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

PALM - COEIN

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 patient’s 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