Determining causes of AUB by Clinical Diagnosis, SIS & Ultrasound Findings to Assertain PALM COEIN Status for Planning Line of Management

Abstract

Introduction: Abnormal uterine bleeding (AUB) affects about 14 to 25% of the population, with a prevalence of 17.9% in India. This condition poses an intricate gynaecological challenge for women. Across all age groups, varied diagnostic approaches are available, viz., History taking, Ultrasound examination, Saline infusion sonography with or without 3D, Hysteroscopy, MRI imaging, CT scan, and so on. All these help us ascertain the PALM COEIN of the underlying pathology. (PALM: Polyp, Adenomyosis, Leiomyoma, Malignancy) (COEIN: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not classified). This study aims to investigate the causes of menorrhagia to improve patient management according to the PALM-COEIN classification developed by the International Federation of Gynaecology and Obstetrics (FIGO).
Materials and Methods: A prospective observational study was conducted over one year at Ruxmaniben Deepchand Gardi Medical College, Ujjain, involving 151 women aged 18 to 65 years with AUB. Participants underwent comprehensive assessments, including menstrual history review, physical examinations, transvaginal ultrasound, and saline infusion sonography (SIS), with histopathological analysis performed on tissue samples.
Results: The majority of participants (48.3%) were aged 40 to 49, with 90.7% from rural areas and predominantly employed in farming (42.4%). Heavy menstrual bleeding was the most prevalent symptom (45%). Ultrasound detected normal findings in 50.3% of cases, whereas SIS revealed normal findings in 41.7%. Histological findings showed normal results in 47%, while SIS demonstrated superior diagnostic performance for detecting polyps (AUC: 0.970) and endometrial hyperplasia (AUC: 0.917) compared to transvaginal ultrasound.
Conclusion: This study highlights the superior diagnostic accuracy of SIS over ultrasound in identifying uterine pathologies associated with AUB. SIS (Saline Infusion Sonography) provides greater sensitivity and specificity, identifying key etiological factors such as polyps, submucosal fibroids, and endometrial hyperplasia. These findings propose that SIS can enhance patient management strategies and improve treatment outcomes, ultimately preserving uterine health.