Abnormal uterine bleeding: A management algorithm
Abnormal uterine bleeding: A management algorithm
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DOI：
10.3122/jabfm.19.6.590
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发表时间：
2006-11-01
影响因子：
2.9
通讯作者：
Bowdler, Noelle C.
中科院分区：
文献类型：
--
作者：
Ely, John W.;Kennedy, Colleen M.;Bowdler, Noelle C.
异常子宫出血是一个常见的问题，其管理可以是复杂的。由于这种复杂性，很难制定出简明的指导方针。我们基于对文献的系统回顾以及对妇科门诊患者的实际管理，构建了一个简洁而全面的处理月经初潮至绝经期子宫异常出血的算法。我们首先起草了一个基于MEDLINE搜索相关评论和原始研究的算法。我们将该算法与在大学妇科诊所随机抽取的100名异常出血妇女的实际护理进行了比较。4名调查人员（2名家庭医生和2名妇科医生）在录音会议上讨论了算法与实际护理之间的差异。这些录音带被用来修正算法。在这个过程的3次迭代（总共300名患者）之后，我们同意了一个最终的算法，该算法通常遵循我们观察到的做法，同时保持与证据的一致性。在临床上，妇科医生将患者的出血类型分为四种类型中的一种：不规则出血、大量但有规律的出血（月经过多）、严重急性出血和与避孕方法相关的异常出血。随后的管理包括诊断和治疗干预，往往同时发生。本文中的算法旨在帮助初级保健医生使用与证据一致的策略以及妇科医生的实际实践来管理异常子宫出血。
Abnormal uterine bleeding is a common problem, and its management can be complex. Because of this complexity, concise guidelines have been difficult to develop. We constructed a concise but comprehensive algorithm for the management of abnormal uterine bleeding between menarche and menopause that was based on a systematic review of the literature as well as the actual management of patients seen in a gynecology clinic. We started by drafting an algorithm that was based on a MEDLINE search for relevant reviews and original research. We compared this algorithm to the actual care provided to a random sample of 100 women with abnormal bleeding who were seen in a university gynecology clinic. Discrepancies between the algorithm and actual care were discussed during audiotaped meetings among the 4 investigators ( 2 family physicians and 2 gynecologists). The audiotapes were used to revise the algorithm. After 3 iterations of this process ( total of 300 patients), we agreed on a final algorithm that generally followed the practices we observed, while maintaining consistency with the evidence. In clinic, the gynecologists categorized the patient's bleeding pattern into 1 of 4 types: irregular bleeding, heavy but regular bleeding ( menorrhagia), severe acute bleeding, and abnormal bleeding associated with a contraceptive method. Subsequent management involved both diagnostic and treatment interventions, which often occurred simultaneously. The algorithm in this article is designed to help primary care physicians manage abnormal uterine bleeding using strategies that are consistent with the evidence as well as the actual practice of gynecologists.