Clinical pathway for evaluating women with abnormal uterine bleeding

Area of Science:

• Gynecology
• Clinical Medicine
• Evidence-Based Practice

Background:

• Abnormal uterine bleeding (AUB) is a common gynecological complaint.
• Traditional evaluation often involves invasive procedures like endometrial biopsy.
• There is a need for more efficient and targeted diagnostic strategies for AUB.

Purpose of the Study:

• To develop and implement a clinical pathway for the evaluation of women with abnormal uterine bleeding.
• To assess the impact of this pathway on the utilization of endometrial biopsies.

Main Methods:

• A prospective study involving 1000 women with AUB.
• Implementation of a risk-stratified clinical pathway.
• Categorization of patients into premenopausal, postmenopausal, low-risk, and high-risk groups.
• Endometrial biopsy was performed only if a risk factor was identified.

Main Results:

• The clinical pathway reduced the number of endometrial biopsies by 50% (570 biopsies performed).
• Five cases of endometrial cancer and three of complex atypical hyperplasia were diagnosed in postmenopausal, high-risk women.
• No cases of endometrial cancer were missed, and none developed within two years post-evaluation.

Conclusions:

• The developed clinical pathway is effective in reducing unnecessary endometrial biopsies for abnormal uterine bleeding.
• Successful implementation of the clinical pathway at the institution demonstrates its practical utility.
• This pathway allows for targeted diagnostic evaluation, improving efficiency and patient care.