SANGRADO UTERINO ANORMAL- DR. JORGE HUATUCO
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Transcript of SANGRADO UTERINO ANORMAL- DR. JORGE HUATUCO
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Dr. Jorge Huatuco
SANGRADO UTERINO ANORMAL
Jorge Antonio Huatuco Hernández
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Dr. Jorge Huatuco
OBJETIVOS Actualizar las definiciones operacionales de
patrones anormales de sangrado uterino. Revisar las diferentes etiologías de las SUA. Estandarizar el uso del PALM-COEIN Discutir el tratamiento de las SUA por transtornos
ovulatorios o endometriales.
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Dr. Jorge Huatuco
HEMORRAGIA UTERINA ANORMAL
Se define como la pérdida de sangre proveniente del sistema genital femenino que sale de los rangos de normalidad (en mayor volumen, frecuencia o cantidad).
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CICLO MENSTRUAL (rangos)
Variación < Rango >Rango
Duración del ciclo 21 a 35 Polimenorrea Oligomenorrea
Duración del flujo
Menstrual2 a 7 días Hipomenorrea Menorragia
Pérdida sanguínea 20 a 80 ml Hipomenorrea Hipermenorrea
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Dr. Jorge Huatuco
CLASIFICACION DE LA HEMORRAGIA UTERINA
ANORMAL
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Dr. Jorge Huatuco
HUA
ORGANICA IATROGENICA DISFUNCIONAL
CLASIFICACION DE HUA
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Dr. Jorge Huatuco
HUD
PASO 2
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Dr. Jorge Huatuco
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Dr. Jorge Huatuco
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Dr. Jorge Huatuco
PALM-COEIN La nueva Clasificación PALM-COEIN de
las Causas del Sangrado Anormal desarrollada por el Grupo de Trastornos Menstruales de la FIGO:FMDG. El FMDG además recomienda el abandono de los términos menorragia, metrorragia y sangrado uterino disfuncional
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Dr. Jorge Huatuco
DEFINICIONES
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Dr. Jorge Huatuco
SANGRADO UTERINO ANORMAL CRONICO
Se define como sangrado del cuerpo uterino que es anormal en volumen, regularidad, temporalidad (o los tres) que ha estado presente durante la mayor parte de los últimos seis meses.
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Dr. Jorge Huatuco
SANGRADO UTERINO ANORMAL AGUDO
Se define como un episodio de sangrado abundante que, en opinión del médico, es de gravedad suficiente para requerir la intervención inmediata para prevenir una mayor pérdida de sangre.Puede ocurrir en el contexto del SUAC o sin un antecedente.
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Dr. Jorge Huatuco
SANGRADO INTERMENSTRUAL
Es el que ocurre entre menstruaciones claramente definidas como cíclicas y predecibles; comprende la ocurrencia de episodios aleatorios, así como los que se manifiestan predeciblemente al mismo tiempo en cada ciclo.
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Dr. Jorge Huatuco
PALM-COEIN
Estructurales: imágenes o histopatología
No estructurales
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POLIPO ENDOMETRIAL= ECOGRAFIA O HISTEROSCOPIA +/-
PATOLOGIA
- P1A0L0M0-C0O0E0I0N0 : Pólipo presente.- P0A0L0M0-C0O0E0I0N0 : Pólipo ausente.
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POLIPO ENDOMETRIAL
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Dr. Jorge Huatuco
POLIPO ENDOMETRIAL
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Dr. Jorge Huatuco
MIOMA SUBMUCOSO
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Dr. Jorge Huatuco
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Dr. Jorge Huatuco
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ADENOMIOSIS
Dr. Jorge Huatuco
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Dr. Jorge Huatuco
ADENOMIOSIS
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Dr. Jorge Huatuco
AdenomiosisAdenomiosis
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ADENOMIOSIS= ECOGRAFIA O RESONANCIA MAGNETICA
- P0A1L0M0-C0O0E0I0N0 : Adenomiosis presente.- P0A0L0M0-C0O0E0I0N0 : Adenomiosis ausente.
