Ambulatory kvitfjell

Diagnosis and ambulatory therapy of bleeding

abnormalities

Andreas Thurkow

Kvitfjell 2008Kvitfjell 2008 [email protected]@planet.nl

Introduction

• Diagnosis: how? (methods)

• Therapy: how? (techniques) • Logistics


Diagnosis

• Anamnesis: – questionnaires – web-based


Diagnosis

• Anamnesis• Physical examination


Diagnosis

• Anamnesis (questionnaires, web-based) • Physical examination• US •3D?

•Doppler!D.Timmermans US O&G 2003

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Diagnosis

• Anamnesis (questionnaires, web-based)

• Physical examination• US

• SIS = SHG


Shortcomings TVU

• echoscopic information on uterine cavity depends on visualisation of the endometrium

BUT:

in 10 - 40 %:

NO endometrium is visible!


SIS meta-analysisSIS meta-analysis

6 prospective studies with 486 proceduresPre- en postmenopausal womenReference test: hysteroscopy

• Sensitivity 94% (95% CI 91-97)• Specificity 89% (95% CI 85-94)• NPV 92% (89-97)• PPV 91% (87-95)• LR test + 8,5 (5,9-13,7)

De Kroon et al. Ultrasound Obstet Gynecol 2002;20:S40


Efficacy SIS

one-stop• Dueholm (1999) n=114 93%• Jones (2001) n=93 89%

No hysteroscopy

• Brölmann (2003) n=457 93% (59%)• De Kroon (2003) n=214 84%

QuickTime en eenª-decompressor


QuickTime en eenª-decompressor


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Diagnosis

• Anamnesis (questionnaires, web-based) • Physical examination• US• SIS = SHG• Hysteroscopy


DiagnosisDiagnosis

• Anamnesis (questionnaires, web-based) • Physical examination• US• SIS = SHG• Hysteroscopy• MRI


MRI uterus Submucous Myoma


Adenomyosis


One StopOne Stop

Abu et al. BJOG 2001: Quantitative and qualitative assessment of women’s experience of a one-stop menstrual clinic in comparison with traditional gynaecology clinics

126 (traditional) vs 113 (one-stop)

Women were consistently more positive about their experience in the one stop clinic


Health & Medicine

Ambulatory kvitfjell