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PALM - COEIN

F I G O C L A S S I F I C AT I O N O F A U B

PALM COEIN

polyp;
adenomyosis;
leiomyoma;
malignancy and hyperplasia;
coagulopathy;
ovulatory dysfunction;
endometrial;
iatrogenic; and
not yet classified

MANAGEMENT
Tujuan terapi:
Mengendalikan perdarahan akut
Mengurangi kehilangan darah dalam siklus menstruasi berikutnya

First line: Hormonal


(untuk AUB akut tanpa gangguan pembekuan darah)
Combined OCs and oral progestins
medroxyprogesterone

Studies of treatments of acute AUB are limited, and only


one treatment (intravenous [IV] conjugated equine
estrogen) is specifically approved by the U.S. Food and
Drug Administration for the treatment of acute AUB.

SURGICAL MANAGEMENT
Keputusan untuk tindakan operasi tergantung
dari:

Stabilitas pasien
Keparahan pendarahan
Kontraindikasi untuk perawatan dengan obat
Gagal terapi dengan obat obatan
Kontraindikasi medis lainnya.

SURGICAL MANAGEMENT (2)

dilation and curettage (D&C),


endometrial ablation,
uterine artery embolization,
hysterectomy.
The choice of surgical modality (eg, D&C versus
hysterectomy) is based on the aforementioned factors plus
the patients desire for future fertility.
Specific treatments (hysteroscopy with D&C, polypectomy,
or myomectomy) may be required if structural abnormalities
are suspected as the cause of acute AUB
Hysterectomy, the definitive treatment for controlling heavy
bleeding, may be necessary for patients who do not respond
to medical therapy

P - POLYP

Jaringan abnormal yang tumbuh di mukosa


Surgical Management: Polypectomy
Gejala tersering: perdarahan pervaginam
Penyebab perdarahan pervaginam pada:
39% wanita premenopause
21-28% wanita post menopause

Diagnosa dengan:
TVUS,
saline infusion sonography
hysteroscopy