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Fertility and Sterility Jun 2011At this juncture, clinical management, education for medical providers, and the design and interpretation of clinical trials have been hampered by the absence of a...
At this juncture, clinical management, education for medical providers, and the design and interpretation of clinical trials have been hampered by the absence of a consensus system for nomenclature for the description of symptoms as well as classification of causes or potential causes of abnormal uterine bleeding (AUB). To address this issue, the Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) has designed the PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy and Hyperplasia, Coagulopathy, Ovulatory Disorders, Endometrial Disorders, Iatrogenic Causes, and Not Classified) classification system for causes of AUB in the reproductive years.
Topics: Age Factors; Aging; Female; Humans; International Agencies; Practice Guidelines as Topic; Pregnancy; Reproduction; Risk Assessment; Risk Factors; Terminology as Topic; Uterine Hemorrhage
PubMed: 21496802
DOI: 10.1016/j.fertnstert.2011.03.079 -
Ultrasound in Obstetrics & Gynecology :... Jan 2021To describe the ultrasound features of different endometrial and other intracavitary pathologies inpre- and postmenopausal women presenting with abnormal uterine... (Observational Study)
Observational Study
Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding.
OBJECTIVE
To describe the ultrasound features of different endometrial and other intracavitary pathologies inpre- and postmenopausal women presenting with abnormal uterine bleeding, using the International Endometrial Tumor Analysis (IETA) terminology.
METHODS
This was a prospective observational multicenter study of consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler and fluid-instillation sonography were performed. Endometrial sampling was performed according to each center's local protocol. The histological endpoints were cancer, atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (EIN), endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma and other. For fluid-instillation sonography, the histological endpoints were endometrial polyp, intracavitary leiomyoma and cancer. For each histological endpoint, we report typical ultrasound features using the IETA terminology.
RESULTS
The database consisted of 2856 consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler was performed in all cases and fluid-instillation sonography in 1857. In 2216 women, endometrial histology was available, and these comprised the study population. Median age was 49 years (range, 19-92 years), median parity was 2 (range, 0-10) and median body mass index was 24.9 kg/m (range, 16.0-72.1 kg/m ). Of the study population, 843 (38.0%) women were postmenopausal. Endometrial polyps were diagnosed in 751 (33.9%) women, intracavitary leiomyomas in 223 (10.1%) and endometrial cancer in 137 (6.2%). None (0% (95% CI, 0.0-5.5%)) of the 66 women with endometrial thickness < 3 mm had endometrial cancer or atypical hyperplasia/EIN. Endometrial cancer or atypical hyperplasia/EIN was found in three of 283 (1.1% (95% CI, 0.4-3.1%)) endometria with a three-layer pattern, in three of 459 (0.7% (95% CI, 0.2-1.9%)) endometria with a linear endometrial midline and in five of 337 (1.5% (95% CI, 0.6-3.4%)) cases with a single vessel without branching on unenhanced ultrasound.
CONCLUSIONS
The typical ultrasound features of endometrial cancer, polyps, hyperplasia and atrophy and intracavitary leiomyomas, are described using the IETA terminology. The detection of some easy-to-assess IETA features (i.e. endometrial thickness < 3 mm, three-layer pattern, linear midline and single vessel without branching) makes endometrial cancer unlikely. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Endometrium; Female; Humans; Middle Aged; Prospective Studies; Ultrasonography; Uterine Diseases; Uterine Hemorrhage
PubMed: 32484286
DOI: 10.1002/uog.22109 -
Biology of Reproduction Dec 2019Abnormal uterine bleeding (AUB) is an extremely common problem and represents a clinical area of unmet need. It has clinical implications and a high cost for the... (Review)
Review
Abnormal uterine bleeding (AUB) is an extremely common problem and represents a clinical area of unmet need. It has clinical implications and a high cost for the healthcare system. The PALM-COEIN acronym proposed by FIGO may be used as a foundation of care; it improves the understanding of the causes of AUB, and in doing so facilitates effective history taking, examination, investigations, and management. Heavy menstrual bleeding, a subset of AUB, is a subjective diagnosis and should be managed in the context of improving the woman's quality of life. Available evidence suggests that there is poor satisfaction with standard treatment options often resulting in women opting for major surgery such as hysterectomy. Such women would benefit from a tailored approach, both for diagnosis and treatment, highlighting the deficiency of biomarkers in this area. This article focuses on the causes of AUB as per the PALM-COEIN acronym, the researched biomarkers in this area, and the potential pathogenetic mechanisms. In the future, these approaches may improve our understanding of AUB, thereby enabling us to direct women to most suitable current treatments and tailor investigative and treatment strategies to ensure best outcomes, in keeping with the principles of personalized or precision medicine.
