criteria diagnose obstetric and gynaecology

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					         KRITERIA MEDIS OBGYN



                                dr. Justisiani Fatira




Syndromes or Disease Entities That Have Been Associated
with Polycystic Ovaries............................................................1

Diagnostic Criteria in Polycystic Ovary Syndrome
(PCOS).......................................................................................3

Amsel's Diagnostic Criteria for Bacterial Vaginosis.............5

CDC Diagnostic Criteria for the Diagnosis of Pelvic
Inflammatory Disease
(PID)..........................................................................................5

2001 Bethesda System Terminology.......................................7

ACR/BI-RADS Breast Imaging Reporting and Data
System......................................................................................10
Syndromes or Disease Entities That Have Been Associated
with Polycystic Ovaries


     ·    Hyperandrogenism
           o     Steroidogenic enzyme deficiencies
                    §     Congenital adrenal hyperplasia
                    §     Aromatase deficiency
           o     Androgen-secreting tumors
                    §     Ovarian
                    §     Adrenal
           o     Exogenous androgens
                    §     Anabolic steroids
                    §     Transsexual hormone replacement
           o     Other
                    §     Acne
                    §     Idiopathic hirsutism
     ·    Hyperandrogenism and Insulin Resistance
           o     Congenital
                    §     Type A syndrome
                    §     Type B syndrome
                    §     Leprechaunism
                    §     Lipoatrophic diabetes
                    §     Rabson-Mendenhall syndrome
                    §     Polycystic ovary syndrome
           o     Acquired
                    §     Cushing's syndrome
     ·   Insulin Resistance
           o     Glycogen storage diseases
           o     Type 2 diabetes
     ·   Other
           o     Central nervous system
                    §     Trauma/lesions
                    §     Hyperprolactinemia
           o     Nonhormonal medications
                    §     Valproate
           o     Heriditary angioedema
           o     Bulimia
                                                            1
              o     Idiopathic (includes normoandrogenic women with
                  cyclic menses)

References:

   1.   The Rotterdam ESHRE/ASRM-Sponsored PCOS consensus
        workshop group. Revised 2003 consensus on diagnostic criteria
        and long-term health risks related to polycystic ovary syndrome
        (PCOS). Hum Reprod. 2004 Jan;19(1):41-7. [Medline]
   2.   Legro R. Diagnostic Criteria in Polycystic Ovary Syndrome. Semin
        Reprod Med. 2003 Aug;21(3):267-75 [Medline]
   3.   Reaven G. The metabolic syndrome or the insulin resistance
        syndrome? Different names, different concepts, and different goals.
        Endocrinol Metab Clin North Am. 2004 Jun;33(2):283-303.
        [Medline]




                                                                         2
Diagnostic Criteria in Polycystic Ovary Syndrome (PCOS)

Revised diagnostic criteria of PCOS
1999 criteria (both 1 and 2)
1. Chronic anovulation
2. Clinical and/or biochemical signs of hyperandrogenism, and exclusion of
other aetiologies


Revised 2003 criteria (2 out of 3)
1. Oligo- and/or anovulation
2. Clinical and/or biochemical signs of hyperandrogenism
3. Polycystic ovaries
and exclusion of other aetiologies (congenital adrenal hyperplasias,
androgen-secreting tumours, Cushing’s syndrome)


Other Proposed Diagnostic Criteria in Polycystic Ovary Syndrome
    1. Inappropriate gonadotropin secretion
            a)     Elevated LH-to-FSH ratio
            b)     Abnormal response to GnRH agonist testing
    2.   Hyperandrogenism
            a)     Hirsutism, androgenic alopecia, acne
            b)     Hyperandrogenemia
                      I. Total testosterone
                     II.   Free testosterone (free androgen index, etc.)
    3.   Ovarian appearance
            a)     Polycystic-appearing ovaries
            b)     Increased (stromal) size
    4.   Insulin resistance
            a)     Acanthosis nigricans
            b)     Fasting measures of insulin/glucose
            c)     Oral glucose tolerance test
            d)     Dynamic tests of insulin sensitivity
            I.    Euglycemic
             II.    Frequently sampled intravenous glucose tolerance test
    5.   Chronic anovulation
            a)     Self-reported history
            b)     Tests of ovulatory function
                      I.   Basal body temperature charting
                      II.   Urinary LH testin
                                                                            3
                    III.   Serum progesterone measurement
                    IV.    Endometrial biopsy

FSH, follicle-stimulating hormone; GnRH, gonadotropin-releasing
hormone; LH, luteinizing hormone.

References:

    1.   The Rotterdam ESHRE/ASRM-Sponsored PCOS consensus
         workshop group. Revised 2003 consensus on diagnostic criteria
         and long-term health risks related to polycystic ovary syndrome
         (PCOS). Hum Reprod. 2004 Jan;19(1):41-7. [Medline]
    2.   Legro R. Diagnostic Criteria in Polycystic Ovary Syndrome. Semin
         Reprod Med. 2003 Aug;21(3):267-75 [Medline]
    3.   Reaven G. The metabolic syndrome or the insulin resistance
         syndrome? Different names, different concepts, and different goals.
         Endocrinol Metab Clin North Am. 2004 Jun;33(2):283-303.
         [Medline]




                                                                          4
Amsel's Diagnostic Criteria for Bacterial Vaginosis

Three of four criteria must be met; establishes accurate diagnosis of
bacterial vaginosis in 90 percent of affected women.

        Homogeneous vaginal discharge (color and amount may vary)
        Amine (fishy) odor when potassium hydroxide solution is added to
         vaginal secretions (commonly called the "whiff test")
        Presence of clue cells (greater than 20%) on microscopy*
        Vaginal pH greater than 4.5

* Highly significant criterion.

References:

    1.   Egan ME, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician.
         2000 Sep 1;62(5):1095-104. [Medline]
    2.   Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D,
         Holmes KK. Nonspecific vaginitis. Diagnostic criteria and
         microbial and epidemiologic associations. Am J Med. 1983
         Jan;74(1):14-22. [Medline]




CDC Diagnostic Criteria for the Diagnosis of Pelvic Inflammatory
Disease (PID)

Minimal criteria*

        Lower abdominal tenderness
        Uterine/adnexal tenderness
        Cervical motion ten
				
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