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New FIGO classification system benefits women with AUB Published on May 21, 2011 at 4:45 AM No Comments Published

d in the International Journal of Gynecology & Obstetrics Abnormal uterine bleeding (AUB) in women of reproductive age may be due to a wide range of disorders or pathologies. Until now, there has been no universally accepted method for classifying such patients, which has impeded basic science and clinical investigation, as well as the practical, rational, and consistent application of medical and surgical therapy. As the result of a stringent 5-year review process, a multinational group of clinicianinvestigators with broad experience in the investigation of AUB has now agreed on a classification system to facilitate multi-institutional investigation into the epidemiology, etiology, and treatment of women with acute and chronic AUB. This classification has been approved by the International Federation of Gynecology and Obstetrics (FIGO) Executive Board as a FIGO classification system and has been published in the International Journal of Gynecology & Obstetrics. "There has been general inconsistency in the nomenclature used to describe abnormal uterine bleeding in reproductive aged women, and there is a plethora of potential causes-several of which may coexist in a given individual," commented Malcolm G. Munro, MD, FRCS(c), FACOG, Professor of Obstetrics and Gynecology at the David Geffen School of Medicine, UCLA and Director of Gynecologic Services, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California. "It seems clear that the development of consistent and universally accepted nomenclature is a step toward rectifying this unsatisfactory circumstance. Another requirement is the development of a classification system for the causes of AUB, which can be used by clinicians, investigators, and even patients themselves to facilitate communication, clinical care, and research." Beginning with workshops in 2005, contributors from more than 17 countries on 6 continents developed the PALMCOEIN (pronounced "pahm-koin") classification system for causes of AUB in the reproductive years. The basic system comprises 9 categories: The first 4 are defined by visually objective structural criteria (PALM: polyp; adenomyosis; leiomyoma; and malignancy and hyperplasia); a second 4 that are unrelated to structural anomalies (COEI: coagulopathy; ovulatory dysfunction; endometrial; and iatrogenic), and a final category reserved for entities that are not yet classified (N). A draft system was developed and revised, distributed for comments, and then discussed at a face-to-face meeting held in association with the 2009 FIGO World Congress in Cape Town, South Africa. The process was systematically designed to create a practical system that could be used by clinicians in most countries worldwide to classify patients with AUB readily and consistently. Drs. Munro, Critchley and Fraser note that it is "recognized that the system will require periodic modification and occasional substantial revision depending on advances in knowledge and technology, and increasing availability of investigative options across geographic regions. Consequently, we recommend a scheduled systematic review of the system on a regular basis by a permanent committee of an international organization such as FIGO, which has already endorsed the establishment of a suitable ongoing Working Group on Menstrual Disorders." FIGO Chief Executive Hamid Rushwan said: "There is no existing classification of the causes of these common gynecologic symptoms that allows good communication between practicing clinicians and researchers, and which encourages focus on the optimal approaches to modern management. Therefore, FIGO is pleased to have a role in facilitating the use of this ground-breaking new classification worldwide." Ground-breaking FIGO Classification published in IJGO Friday, 20th May 2011 The new FIGO Classification of Causes of Abnormal Uterine Bleeding has been published in the April edition of the International Journal of Gynecology and Obstetrics (IJGO), and is now accessible free of charge on the FIGO website.

