Abnormal Uterine Bleeding

Abnormal uterine bleeding can be defined as dysfunctional, but before this diagnosis is made, pregnancy, inflammation and neoplasm must be excluded. Complete physical examination, thorough history, and blood count are important diagnostic measures. Management by curettage and hormonal therapy is geared to control excessive bleeding and establish cyclicity.     

Evaluation and Management of Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) is a common condition that leads to increased health care costs and decreased quality of life. A systematic approach to AUB evaluation can simplify management and enhance women’s well-being. Abnormal uterine bleeding describes any variation from normal bleeding patterns in nonpregnant, reproductive-aged women beyond menarche lasting for at least 6 months. Ambiguous and inconsistent use of terminology and definitions to characterize AUB in the past decades necessitated a new, consensus-based approach to nomenclature and AUB evaluation. This led to the International Federation of Gynecology and Obstetrics (FIGO) System 1 in 2007, which standardized nomenclature, set parameters, and defined normal and abnormal bleeding based on the 5th to 95th percentile data from available large-scale epidemiologic studies. FIGO System 1, endorsed by several national and international societies, improved worldwide communication among educators, clinicians, and researchers. FIGO System 2, published in 2011, focused on classifications of AUB etiology into structural and nonstructural entities using the PALM-COEIN (polyp[s], adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial disorders, iatrogenic, and not yet classified) classification system. The PALM-COEIN classification is facilitated by a complete patient history combined with appropriate imaging, histopathologic analysis, or laboratory evaluation to ensure accurate diagnostic and treatment approaches to AUB. Herein we present the systematic evaluation of AUB.     

宫腔镜诊断异常子宫出血151例分析

目的：探讨宫腔镜检查术在各种异常子宫出血中的诊断价值。方法：应用宫腔镜检查异常子宫出血患者151例,术中行定位取材或诊断性刮宫,结果：宫腔镜诊断子宫内膜息肉的敏感性为92．59％,子宫中粘膜下肌瘤为92．86％,子宫内膜增殖症为61．54％,子宫内膜癌为66．67％,结论：宫腔镜检查异常子宫出血,可提高对子宫内膜息肉及粘膜下子宫肌瘤的诊断率。     

宫腔镜在协助诊断异常子宫出血中的价值

【目的】探讨宫腔镜协助诊断异常子宫出血的价值和优势。【方法】应用宫腔镜检查262例异常子宫出血患者,并在宫腔镜下定位取材或诊断性刮宫。【结果】宫腔镜诊断手宫黏膜下肌瘤、子宫内膜息肉、萎缩型子宫内膜、子宫内膜炎的敏感性高,宫腔镜检查与病理检查结果总符合率93．35％。萎缩型子宫内膜、子宫内膜炎是本组患者绝经后出血的主要原因,子宫内膜增生症、子宫内膜息肉是绝经前异常子宫出血的主要原因。【结论】宫腔镜检查能直视宫腔内病变,定位取材送病理检查可提高诊断准确率,对部分病人可达到诊断和治疗一体化的作用。     

Slowing the Flow: Management of Benign Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB), specifically heavy menstrual bleeding, is a common condition that can significantly affect women’s lives. AUB can impact women’s health, finances, social engagement, and overall quality of life. Potential causes of AUB can be assessed using a standard mnemonic to identify the origin as structural or nonstructural. The PALM-COEIN mnemonic stands for polyps, adenomyosis, leiomyoma, malignancy, hyperplasia, coagulopathy, ovulatory dysfunction, endometrial disorders, iatrogenic causes, and those not yet classified that are rare or not clearly defined. Treatment options include medical therapies, procedures, or surgical interventions. Nurse practitioners should partner with patients to individualize their plan of care based on best practices, beginning with the least invasive method. This case challenge highlights an underused treatment option for premenopausal women with heavy menstrual bleeding.     

宫腔镜联合B超检查对异常子宫出血的病因诊断价值

目的:探讨联合应用宫腔镜与B超对异常子宫出血(AUB)的病因诊断价值.方法:对103例初诊为AUB者进行宫腔镜联合B超检查及定位活检,回顾分析其临床资料.结果:103例均行盆腔B超检查、官腔镜直视下活检或宫腔镜检查后B超引导下的定位活检,最后经组织病理学检查证实诊断.官腔镜诊断子宫内病变的符合率为90.3%,B超诊断符合率为62.1%,两者联合诊断符合率为95.1%.103例均无并发症发生.结论:宫腔镜检查对AUB的病因诊断具有较高价值,联合B超检查可提高操作安全性.值得临床推广应用.     

