Management of the Not Yet Classified and Unexplained AUB a New, Proposed approach

Management of the Not Yet Classified and Unexplained AUB a

New Proposed Approach

Prof.Refaat AlSheemy

Al Azhar University

Abstract: Abnormal uterine bleeding (AUB) is the commonest presenting symptom in gynecology and the leading indication for hysterectomy. The recent FIGO Classification of Causes o AUB has been published in IJGO 2011 with advice of 40 experts in the field at 2 international workshops. It is designed to be flexible and suitable for regular revision to be adaptable for clinical application The new system, which is published in the June issue of the International Journal of Gynecology & Obstetrics, should facilitate basic science and clinical research, as well as the practical, rational, and consistent application of medical and surgical treatments Of the 9 categories in the new FIGO classification system (PALM-COEIN), the first 4 are defined as visually objective structural criteria (PALM: polyp, adenomyosis, leiomyoma, and malignancy and hyperplasia). The second 4 are unrelated to structural abnormalities (COEI: coagulopathy, ovulatory dysfunction, endometrial, and iatrogenic), and the final category is for entities that are not yet classified (N).

"There has been general inconsistency in the nomenclature used to describe ...AUB in reproductive aged women, and there is a plethora of potential causes—several of which may coexist in a given individual," . In contrast to the PALM group, the COEIN group (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified) includes nonstructural entities that are not defined on imaging or histopathology testing. The "iatrogenic" category refers to AUB associated with the use of exogenous gonadal steroids, intrauterine systems or devices, or other systemic or local agents

The Not Yet Classified (AUB-N,),reserved for causes that till poorly identified or not well examined such as uterine arteriovenous fistula and myometrial hypertrophy, our work in this field proposed to add to this group bleeding as a result of C S scar defect and causes that act on endometrial molecular level. In this study we found this group in 40% of cases presented with AUB As the management of. (AUB-N,),is challenging ,we tried to treat this group by bilateral transvaginal ligation of uterine artery(VBUAL)operation, a minimally invasive, simple ,easy to done and learn, with a promising results .After 2 years of follow up there is a good satisfaction in the part of studied group for preservation of the uterus and fertility with unremarkable pregnancy outcome. The studies recommend VBUAL for all unexplained cases of AUB, and can be performed in such –AUB-N group.

07/03/2015

Management of the Not Yet Classified and Unexplained AUB a New, Proposed approach

To my dear colleagues who are interested in these issues you can enter my site in Google, and YouTube just write Refaat Alsheemy.,Also it is written and published in the American Science Journal 2014 &2015)

07/03/2015