Ian Fraser, Co-chair of the FIGO Working Group on Menstrual Disorders, said: The Classification has been developed over a five-year period by the FIGO Working Group on Menstrual Disorders, with advice and input from over 40 experts in the field at two international workshops. Its purpose is to provide a structured context for clinical research, medical education, and the provision of clinical care for women with abnormal uterine bleeding (AUB). It has been designed to be flexible, suitable for regular review and revision and adaptable for use at the primary care, specialist and clinical investigator levels. Advantages of new Classification The system eliminates the use of vague and undefined diagnostic terms like dysfunctional uterine bleeding and menorrhagia, therefore allowing improved diagnostic precision, a critical element of any strategy designed to enhance the standard of care for women with AUB. Widespread use of the Classification will allow much improved comparison of the findings in different research publications, in case studies and in routine clinical practice. Working with leading journals The co-authors of the Classification, FIGO and the IJGO are working with the editors of leading reproductive journals to encourage clinical investigators to utilise the principles of the Classification when designing, interpreting, and publishing their research on topics related to AUB. FIGO also believes that the Classification should be used widely in undergraduate and postgraduate education to facilitate the development of practitioners who are able to provide quality care for women with AUB. Ideally, this Classification should be used in association with the previous FIGO-supported publications on uniform menstrual and AUB terminologies and definitions 1,2. References: 1. Fraser IS, Critchley HOD, Munro MG, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Hum Reprod 2007; 22: 635-643; Simultaneous publication in Fertility and Sterility; 2. Fraser IS, Critchley HOD, Munro MG, Broder M. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of uterine bleeding. Fertil Steril 2007; 87:466-476; Simultaneous publication in Human Reproduction http://www.figo.org/news/ground-breaking-figo-classification-published-ijgo-003662 International Federation of Gynecology and Obstetrics FIGO's new classification of causes of abnormal uterine bleeding benefits patients Published in the International Journal of Gynecology & Obstetrics Philadelphia, PA, May 18, 2011 Abnormal uterine bleeding (AUB) in women of reproductive age may be due to a wide range of disorders or pathologies. Until now, there has been no universally accepted method for classifying such patients, which has impeded basic science and clinical investigation, as well as the practical, rational, and consistent application of medical and surgical therapy. As the result of a stringent 5-year review process, a multinational group of clinicianinvestigators with broad experience in the investigation of AUB has now agreed on a classification system to facilitate multi-institutional investigation into the epidemiology, etiology, and treatment of women with acute and chronic AUB. This classification has been approved by the International Federation of Gynecology and Obstetrics (FIGO) Executive Board as a FIGO classification system and has been published in the International Journal of Gynecology & Obstetrics.

"There has been general inconsistency in the nomenclature used to describe abnormal uterine bleeding in reproductive aged women, and there is a plethora of potential causesseveral of which may coexist in a given individual," commented Malcolm G. Munro, MD, FRCS(c), FACOG, Professor of Obstetrics and Gynecology at the David Geffen School of Medicine, UCLA and Director of Gynecologic Services, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California. "It seems clear that the development of consistent and universally accepted nomenclature is a step toward rectifying this unsatisfactory circumstance. Another requirement is the development of a classification system for the causes of AUB, which can be used by clinicians, investigators, and even patients themselves to facilitate communication, clinical care, and research." Beginning with workshops in 2005, contributors from more than 17 countries on 6 continents developed the PALMCOEIN (pronounced "pahm-koin") classification system for causes of AUB in the reproductive years. The basic system comprises 9 categories: The first 4 are defined by visually objective structural criteria (PALM: polyp; adenomyosis; leiomyoma; and malignancy and hyperplasia); a second 4 that are unrelated to structural anomalies (COEI: coagulopathy; ovulatory dysfunction; endometrial; and iatrogenic), and a final category reserved for entities that are not yet classified (N). A draft system was developed and revised, distributed for comments, and then discussed at a face-to-face meeting held in association with the 2009 FIGO World Congress in Cape Town, South Africa. The process was systematically designed to create a practical system that could be used by clinicians in most countries worldwide to classify patients with AUB readily and consistently. Drs. Munro, Critchley and Fraser note that it is "recognized that the system will require periodic modification and occasional substantial revision depending on advances in knowledge and technology, and increasing availability of investigative options across geographic regions. Consequently, we recommend a scheduled systematic review of the system on a regular basis by a permanent committee of an international organization such as FIGO, which has already endorsed the establishment of a suitable ongoing Working Group on Menstrual Disorders." FIGO Chief Executive Hamid Rushwan said: "There is no existing classification of the causes of these common gynecologic symptoms that allows good communication between practicing clinicians and researchers, and which encourages focus on the optimal approaches to modern management. Therefore, FIGO is pleased to have a role in facilitating the use of this ground-breaking new classification worldwide." ### An accompanying special editorial provides additional insights about the classification system. Both the classification and editorial are available to download free of charge from www.figo.org (Publications section). The article is "FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age" by Malcolm G. Munro, Hilary O.D. Critchley, Michael S. Broder, and Ian S. Fraser; for the FIGO Working Group on Menstrual Disorders (doi: 10.1016/j.ijgo.2010.11.011). The editorial is "The FIGO classification of causes of abnormal uterine bleeding" by Malcolm G. Munro, Hilary O.D. Critchley, and Ian S. Fraser (doi: 10.1016/j.ijgo.2011.01.001). Both appear in the International Journal of Gynecology & Obstetrics, Volume 113, Issue 1, April 2011, published by Elsevier. Public release date: 18-May-2011 http://www.eurekalert.org/pub_releases/2011-05/ehs-fnc051811.php Classifying Uterine Myoma and Adenomyosis Based on Ultrasound Image Fractal and Texture Features