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Dr. Jorge Huatuco
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Dr. Jorge Huatuco
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LEIOMIOMATOSIS
Dr. Jorge Huatuco
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LEIOMIOTASIS= ECOGRAFIA
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- P0A0L1M0-C0O0E0I0N0 : Leiomiomatosis presente (clasificación primaria).
- P0A0L1M0-C0O0E0I0N0 : Leiomiomatosis ausente (clasificación primaria).
- P0A0L1(SM)M0-C0O0E0I0N0 : Leiomiomatosis presente (clasificación secundaria).
- P0A0L1(O)M0-C0O0E0I0N0 : Leiomiomatosis presente (clasificación secundaria).
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SECUNDARIO TERCIARIO
TERCIARIO
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ENFERMEDADES PREMALIGNAS Y MALIGNAS=-HIPERPLASIA ATIPICA -CANCER DE ENDOMETRIO O MIOMETRIO
Dr. Jorge Huatuco
HISTOLOGIA
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Dr. Jorge Huatuco
ANTECEDENTES: OBESIDAD, ANOVULACION CRONICA, SINDROME METABOLICO
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ENFERMEDADES PREMALIGNAS Y MALIGNAS
- P0A0L0M1-C0O0E0I0N0 : Malignidad o premalignidad presente.
- P0A0L0M0-C0O0E0I0N0 : Malignidad o premalignidad Malignidad o premalignidad ausente.
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COAGULOPATIA= HISTORIA CLINICA ESTRUCTURADA
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Dr. Jorge Huatuco
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COAGULOPATIAS
- P0A0L0M0-C1O0E0I0N0 : Coagulopatía presente.
- P0A0L0M0-C0O0E0I0N0 : Coagulopatía ausente.
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TRANSTORNOS OVULATORIOS= HISTORIA CLINICA .
Presencia de :-Causas de amenorreas de compatimientos 2,3,4: SOP, hiperprolactinemia, hipotiroidismo, anorexia, bulimia, estrès, ejercicio.-Medicamentos que causan anovulación: fenotiazinas, antidepresivos tricíclicos, esteroides gonadales.
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TRASNTORNOS OVULATORIOS- P0A0L0M0-C0O1E0I0N0 : Transtorno ovulatorio
presente.
- P0A0L0M0-C0O0E0I0N0 : Transtorno ovulatorio ausente.
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TRANSTORNOS OVULATORIOS= HISTORIA CLINICA .
Presencia de :-Causas de amenorreas de compatimientos 2,3,4: SOP, hiperprolactinemia, hipotiroidismo, anorexia, bulimia, estrès, ejercicio.-Medicamentos que causan anovulación: fenotiazinas, antidepresivos tricíclicos, esteroides gonadales.
Sangrado acíclico
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CAUSAS ENDOMETRIALES= HISTORIA CLINICA .
Mecanismo :-Predominan las causas que incrementan el sangrado local del endometrio: -Incremento del FA del plasminógeno, Prostaglandina I2 y E2.-Disminución de la F2 alfa y endotelina 1.-Inflamación del endometrio: endomtritis.
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TRASNTORNOS ENDOMETRIALES- P0A0L0M0-C0O0E1I0N0 : Transtorno endometrial
presente.
- P0A0L0M0-C0O0E0I0N0 : Transtorno endometrial ausente.
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TRASNTORNOS ENDOMETRIALES
Sangrado cíclico: sin evidencia de otra patología.
Sangrado intermenstrual: sin evidencia de otra patología
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CAUSAS IATROGENAS= HISTORIA CLINICA .
Mecanismo :-Sangrado por deprivación causada por estrógenos o progesterona: -DIU de levonorgestrel-Anticonceptivos hormonales.
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CAUSAS IATROGENAS
- P0A0L0M0-C0O0E0I1N0 : causas iatrógenas presentes.
- P0A0L0M0-C0O0E0I0N0 : causas iatrógenas presentes.
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NO CLASIFICADOS- Malformaciones
arteriovenosas.- Hipertrofia
endometrial.
- Futuras afecciones que serán determnadas por biología molecular.
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Dr. Jorge Huatuco
oO ICM
AL
C
o
C
C
Ecografia
PALM
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Dr. Jorge Huatuco
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