Podcast
Questions and Answers
What does the updated CDC Medical Eligibility Criteria focus on?
What does the updated CDC Medical Eligibility Criteria focus on?
Which of the following is a target group for the CDC's medical criteria updates?
Which of the following is a target group for the CDC's medical criteria updates?
Which of the following is emphasized in the Management of acute abnormal uterine bleeding guidelines?
Which of the following is emphasized in the Management of acute abnormal uterine bleeding guidelines?
Which factor is NOT generally considered a contraindication for contraceptive use according to the medical eligibility criteria?
Which factor is NOT generally considered a contraindication for contraceptive use according to the medical eligibility criteria?
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What is a key aspect of clinical guidelines for contraceptive use as proposed by the CDC?
What is a key aspect of clinical guidelines for contraceptive use as proposed by the CDC?
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What percentage of women experienced cessation of bleeding when treated with oral contraceptives (OCs) for acute abnormal uterine bleeding (AUB)?
What percentage of women experienced cessation of bleeding when treated with oral contraceptives (OCs) for acute abnormal uterine bleeding (AUB)?
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Which medication showed a lower efficacy in stopping bleeding compared to OCs based on the provided data?
Which medication showed a lower efficacy in stopping bleeding compared to OCs based on the provided data?
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What is a potential contraindication for using conjugated equine estrogen in treating acute AUB?
What is a potential contraindication for using conjugated equine estrogen in treating acute AUB?
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Which treatment regimen was administered three times daily for one week as an intervention for acute AUB?
Which treatment regimen was administered three times daily for one week as an intervention for acute AUB?
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What clinical guideline provides recommendations on the diagnosis and management of von Willebrand disease?
What clinical guideline provides recommendations on the diagnosis and management of von Willebrand disease?
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What is the first step in evaluating a patient with acute abnormal uterine bleeding?
What is the first step in evaluating a patient with acute abnormal uterine bleeding?
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Which of the following treatments is primarily considered for the medical management of acute abnormal uterine bleeding?
Which of the following treatments is primarily considered for the medical management of acute abnormal uterine bleeding?
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When should surgical management be considered for patients experiencing acute abnormal uterine bleeding?
When should surgical management be considered for patients experiencing acute abnormal uterine bleeding?
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What system is suggested for classifying the etiologies of acute abnormal uterine bleeding?
What system is suggested for classifying the etiologies of acute abnormal uterine bleeding?
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In the context of treating acute abnormal uterine bleeding, what is a crucial consideration regarding medical management?
In the context of treating acute abnormal uterine bleeding, what is a crucial consideration regarding medical management?
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What defines abnormal uterine bleeding (AUB)?
What defines abnormal uterine bleeding (AUB)?
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What should be prepared rapidly for a patient with acute abnormal uterine bleeding upon initial assessment?
What should be prepared rapidly for a patient with acute abnormal uterine bleeding upon initial assessment?
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What is recommended after controlling an acute bleeding episode in a patient?
What is recommended after controlling an acute bleeding episode in a patient?
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Study Notes
Management of Acute Abnormal Uterine Bleeding
- Initial evaluation includes assessing for hypovolemia and hemodynamic instability.
- Rapidly stabilize the patient, if unstable; initiate intravenous access and be prepared for blood transfusion.
- Classify the etiology of bleeding using the PALM-COEIN system.
- Medical management is the initial treatment option for most patients.
- Options include intravenous conjugated equine estrogen, oral contraceptives, oral progestins, and tranexamic acid.
- Decisions depend on medical history and contraindications.
- Surgical management is considered for patients who are not stable, unsuitable for medical treatment, or failed medical treatment.
- Surgical choice depends on underlying medical conditions, desired fertility, and surgical options like D&C, endometrial ablation, uterine artery embolization, and hysterectomy.
- Long-term maintenance therapy is crucial after controlling immediate bleeding.
Etiologies of Acute Abnormal Uterine Bleeding
- Etiologies are similar to those for chronic AUB.
- The PALM-COEIN classification system is used.
- PALM-COEIN includes Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia.
- COEIN includes Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not otherwise classified.
Assessment of the Patient With Acute Abnormal Uterine Bleeding
- Initial evaluation focuses on signs of hypovolemia and hemodynamic instability.
- The thorough medical history guides laboratory/radiologic testing.
- Pelvic examination includes assessing vaginal/cervical findings for bleeding causes.
- Pelvic examination helps to identify any uterine abnormalities (ex. leiomyomas).
Laboratory Testing and Imaging
- Complete blood count, blood type, pregnancy test, coagulation tests (PTT, PT, aPTT, Fibrinogen), von Willebrand factor, thyroid-stimulating hormone, liver function tests are typically ordered for acute AUB.
- Tests for bleeding disorders are essential.
- Thyroid and liver disorders, sepsis, or leukemia may be considered.
- Endometrial biopsy is recommended for patients >45 or those with a history of estrogen exposure, failed medical management, or persistent bleeding.
- Pelvic ultrasound may be considered based on the clinical picture.
Treatment
- Medical management (first line) includes IV conjugated estrogen, oral contraceptives, oral progestins, and tranexamic acid.
- Surgical management involves D&C, endometrial ablation, uterine artery embolization, and possible hysterectomy; choice dependent on patient factors.
Surgical Management
- Surgical treatment is considered based on patient stability, bleeding severity, and contraindications.
- Options include dilation and curettage, endometrial ablation, uterine artery embolization, and hysterectomy.
- Hysteroscopy with D&C or polypectomy may be needed if structural abnormalities are suspected.
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Description
This quiz covers the management strategies for acute abnormal uterine bleeding, including assessment techniques and treatment options. It discusses the importance of initial evaluation, classification systems, and both medical and surgical management approaches. Participants will enhance their understanding of effective management protocols in clinical settings.
