Management of Acute Abnormal Uterine Bleeding

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Questions and Answers

What does the updated CDC Medical Eligibility Criteria focus on?

  • Management of chronic reproductive health issues
  • Safety of contraceptive methods during pregnancy
  • Long-term side effects of various contraceptive methods
  • The use of contraceptive methods during the postpartum period (correct)

Which of the following is a target group for the CDC's medical criteria updates?

  • Women over 40 with chronic diseases
  • Nonpregnant reproductive-aged women (correct)
  • Pregnant women
  • Postmenopausal women seeking contraception

Which of the following is emphasized in the Management of acute abnormal uterine bleeding guidelines?

  • Assessment and treatment based on patient age
  • Comprehensive evaluation before initiating treatment (correct)
  • Immediate surgical intervention for all cases
  • Use of hormonal treatments as the first approach

Which factor is NOT generally considered a contraindication for contraceptive use according to the medical eligibility criteria?

<p>History of infertility (C)</p> Signup and view all the answers

What is a key aspect of clinical guidelines for contraceptive use as proposed by the CDC?

<p>Contraceptive methods must be tailored to individual health needs (A)</p> Signup and view all the answers

What percentage of women experienced cessation of bleeding when treated with oral contraceptives (OCs) for acute abnormal uterine bleeding (AUB)?

<p>88% (C)</p> Signup and view all the answers

Which medication showed a lower efficacy in stopping bleeding compared to OCs based on the provided data?

<p>Medroxyprogesterone acetate (A)</p> Signup and view all the answers

What is a potential contraindication for using conjugated equine estrogen in treating acute AUB?

<p>History of deep vein thrombosis (C)</p> Signup and view all the answers

Which treatment regimen was administered three times daily for one week as an intervention for acute AUB?

<p>Oral contraceptives (A), Medroxyprogesterone acetate (B)</p> Signup and view all the answers

What clinical guideline provides recommendations on the diagnosis and management of von Willebrand disease?

<p>NHLBI Publication No. 08-5832 (B)</p> Signup and view all the answers

What is the first step in evaluating a patient with acute abnormal uterine bleeding?

<p>Evaluate for signs of hypovolemia and hemodynamic instability. (D)</p> Signup and view all the answers

Which of the following treatments is primarily considered for the medical management of acute abnormal uterine bleeding?

<p>Intravenous conjugated equine estrogen. (A)</p> Signup and view all the answers

When should surgical management be considered for patients experiencing acute abnormal uterine bleeding?

<p>If they are clinically unstable or unsuitable for medical management. (D)</p> Signup and view all the answers

What system is suggested for classifying the etiologies of acute abnormal uterine bleeding?

<p>PALM–COEIN system. (B)</p> Signup and view all the answers

In the context of treating acute abnormal uterine bleeding, what is a crucial consideration regarding medical management?

<p>It must be based on the patient's medical history and any contraindications. (B)</p> Signup and view all the answers

What defines abnormal uterine bleeding (AUB)?

<p>Bleeding from the uterine corpus that is irregular in volume, frequency, or duration. (D)</p> Signup and view all the answers

What should be prepared rapidly for a patient with acute abnormal uterine bleeding upon initial assessment?

<p>Blood transfusion and clotting factor replacements. (D)</p> Signup and view all the answers

What is recommended after controlling an acute bleeding episode in a patient?

<p>Transition to long-term maintenance therapy. (D)</p> Signup and view all the answers

Flashcards

Acute Abnormal Uterine Bleeding (AUB)

Bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration, occurring outside of pregnancy.

PALM-COEIN system

A system for categorizing the causes of acute abnormal uterine bleeding, dividing them into structural (PALM) and non-structural (COEIN) causes.

Medical Management (AUB)

Initial treatment option for most patients with acute AUB, using medications like conjugated equine estrogen, combined oral contraceptives, oral progestins, or tranexamic acid, based on patient history and contraindications.

Surgical Management (AUB)

Treatment option for AUB in cases where medical management isn't appropriate or has failed, considering the patient's medical conditions, underlying pathology, and future fertility desires.

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Hypovolemia and Hemodynamic Instability

Serious conditions related to low blood volume and unstable blood pressure, requiring immediate assessment and stabilization in cases of acute AUB.

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Initial Evaluation (AUB)

First steps in assessing a patient with acute AUB, focusing on identifying signs of hypovolemia and potential hemodynamic instability.

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Long-term Maintenance Therapy

Treatment provided after acute AUB is managed, aimed at preventing future episodes.

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Medical Eligibility Criteria for Contraceptive Use

Guidelines that dictate which contraceptive methods are suitable for individuals with specific health conditions.

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Postpartum Period Contraceptive Use

Recommendations for contraceptive methods during the period after childbirth.

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Acute Abnormal Uterine Bleeding

Sudden or heavy uterine bleeding in women of reproductive age, outside of pregnancy.

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Reproductive-aged Women

Women within the age range typically capable of childbearing.

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Contraceptive Methods

Various strategies for preventing pregnancy, including hormonal and barrier methods.

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Committee Opinion No. 557

A formal medical guideline from an organization (likely American College of Obstetricians and Gynecologists) for managing a specific medical issue.

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Acute Menorrhagia

Heavy menstrual bleeding, occurring outside of pregnancy.

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Underlying Bleeding Disorder

A medical condition that makes bleeding heavier or easier.

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Combined Oral Contraceptives (OCs)

Medication containing estrogen and progestin, used to regulate menstrual cycle.

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Medroxyprogesterone Acetate

Progestin hormone used to treat menstrual issues.

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Acute AUB Treatment

Treatment for heavy, irregular uterine bleeding.

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Potential Contraindications

Possible reasons why a particular treatment might not be suitable for a patient.

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FDA Labeling

Information provided by the US Food and Drug Administration about a medication's appropriate use.

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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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Related Documents

Management of Acute Abnormal Uterine Bleeding (2013) PDF

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