Clinicopathological correlation of abnormal uterine bleeding according to PALM-COEIN classification in reproductive age group in a tertiary care center, North India
Keywords:Abnormal uterine bleeding, FIGO, Menorrhagia, PALM-COEIN, Perimenopause
Background: AUB is a common problem encountered by women of reproductive age group with increased risk during perimenopausal period. International Federation of Gynecology and Obstetrics (FIGO) has designed a new classification system PALM-COEIN in order to standardize the causes of AUB. Aims and Objectives were to stratify causes of AUB in women of reproductive age group in context to PALM-COEIN classification system. To establish a clinico-pathological correlation among causes of AUB taking aid of radiology wherever required.
Methods: All women of reproductive age group presenting with complaints of AUB in department of gynecology from January 2018 to December 2021 were included in the study. The cause were classified based on PALM-COEIN classification both clinically and histopathologically. Radiological investigation was carried out wherever required.
Results: Total 560 women of reproductive age group were registered. Majority 321 (57.32%) women were between 41-50 years of age and commonest complaint was heavy menstrual bleeding in 401 (71.60%). PALM and COEIN groups accounted for 40% and 60% respectively. Among structural causes, leiomyoma was the commonest cause 153 (27.32%) of AUB whereas among the functional causes most common was endometrial 188 (33.57%). The clinico-histopathological correlation was statistically significant in cases of AUB-P, AUB-A, AUB-O and AUB-E.
Conclusions: The PALM-COEIN classification system helps to understand the causes of AUB and gives simpler terminology, diagnosis and investigations of the causes of AUB and offers better patient management. It can provide better means of quality assurance and appropriateness of treatment.
Singh K, Agarwal C, Pujani M, Raychaudhuri S, Sharma N, Chauhan V, et al. A clinicopathological correlation of international federation of gynecology and obstetrics’s PALM-COEIN classification of abnormal uterine bleeding: Indian scenario. J Mid-Life Health. 2019;10(3):147.
Jahan I, Rumana R, Munni N. Spectrum of clinico-pathological correlation of abnormal uterine bleeding cases in a tertiary care hospital. Surg Res. 2020;2(1):1-5.
Bahamondes L, Ali M. Recent advances in managing and understanding menstrual disorders. F1000Prime Rep. 2015;7:33.
Inal ZO, Inal HA, Kucukosmanoglu I, Kucukkendirci H. Assessment of endometrial sampling and histopathological results: Analysis of 4,247 cases. Eurasian J Med. 2017;49:44-7.
Munro MG, Critchley HO, Fraser IS. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? Am J Obstet Gynecol. 2012;207:259-65.
Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet. 2011;113(1):3-13.
Kelekci S, Kaya E, Alan M, Alan Y, Bilge U, Mollamahmutoglu L. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertil Steril. 2005;84(3):682-6.
Guido RS, Shakir AK, Rulin MC, Christopherson WA. Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. J Reprod Med. 1995;40:553-5.
Mishra D, Sultan S. FIGO’s PALM-COEIN classification of abnormal uterine bleeding: a clinico-histopathological correlation in Indian setting. J Obstet Gynecol India. 2017;67(2):119-25.
Goel P, Rathore SB. PALM-COEIN FIGO classification for diagnosis of Abnormal Uterine Bleeding: Practical utility of same at tertiary care centre in North India. Sch J Appl Med Sci. 2016;4:2771-3.
Gouri SR, Lakshmi PV, Rani NG, Kumar NA. Categorization of the causes of Abnormal Uterine Bleeding according to PALM-COEIN classification. Int J Sci Stud. 2016;4:104-6.
Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynecol. 2016;34:54-65.
Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle aged women with atypical uterine bleeding: A study of 219 cases. J Midlife Health. 2013;4:216-20.
Shukla M, Fonseca MN, Kharat D, Tekale P. A study to correlate histopathological findings in patients with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2017;6:654-7.
Qureshi FU, Yusuf AW. Distribution of causes of AUB using the new FIGO classification system. J Pak Med Assoc. 2013;63:974.
Praveen S, Perveen S. Endometrium histology in abnormal uterine bleeding. Q Med Channel. 2011;17(4):68-70.
McPherson K, Herbert A, Judge A, Clarke A, Bridgman S, Maresh M, et al. Psychosexual health 5 years after hysterectomy: population‐based comparison with endometrial ablation for dysfunctional uterine bleeding. Health Expect. 2005;8(3):234-43.
Khan S, Hameed S, Umber A. Histopathological pattern of endometrium on diagnostic D and C in patients with abnormal uterine bleeding. Annals. 2011;17(2):166-70.
Doraiswami S, Johnson T, Rao S, Rajkumar A, Vijayaraghavan J, Panicker VK. Study of endometrial pathology in abnormal uterine bleeding. J Obstet Gynaecol India. 2011;61(4):426-30.
Prajapati R, Daveshwar MR. A clinic pathological correlation of endometrial pattern in patients with abnormal uterine bleeding (Aub). Int J Res Med. 2015;4:128 32.
Khare A, Bansal S, Sharma P, Elhence N, Makkar N, Tyagi Y. Morphological spectrum of endometrium in patients presenting with dysfunctional uterine bleeding. Peoples J Sci Res. 2012;5:13-6.
Munro MG, Broder M, Critchley HO, Matteson K, Haththotuwa R, Fraser IS. An international response to questions about terminologies, investigation, and management of abnormal uterine bleeding: Use of an electronic audience response system. Semin Reprod Med. 2011;29:436-45.
Ahmed SB, Mogri S. Application of PALM-COEIN FIGO classification in diagnosis of abnormal uterine bleeding (AUB) patients. Indian Journal of Obstetrics and Gynecology Research. 2018;5(2):278-81.
Betha K, Malvatu L, Talasani S. Distribution of causes of abnormal uterine bleeding using new FIGO classification system-PALM COEIN: a rural tertiary-based study. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3523-7.
Sudha R, Pallavi YR. Distribution of causes of abnormal uterine bleeding according to polyp adenomyosis leiomyoma malignancy and hyperplasia coagulopathy ovulatory dysfunction endometrial iatrogenic not yet classified classifiction in a tertiary care centre. Int J Scient Stud. 2017;4(10).
Parulekar SV. Critical evaluation of PALM-COEIN classification. JPGO. 2016;3.
Jayasundara DMCS, Gunasena GG. A clinical utility of PALMCOEIN classification for abnormal uterine bleeding. Sri Lanka J Obstet Gynecol. 2017;39:49-52.