Kaikai Wu; Yuanyuan Wang; Ying Pan; Junhua Zhang; Bin Qian; Cai Chang; Dept. of Electron. Eng., Fudan Univ., Shanghai This paper appears in: Engineering in Medicine and Biology Society, 2005. IEEE-EMBS 2005. 27th Annual International Conference of the Issue Date: 17-18 Jan. 2006 On page(s): 1790 - 1793 Location: Shanghai

Print ISBN: 0-7803-8741-4 References Cited: 5 INSPEC Accession Number: 9108851 Digital Object Identifier: 10.1109/IEMBS.2005.1616795 Date of Current Version: 10 April 2006 Abstract The classification of the uterine myoma and adenomyosis from their ultrasound images mainly depends on doctors' experience and lacks objective criterions. Here a novel classification method is proposed using the multiresolution analysis and the orientational fractal analysis. Firstly, texture features under various resolutions and orientational fractal features are obtained from ultrasound images. Then the feature selection (FS) process is implemented using the sequential forward selection algorithm (SFS). Finally a classifier based on the support vector machine (SVM) is set up to classify the images into normal (Nor), myoma (Myo) and adenomyosis (Ad) cases. From the application of 27 Nor, 45 Ad and 74 Myo cases, it is showed that orientational fractal features and some multiresolution texture features are sensitive to the uterine Myo and Ad classification. The SVM classifier with the selected features may be useful in the practical classification J Obstet Gynaecol (Lahore). 1987;8(2):135-8. Obstetric problems in the grand multipara: a clinical study of 1330 cases. Al-sibai MH, Rahman MS, Rahman J. Abstract From January 1982-December 1986, researchers reviewed 1130 patients who had 7 or more viable pregnancies at the University Teaching Hospital in Al-Khobar, Saudi Arabia. The majority of the patients (90%) received regular prenatal care and most of the remaining patients attended a prenatal clinic 3-4 times. For the grand multipara, the rate of spontaneous abortion was higher (24%) compared to total deliveries (13%) in that hospital during the study period. Anemia was the leading predelivery complication for the study group (16.6% vs. 3.5% for total deliveries). Preeclampsia followed as the 2nd leading complication (6.1% vs. 5.2% for total deliveries). In 1 case a 45 year old gravida 13 had eclampsia, and both mother and infant survived. Antepartum hemorrhage occurred in 5.8% of the multiparous women (2.3% for total deliveries) due to abruptio placentae in 43 patients and placenta previa in 34 others. 5.6% of the multiparous patients (1.2% for total deliveries) experienced unstable lie, while successful induction of labor at term occurred in 60% of these women. Diabetes mellitus caused the least predelivery complications (4.8% vs. 2.8%). 73.3% of all deliveries to grand multiparous women resulted in normal deliveries. Delivery complications were higher for the study group, however, than for total deliveries: breech deliveries, 7% vs. 2.7%; premature labor, 7.5% vs. 2.7; cesarean section, 11.4% vs. 8.9%; and postpartum hemorrhage. 6.5% vs. 3.1%. The perinatal mortality rate of 62/1000 for the grand multiparous women was 3 times the overall rate for the hospital (21/1000). Stillbirt accounted for 50% of perinatal deaths for the remaining deliveries. 1 maternal death occurred among the grand multigravida.

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