of 1year from November 17 to October 18. They were assessed on the basis of structured history, physical examination, local pelvis examination, investigations, USG findings and endometrial histopathological report. Cause of AUB was determined and treatment was given to the patient as appropriated by categorization done in agreement with the PALM-COEIN classification.Results: The most prevalent cause of AUB was ovulatory dysfunction (n=99, 28.2%). Next common cause was leiomyoma (n=90, 25.7%), followed by endometrial causes (n=52, 14.5%), adenomyosis (n=30, 8.5%) not yet classified (n=32, 9.7%), malignancy and hyperplasia (n=28, 8.1%), polyp (n=9, 2.5%), iatrogenic (n=7, 2.2%) and coagulopathy (n=1, 0.3%).Conclusions: The PALM-COEIN classification helps to practically as certain because of AUB, and there by effectively adopt the correct treatment for AUB patients

A case report on ruptured rudimentary horn ectopic pregnancy

Unicornuate uterus with noncommunicating rudimentary horn occurs due to incomplete fusion of mullerian ducts. This malformation results from the defective fusion of the duct with the contra-lateral side. This rudimentary horn may or may not have functional cavity. Pregnancy in this horn is a rare phenomenon usually resulting in rupture during second trimester of pregnancy. IT is a rare condition that can lead to a catastrophic outcome when it rupture. Prerupture diagnosis of pregnancy in rudimentary horn with ultrasonography is technically difficult, with sensitivity of 30%. Pregnant rudimentary horn can present with wide range of symptoms that may be similar to ectopic pregnancy or may remain silent with features of normal pregnancy.1-2 We report a case of ruptured non-communicating rudimentary horn at 19 weeks in pregnant lady. In our opinion, routine excision of rudimentary horn should be undertaken during non-pregnant state laparoscopically. However, those women who refuse should be adequately counselled regarding potential complications and if pregnancy occurs in rudimentary horn, first trimester laparoscopic excision should be done