Abnormal uterine bleeding

Т. Ф Татарчук, Н. В. Косей, О. В. Занько, Н. В. Яроцька

Abstract


The article describes a clinical case of severe uterine bleeding in a patient with III degree of mitral valve insufficiency after mitral valve replacement, which was placed a clinical diagnosis of abnormal uterine bleeding (AUB). Given the categorical refusal of the patient and her relatives from holding hysteroscopy the conservative haemostatic therapy was appointed.

In view of the congenital heart disease and the risks of thrombotic complications the oral contraceptive for patient was contraindicated. Therefore, for the treatment was selected the drug of tranexamic acid Vidanol at dose of 1.5 g every 8 hours for 5 days, as well as non-steroidal anti-inflammatory drug diclofenac sodium in rectal suppositories of 100 mg over 5 days. Considering the moderate secondary anemia and the severity of clinical symptoms, for patient was also appointed anti-anemia drug Ferinzhekt at a dose of 1000 mg intravenously once, followed by the appointment after 1 week Maltofer on 1 tablet 3 times a day for a month.

During the first 12 hours of treatment with the combination Vidanol +diclofenac sodium was observed a decrease in the volume of blood loss of patient, the decrease of intensity of pain, and improvement in overall condition. Against the background stabilization of the general condition of the patient under ultrasound was performed the dissection and separation of intrauterine adhesions, which were detected during diagnostic hysteroscopy. In order to prevent recurrence of occurrence of this disease was introduced anti-adhesion gel Defensal in the uterus. Postoperatively, the patient also received antibiotic prophylaxis and complex of anti-inflammatory therapy.

In the next two menstrual cycles in order to prevent of AUB the patient took from 1 to 5 day of menstruation on 500 mg of Vidanol 3 times a day, as well as suppositories diclofenac sodium one day before the onset of menstruation and within 5 days of the cycle. After 2 months at the time of the next menstruation for woman was set intrauterine system (IUS), which releasing daily 13.5 mg of levonorgestrel. At the control examination 3 months after IUS installation the patient was no complaints, no bleedings and pain, and her general condition was improved.

This clinical case is an example of an effective and safe treatment for severe AUB for patient of reproductive age with severe somatic pathology. Appointment of tranexamic acid in combination with nonsteroidal anti-inflammatory drugs and anti-anemia therapy is effective in the treatment of AUB and can be used for the prevention of uterine bleeding.


Keywords


clinical case; abnormal uterine bleeding; failure of the mitral valve; tranexamic acid; Vidanol; diclofenac sodium; Ferinzhekt; Maltofer

References


Order of the MOH of Ukraine from 13.04.2016 N 353. “About approval and introduction of medical and technological documents for standardization of medical care in abnormal uterine bleedings.”

Association of Gynecologist and Endocrinologist of Ukraine. “National consensus of management patients with abnormal uterine bleeding.” Reproductive Endocrinology 1 (2015): 7–12.

Gultekin, M., Diribas, K., Buru, E., Gökceoglu, M.A. “Role of a non-hormonal oral anti-fibrinolytic hemostatic agent (tranexamic acid) for management of patients with dysfunctional uterine bleeding.” Clin Exp Obstet Gynecol 36.3 (2009): 163.

Henry, D.A., Carles, P.A., Moxey, A., et al. “Antifibrinolytic use for minimising perioperative allogenic blood transfusion.” Cochrane Database Syst Review (2007): Issue 4.

Ali, A., Sumbul, S., Shaista, R., Syed, T. “Impact of tranexamic acid on quality of life in women with heavy menstrual bleeding.” Pak J Surg 32.1 (2016): 44–8.

Srivaths, L.V., Dietrich, J.E., Yee, D.L., et al. “Oral tranexamic acid versus combined oral contraceptives for adolescent heavy menstrual bleeding: a pilot study.” J Pediatr Adolescent Gynecol 28 (2015): 254–7.

Hodgson, S., Larvin, J.T., Dearman, Ch. “What dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery?” Interact Cardio Vasc Thorac Surg 21.3 (2015)): 384–8.

Danielson, B.G. “Structure, chemistry, and pharmacokinetics of intravenous iron agents.” J Am Soc Nephrol 15.2 (2004): 93–8.

Bonnar, J., Sheppard, B.L. “Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid.” BMJ 313 (1996): 579.


GOST Style Citations


1. Наказ МОЗ України № 353 від 13.04.2016 р. «Про затвердження та впровадження медико-технологічних документів зі стандартизації медичної допомоги при аномальних маткових кровотечах».

2. Асоціація гінекологів-ендокринологів України. Національний консенсус щодо ведення пацієнток із аномальними матковими кровотечами / Репродуктивна ендокринологія. – 2015. – № 1. – С. 7–12.

3. Gultekin, M., Diribas, K., Buru, E., Gökceoglu, M.A. “Role of a non-hormonal oral anti-fibrinolytic hemostatic agent (tranexamic acid) for management of patients with dysfunctional uterine bleeding.” Clin Exp Obstet Gynecol 36.3 (2009): 163.

4. Henry, D.A., Carles, P.A., Moxey, A., et al. “Antifibrinolytic use for minimising perioperative allogenic blood transfusion.” Cochrane Database Syst Review (2007): Issue 4.

5. Ali, A., Sumbul, S., Shaista, R., Syed, T. “Impact of tranexamic acid on quality of life in women with heavy menstrual bleeding.” Pak J Surg 32.1 (2016): 44–8.

6. Srivaths, L.V., Dietrich, J.E., Yee, D.L., et al. “Oral tranexamic acid versus combined oral contraceptives for adolescent heavy menstrual bleeding: a pilot study.” J Pediatr Adolescent Gynecol 28 (2015): 254–7.

7. Hodgson, S., Larvin, J.T., Dearman, Ch. “What dose of tranexamic acid is most effective and safe for adult patients undergoing cardiac surgery?” Interact Cardio Vasc Thorac Surg 21.3 (2015)): 384–8.

8. Danielson, B.G. “Structure, chemistry, and pharmacokinetics of intravenous iron agents.” J Am Soc Nephrol 15.2 (2004): 93–8.

9. Bonnar, J., Sheppard, B.L. “Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid.” BMJ 313 (1996): 579.





DOI: http://dx.doi.org/10.18370/2309-4117.2016.31.103-106

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ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)