Applicability of PALM-COEIN Classification for Categorization of Abnormal Uterine Bleeding: A Clinico-Confirmatory Comparison in Women from South India

Abstract

Objective: To categorize the causes of abnormal uterine bleeding(AUB) using PALM-COEIN classification and to compare the structural causes (PALM) with histopathological examination and non-structural causes (COEIN) with appropriate laboratory testing and histopathological examination.

Design: A prospective observational study

Setting: All women with AUB attending the gynaecology outpatient department at southern railway headquarters hospital, Chennai from June 2017 to May 2019.

Methods: All 205 women included in this study were categorized clinically using the PALM-COEIN classification with the help of history, clinical examination and imaging. It was followed by appropriate laboratory testing and histopathological examination to obtain the confirmatory diagnosis. The clinical and confirmatory diagnosis were compared using chi-square test.

Main outcome measures: clinically diagnosed causes of AUB compared with confirmatory diagnosis.

Results: In clinical diagnosis, leiomyoma (38%, n=78) was the most common cause   followed by ovulatory dysfunction (27.32%, n=56), but in the confirmatory diagnosis, adenomyosis (46.83%, n=96) contribute to most of the cases as it was underdiagnosed in 55 patients. The test was statistically significant (p≤ 0.05) in the category of adenomyosis (p<0.001) and malignancy& endometrial hyperplasia(p=0.04), as histopathological examination could diagnose more cases.

Conclusion: PALM-COEIN classification helps in diagnosing all possible etiologies of AUB in a woman clinically. Consideration of laboratory testing and histopathological examination will establish a more accurate and consistent diagnosis.