Topics: Adenomyosis; Anovulation; Biomarkers; Blood Coagulation Disorders; Female; Humans; Leiomyoma; Menorrhagia; Metrorrhagia; Polyps; Precision Medicine; Uterine Diseases; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 30388215
DOI: 10.1093/biolre/ioy231 -
Ginekologia Polska 2018Uterine arteriovenous malformations are uncommon but potentially life-threatening conditions. They can be congenital or acquired and should be suspected in cases of... (Review)
Review
Uterine arteriovenous malformations are uncommon but potentially life-threatening conditions. They can be congenital or acquired and should be suspected in cases of severe or persistent uterine bleeding. In recent years, there has been an in-creasing number of reports of acquired vascular lesions of the uterus following pregnancy, abortion, caesarean delivery and curettage. This paper presents the review of the literature considered epidemiology, pathophysiology, diagnostic methods and treatment options. Unexplained uterine bleeding should be always an indication for colour Doppler ultrasonography and the presence of arteriovenous malformation should be always excluded.
Topics: Arteriovenous Malformations; Female; Humans; Uterine Artery; Uterine Hemorrhage; Uterus
PubMed: 30084480
DOI: 10.5603/GP.a2018.0047 -
British Journal of Anaesthesia Dec 2009Maternal haemorrhage is the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding. This review... (Review)
Review
Maternal haemorrhage is the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding. This review highlights factors that predispose to severe bleeding, its management, and the most recent treatment and guidelines. Advances in obstetric care have provided physicians with the diagnostic tools to detect, anticipate, and prevent severe life-threatening maternal haemorrhage in most patients who have had prenatal care. In an optimal setting, patients at high risk for haemorrhage are referred to tertiary care centres where multidisciplinary teams are prepared to care for and deal with known potential complications. However, even with the best prenatal care, unexpected haemorrhage occurs. The first step in management is stabilization of haemodynamic status, which involves securing large bore i.v. access, invasive monitoring, and aggressive fluid management and transfusion therapy. Care for the patient with maternal bleeding should follow an algorithm that goes through a rapid and successive sequence of medical and surgical approaches to stem bleeding and decrease morbidity and mortality. With the addition of potent uterotonic agents and the advent of minimally invasive interventional radiological techniques such as angiographic embolization and arterial ligation, definitive yet conservative management is now possible in an attempt to avoid hysterectomy in patients with severe peripartum bleeding. If these interventions are inadequate to control the bleeding, the decision to proceed to hysterectomy must be made expeditiously. Recombinant factor VIIa is a relatively new treatment that could prove useful for severe coagulopathy and intractable bleeding.
Topics: Factor VIIa; Female; Humans; Placenta Diseases; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Recombinant Proteins; Risk Factors; Uterine Hemorrhage
PubMed: 20007990
DOI: 10.1093/bja/aep303 -
Women's Health (London, England) Nov 2016Ulipristal acetate was investigated in four phase 3 trials. In PEARL I, ulipristal produced significant normalisation of blood loss within 1 week and decreased fibroid... (Review)
Review
Ulipristal acetate was investigated in four phase 3 trials. In PEARL I, ulipristal produced significant normalisation of blood loss within 1 week and decreased fibroid volume. In PEARL II, ulipristal produced faster and more consistent control of bleeding than leuprorelin acetate and had a more favourable side-effect profile. Ulipristal-induced decreases in fibroid volume persisted for 6 months, whereas fibroids regrew after leuprorelin was stopped. PEARL III showed that ulipristal was effective during long-term treatment, with norethisterone further reducing the magnitude of bleeding in the off-treatment period. PEARL IV investigated ulipristal over four cycles, finding little difference between 5 and 10 mg ulipristal, further changes in menstruation and fibroid volume with repeat courses, and no increase in side effects.
