Severe abdominal pain followed by a decidual cast discharge.

A 32-year-old female presented due to severe abdominal pain followed by a decidual cast discharge. Gravida 1, Para 1; reported her menses to be regular, usually 4-5 days, with heavy volume flow since menarche that occurred at age of 10. She was taking a combined oral contraceptive with Gestodene 75mcg and Ethinylestradiol 30mcg for dysmenorrhea and bleeding control. On 4th month of usage of the COC, she experienced severe abdominal cramps without relief despite the use of common analgesic lasting 2 days, followed by vaginal expulsion of a membranous elastic material similar to the uterine cavity and subsequent vaginal bleeding. She denied previous similar episodes. Except for uterine bleeding, physical and bimanual pelvic examination revealed no anomalies. Please give your opinion.

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Normal lining of endometrium under the effect of hormones become decidualised. The whole endometrium is shed in the form of uterine shape as decidual cast
Here can we go to rullout endometrial hyperplasia?
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Here can we go to rullout endometrial hyperplasia? PAP
Endometrial Necrosis. Tumor necrosis is associated with aggressive features of endometrial cancer and poor prognosis. ... CONCLUSIONS:..Findings indicate that the presence of tumor necrosis within primary tumors is associated with hypoxia, angiogenesis and inflammation responses.
- Decidual cast and hense membranous dysmenorrhea - normal phenomenon - No active measures require
Decidual cast by the effect of progesterone ( mucosal lining of uterus )
Normal decidualised endometrial cast under the influence of hormones.
Endometrial necrotic part
Endometrial Necrosis

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