PALM-COEIN CLASSIFICATION FOR ABNORMAL UTERINE BLEEDING, A STUDY OF INDICATIONS OF HYSTERECTOMIES IN TERTIARY CARE HOSPITAL

Nazish Hayat; Laila Zeb; Sawara Gul

doi:10.46903/gjms/22.01.1568

PALM-COEIN CLASSIFICATION FOR ABNORMAL UTERINE BLEEDING, A STUDY OF INDICATIONS OF HYSTERECTOMIES IN TERTIARY CARE HOSPITAL

Nazish Hayat, Laila Zeb, Sawara Gul

Abstract

Background: One of the most commonly performed gynaecological procedure worldwide is hysterectomy. Important indication for hysterectomy is abnormal uterine bleeding. Due to common use, there has been a need to standardize causes of abnormal uterine bleeding. To fulfil the need PALM-COEIN classification has been recommended that incorporates structural and non-structural causes contributing to abnormal uterine bleeding. The objective of this study was to examine the indications for hysterectomies performed in a tertiary care hospital, using the PALM-COEIN classification

Materials & Methods: It was a retrospective observational study, carried out in Lady Reading Hospital Peshawar. Data was collected over 5 years (from 2016-2022 with two years (2020 and 2021) of Covid surge excluded). Data was collected, on specially designed proformas for all cases undergoing total abdominal hysterectomies for abnormal uterine bleeding. Obstetric and vaginal hysterectomies as well as those done for reasons other than uterine bleeding i.e large fibroids and ovarian malignancies were excluded from the study. Demographic data was noted and indications were grouped according to PALM COEIN classification and compared over the mentioned years. Data was entered and analysed using SPSS v23. Continuous variables were reported as mean and standard deviation and categorical variables as frequencies and percentages.

Results: A total of 854 cases were collected over the 5 years, with 634 hysterectomies happening from 2016 till 2019 for AUB. Mean age of study sample was 48.5 years ± 1.7. Forty Six patients (5.3%) of the total 854 cases were due to polyps (predominantly endometrial). Two hundred and twenty one cases (25.8%) were having adenomyosis. Fibroids were the most frequently detected finding, occurring in 293 (34.3%) of cases. Malignancies accounted for 54 (6.3%) of cases. Ovulatory disorders accounted for 11 (1.2%) of cases. One hundred and fifty five (18%) cases had endometrial cause. About 8.6% (n=74) of cases had no identifiable specific cause.

Conclusion: Our study demonstrates that PALM COEIN classification system can provide a suitable tool to classify women presenting with AUB.

Keywords

Abnormal uterine bleeding; PALM COEIN classification; Hysterectomy; Adenomyosis; Leiomyoma.

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DOI: https://doi.org/10.46903/gjms/22.01.1568