Topics: Adult; Clinical Trials, Phase III as Topic; Contraceptive Agents, Female; Female; Humans; Leiomyoma; Menorrhagia; Norpregnadienes; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 29334010
DOI: 10.1177/1745505717692591 -
EBioMedicine Oct 2022Abnormal Uterine Bleeding (AUB) is a common debilitating condition that significantly reduces quality of life of women across the reproductive age span. AUB creates... (Review)
Review
Abnormal Uterine Bleeding (AUB) is a common debilitating condition that significantly reduces quality of life of women across the reproductive age span. AUB creates significant morbidity, medical, social, and economic problems for women, their families, workplace, and health services. Despite the profoundly negative effects of AUB on public health, advancement in understanding the pathophysiology of AUB and the discovery of novel effective therapies is slow due to lack of reliable pre-clinical models. This review discusses currently available laboratory-based pre-clinical scientific models and how they are used to study AUB. Human and animal in vitro, ex vivo, and in vivo models will be described along with advantages and limitations of each method.
Topics: Female; Humans; Quality of Life; Uterine Hemorrhage
PubMed: 36081283
DOI: 10.1016/j.ebiom.2022.104238 -
Revista Brasileira de Ginecologia E... Dec 2022
Topics: Female; Humans; Anemia, Iron-Deficiency; Uterine Diseases; Uterine Hemorrhage
PubMed: 36580944
DOI: 10.1055/s-0042-1760235 -
American Family Physician May 2020Endometrial biopsy is a safe and efficient method to evaluate the endometrium for a variety of indications, most commonly abnormal uterine bleeding and postmenopausal...
Endometrial biopsy is a safe and efficient method to evaluate the endometrium for a variety of indications, most commonly abnormal uterine bleeding and postmenopausal bleeding. Endometrial biopsy is highly specific for diagnosing atypical hyperplasia and endometrial cancer in postmenopausal women. Pregnancy is the only absolute contraindication to the procedure. The biopsy is performed with an endometrial biopsy catheter that is inserted through the cervix into the uterine cavity. The catheter's piston is then drawn out to create suction. Tissue sampling occurs by rolling the catheter while moving it in and out of the uterine cavity. Nonsteroidal anti-inflammatory drugs can be administered orally before the procedure, and topical lidocaine can be applied to the cervix before starting the procedure to reduce procedure-associated pain. A tenaculum should be applied only if required by cervical mobility or uterocervical angulation because it increases pain and lengthens procedure times. Cramping is a common adverse effect, but serious complications are rare. Patients should be referred for further evaluation if the procedure fails or an insufficient sample is obtained. Postmenopausal women and women with persistent or recurrent symptoms should receive further evaluation even when biopsy results are normal because blind sampling may miss focal lesions.
Topics: Biopsy; Endometrial Neoplasms; Endometrium; Female; Humans; Pain; Postmenopause; Pregnancy; Uterine Hemorrhage
PubMed: 32352730
DOI: No ID Found -
American Family Physician Nov 1998Peripartum emergencies occur in patients with no known risk factors. When the well-being of the fetus is in question, the fetal heart rate pattern may offer etiologic... (Review)
Review
Peripartum emergencies occur in patients with no known risk factors. When the well-being of the fetus is in question, the fetal heart rate pattern may offer etiologic clues. Repetitive late decelerations may signify uteroplacental insufficiency, and a sinusoidal pattern may indicate severe fetal distress. Repetitive variable decelerations suggesting umbilical cord compression may be relieved by amnioinfusion. Regardless of the etiology of the nonreassuring fetal heart pattern, measures to improve fetal oxygenation should be attempted while options for delivery are considered. Massive obstetric hemorrhage requires prompt action. Clinical signs, such as painless bleeding, uterine tenderness and nonreassuring fetal heart patterns, may help to differentiate causes of vaginal bleeding that may or may not require emergency cesarean delivery. The causes of postpartum hemorrhage include uterine atony, vaginal or cervical laceration, and retained placenta. The challenge of managing shoulder dystocia is to effect a rapid delivery while avoiding neonatal and maternal morbidity. The McRoberts maneuver has been shown to be the safest and most successful technique for relieving shoulder dystocia. Eclampsia responds best to magnesium sulfate, supportive care and supplemental hydralazine or labetalol as needed for severe hypertension.
Topics: Algorithms; Decision Trees; Eclampsia; Emergencies; Family Practice; Female; Fetal Distress; Humans; Obstetric Labor Complications; Pregnancy; Risk Factors; Uterine Hemorrhage
PubMed: 9824957
DOI: No ID Found