Poster presented at British International Congress of Obstetrics and Gynaecology - 2007

1. Managing women with Post coital bleeding: a prospective
observational study
Fadi Alfhaily, Specialist Registrar in Obstetrics and Gynaecology1 & Ayman A. A. Ewies, Consultant Gynaecologist2
1 = Hinchingbrooke Health Care NHS Trust 2 = The Ipswich Hospital NHS Trust
Background
• Despite the well-reported association between postcoital
bleeding (PCB) and significant cervical pathology, its
significance has been underestimated by many health care
professionals.
• Further, the management in the UK is inconsistent and there is
no set of guidelines to ensure good practice.
• The Department of Health (DoH) recommended urgent referral
(within 2 weeks) for women >35 years of age with PCB >four
weeks, and early referral (within 4-6 weeks) in all other cases of
repeated unexplained PCB.1
Objectives
To identify the current practice in managing women with PCB in
a large district general hospital setting.
Methods
A prospective observational study over one year period
between September 2005 and August 2006. The details of
management of 120 women referred to The Ipswich hospital
NHS Trust were documented in a specially designed proforma.
Results
1.The demographic data of the 120 women with PCB
included in the study :
2. Type of referral:
3. Type of clinic:
4. The details of management:
5. Investigations performed:
6. The diagnostic outcome of women with PCB:
Discussion
• 53.8% of women with significant pathology were less than 35
years of age, 88.5% had PCB for more than 4 weeks, whereas
19.2% suffered severe episode. This suggests that the duration of
PCB, but not age or severity, could be an indicator of significant
pathology.
• None of the 11 women, in our series, who had cervical cancer or
CIN, had positive smear history.
• 5 % and 8.3 % of women with PCB were found to have chlamydia
and bacterial vaginosis infection, respectively, emphasizing the
importance of infection testing.
• Given the high rate of pathology in these women, we recommend
urgent referral regardless the age. Colposcopy, cervical smear
and testing for infection may be considered in all cases.
• It may be prudent to standardise the management of PCB in the
UK, and provide uniform guidelines based on the best available
evidence.
References
1. Department of Health. Referral guidelines for suspected cancer, 2000; http://www.dh.gov.uk/PublicationsAndStatistics
Age (years)
≤ 35 46 (38.3%)
>35 ≤40 14 (11.7%)
>40 60 (50%)
Median age 39
Range 19-67
Parity
P0 30 (25%)
P1 27 (22.5%)
≥P2 63 (52.5%)
Smoking
No 89 (74.2%)
Yes 27 (22.5%
No known 4 (3.3%)
15%
85%
Routine Urgent
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
GOPC
Colposcopy
GUM
Indications for referral
PCB was the main reason 63 (52.5%)
PCB was associated with IMB 49 (40.8%)
PCB discovered during taking history 8 (6.7%)
Duration of PCB
≤ 4 weeks 12 (10%)
> 4 weeks 108 (90%)
Severity of PCB
Mild (= spotting) 67 (55.8%)
Moderate (= less than a period) 34 (28.3%)
Severe (= similar or more than a period) 13 (10.8%)
Variable 6 (5%)
Result of last smear
Normal 109 (90.8%)
Inadequate 3 (2.5%)
Low grade abnormality 3 (2.5%)
Never had one 5 (4.16%)
Hormonal history
Combined oral contraceptive pill 34 (28.3%)
Progestogens 17 (14.7%)
Hormone replacement therapy 4 (3.3%)
None 65 (5.4%)
0%
5%
10%
15%
20%
25%
30%
35%
N
orm
al
EctropionCervicalpolypsA
trophic
changes
CervicitisCervicalcancer
CIN
Chlam
ydia
BV
Endom
etrialhyperplasia
Endom
etrialpolyps
Endom
etritis
Findings
%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
HVS
endocx
chlamydia
smear
colposcopy
scan
hyteroscopy
pipelle