动脉栓塞治疗产后及异常妊娠子宫出血效果研究

目的探究对动脉栓塞治疗产后及异常妊娠子宫出血效果研究。方法选取在2016年9月~2017年3月我院收治的产后及异常妊娠子宫出血患者100例作为本次研究对象,随机分为对照组和研究组。对照组实施子宫切除手术,研究组实施放射介入动脉栓塞治疗,根据两组患者的临床效果进行分析比较。结果研究组患者各项手术指标以及不良反应发生情况均显著低于对照组(P0.05)。结论对于产后及异常妊娠子宫出血患者来说,实施动脉栓塞治疗不仅可以高效的抑制患者出血率并且减轻患者的病情,与此同时也有利于避免因产后大量出血而实施子宫切除手术给患者带来的心理伤害。     

围绝经期异常子宫出血诊断和治疗专家共识

围绝经期异常子宫出血(abnormal uterine bleeding, AUB)主要与卵巢功能衰退有关。卵巢衰退后常处于无排卵状态, 可能引起月经异常, 同时也是子宫内膜良、恶性病变的诱发因素。多数AUB会使患者不适, 并对其生活质量产生重大影响, 需要及时干预。随着诊断手段的不断丰富和规范化, 越来越多的AUB在门诊即得到了快速诊断。围绝经期异常子宫出血需针对病因进行规范化、个体化治疗。AUB的病因包括结构性改变和无结构性改变。无结构性改变者常需进行药物干预, 如孕激素、口服避孕药(尤其是短效口服避孕药)、放置左炔诺孕酮宫内缓释系统以及抗纤维蛋白溶解药物, 还可辅以微创治疗如宫腔镜手术和子宫内膜消融术等, 这使得很多AUB患者避免或推迟了子宫切除手术。     

立止血联合宫血宁治疗宫内节育器术后子宫异常出血90例

将我院宫内节育器术后子宫异常出血患者90例随机分为观察组和对照组,两组均接受常规治疗,在此基础上观察组接受立止血及宫血宁联合治疗,评估两组治疗效果。结果治疗期间观察组出血天数、滴血天数、出血/滴血次数、月经时间明显短于对照组,两组分别比较差异具有统计学意义(P<0.05)。观察组总有效率97.78%,对照组73.33%,两组分别比较差异具有统计学意义(P<0.05)。两组治疗过程中均未见明显不良治疗反应。止血联合宫血宁治疗宫内节育器术后子宫异常出血的临床效果肯定,治疗安全,值得应用。     

宫腔镜电切术治疗子宫内膜息肉致异常子宫出血的安全性及疗效分析

目的分析宫腔镜电切术治疗子宫内膜息肉致异常子宫出血的安全性及疗效。方法选择我院2010~2011年3月42例子宫内膜息肉致异常子宫出血的患者行宫腔镜电切术,为电切组;选择同期采用宫腔镜后定位诊刮术的42例患者为诊刮术组;宫腔镜下子宫内膜息肉摘除术的患者42例为内摘术组。所有患者术后均随访3~12个月,对治疗效果及复发率进行观察。结果电切术组显效25例,有效16例,总有效率97.62%;摘除术组显效13例,有效21例,总有效率为80.95%;刮宫术组显效12例,有效21例,总有效率78.57%,电切术组总有效率明显高于摘除术组与刮宫术组,复发率明显低于摘除术组与刮宫术组,组间比较差异具有显著性,有统计学意义(P<0.05)。结论宫腔镜电切术治疗子宫内膜息肉致异常子宫出血疗效显著,且复发率低,具有较高的安全性。     

宫腔镜电切术前负压吸宫及术后电熨联合治疗异常子宫出血

目的：探讨宫腔镜电切除术前负压吸宫及术后电熨联合治疗异常子宫出血的疗效及预后。方法：选择有手术指征的异常子宫出血患者87例,采用被动式连续灌流宫腔电切镜行子宫内膜切除40例,肌瘤切除33例,肌瘤及内膜切除3例,息肉切除5例,息肉及内膜切除6例。结果：手术均顺利完成。术后随访3－11个月,总有效率96．6％,其中单纯子宫肌瘤及息肉切除术者,术后月经均减少或恢复正常;49例子宫内膜切除术同时切除肌瘤、息肉者,57．1％无月经,32．7％月经减少,4．1％月经正常,对痛经治愈率为100％,59列术前贫血者术后58例恢复正常,纠正贫血有效率为98．3％。术后并发症为3．4％,宫腔粘连并积血1例,月经无改善2例。结论：宫腔镜电切术前负压吸宫可薄化子宫内薄,电切术后滚球电极电熨切面可灭活由于电切深度不够或宫角处遗漏的内膜,与宫腔镜电切术联合应用可提高手术成功率,减少术后复发率,长期疗效尚待观察。     

High‐Intensity Focused Ultrasound Treatment of Abnormal Vaginal Bleeding Secondary to Uterine Myoma

We describe the use of high‐intensity focused ultrasound for acute vaginal bleeding secondary to uterine myoma in 2 young female patients. Both patients had episodes of abnormal vaginal bleeding with severe dysmenorrhea that was not efficiently controlled by medical treatment. After high‐intensity focused ultrasound ablation, both vaginal bleeding control and symptom relief were achieved without postinterventional complications. The patients remained free of symptoms during 2 months of follow‐up and regained normal menstruation after high‐intensity focused ultrasound therapy. High‐intensity focused ultrasound treatment is one of the least invasive options for dysfunctional vaginal bleeding and may be an effective and safe alternative to other procedures in women of reproductive age with abnormal vaginal bleeding secondary to uterine myoma.