Keywords
Miomectomía uterina
Guía de práctica clínica
Servicio de ginecología y obstetricia en hospital Leiomyoma
Uterine myomectomy
Practice guideline
Obstetrics and gynecology department
Hospital
How to Cite
Abstract
Introduction: The prevalence of uterine fibroids exceeds 70% and is a frequent cause of hysterectomy as a result of abnormal uterine hemorrhage and associated symptoms. There are multiple strategies to manage fibroids and the evidence is insufficient and controversial, leading to a wide variability in clinical practice. Objective: To adapt clinical practice guidelines to assist in decision-making for the diagnosis and treatment of patients with suspicious or diagnosed uterine myomatosis at the Sanitas organization. Materials and methods: During 2015 a process of guidelines adaptation was undertaken, following the national and international recommendations that included the creation of a developer team, the design of 11 clinical questions using PICO, search of pre-existing guidelines in renowned websites, selection and evaluation of four clinical practice guidelines for adaptation, a non-formal expert consensus, writing, and distribution and approval of the document. Results: 59 clinical recommendations were adapted for the diagnosis and treatment of uterine myomatosis, in accordance with the characteristics of the population served at the institution. Conclusion: Having evidence-based recommendations for managing patients with uterine myomatosis contributes to improving the quality of healthcare, reduces any unjustified clinical variability and shows the feasibility of producing clinical guidelines consistent with the needs of the institution leading to better use of the resources available.
References
Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-7. https://doi.org/10.1067/mob.2003.99
Munro MG. Uterine Leiomyomas, Current Concepts: Pathogenesis, Impact on Reproductive Health, and Medical, Procedural, and Surgical Management. Obstet Gynecol Clin North Am [Internet]. Elsevier Inc.; 2011;38(4):703-31. https://doi.org/10.1016/j.ogc.2011.09.006
Shimomura Y, Matsuo H, Samoto T, Maruo T. Up-regulation by progesterone of proliferating cell nuclear antigen and epidermal growth factor expression in human uterine leiomyoma. J Clin Endocrinol Metab. 1998;83(6):2192-8. https://doi.org/10.1210/jc.83.6.2192
Guía Metodológica para la elaboración de Guías de Práctica Clínica con Evaluación Económica en el Sistema General de Seguridad Social en Salud Colombiano, Versión completa final. Marzo de 2014. Disponible en: http://gpc.minsalud.gov.co/recursos/Documents/Gu%C3%ADa%20 Metodol%C3%B3gica_Web.pdf
The ADAPTE Collaboration (2009). The ADAPTE Process: Resource Toolkit for Guideline Adaptation. Versión 2.0. Disponible en: http://www.gi-n.net/document-store/working-groups-documents/adaptation/adapte-resource-toolkit-guideline-adaptation-2-0.pdf
Guía de Práctica Clínica para diagnóstico y tratamiento de Miomatosis Uterina, México: Secretaría de Salud; 2009. Disponible en: http://www. cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/082_GPC_Miomatosisuterina/MIOMATOSIS_EVR_CENETEC.pdf
Farquhar C, Arroll B, Ekeroma A, Fentiman G, Lethaby A, Rademaker L, et al. An Evidence-based guideline for the management of uterine Fibroids. Aust N Z J Obstet Gynaecol. 2001;41(2):125-40. https://doi.org/10.1111/j.1479-828X.2001.tb01198.x
Lefebvre G, Vilos G, Allaire C, Jeffrey J, Arneja J, Birch C, et al; Clinical Practice Gynaecology Committee, Society for Obstetricians and Gynaecologists of Canada.. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2003;25(5):396-418. https://doi.org/10.1016/S1701-2163(16)30582-5
Marret H, Fritel X, Ouldamer L, Bendifallah S, Brun JL, De Jesus I, et al. Therapeutic management of uterine fibroid tumors: Updated French guidelines. Eur J Obstet Gynecol Reprod Biol. 2012;165(2):156-64. https://doi.org/10.1016/j.ejogrb.2012.07.030
Ministerio de Salud de Colombia. Resolución 8430 del 4 de octubre de 1993. Fecha de consulta: 11 de marzo de 2016. Disponible en: https://www.minsalud.gov.co/Normatividad_Nuevo/RESOLUCION%208430%20DE%201993.pdf
Ministerio de Salud y Protección Social. Guía de Práctica Clínica para el manejo del cáncer de cuello uterino invasivo. Guía completa. Colombia 2014. Disponible en: http://gpc.minsalud.gov.co/gpc_sites/Repositorio/Otros_conv/GPC_Cuello_Uterino_inv/gpc_c_uterino_inv_completa.aspx
Levens ED, Decherney AH. P R AC T I C E Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women. 2012;120(1):197-206. https://doi.org/10.1097/AOG.0b013e318262e320
Marret H, Fauconnier a., Chabbert-Buffet N, Cravello L, Golfier F, Gondry J, et al. Clinical practice guidelines on menorrhagia: Management of abnormal uterine bleeding before menopause. Eur J Obstet Gynecol Reprod Biol. 2010;152(2):133-7. https://doi.org/10.1016/j.ejogrb.2010.07.016
Dreisler E, Poulsen LG, Antonsen SL, Ceausu I, Depypere H, Erel CT, et al. EMAS clinical guide: Assessment of the endometrium in peri and postmenopausal women. Maturitas [Internet]. Elsevier Ireland Ltd; 2013;75(2):181-90. https://doi.org/10.1016/j.maturitas.2013.03.011
Casali PG, Jost L, Reichardt P, Schlemmer M, Cutsem E Van, Oliveira J. Clinical Recommendations. Ann Oncol. 2009;20(Supplement 4):2008-10. https://doi.org/10.1093/annonc/mdp131
Marret H, Fritel X, Ouldamer L, Bendifallah S, Brun JL, De Jesus I, et al. Therapeutic management of uterine fibroid tumors: Updated French guidelines. Eur J Obstet Gynecol Reprod Biol. 2012;165(2):156-64. https://doi.org/10.1016/j.ejogrb.2012.07.030
Advancing A, Invasive M, Worldwide G. AAGL Position Statement: Route of Hysterectomy to Treat Benign Uterine Disease. J Minim Invasive Gynecol [Internet]. AAGL; 2011;18(1):1-3. https://doi.org/10.1016/j.jmig.2010.10.001
Summary E. Power Morcellation and Occult Malignancy in Gynecologic Surgery - ACOG. 2014;(May):1-6. Available from: http://www.acog.org/Resources-And-Publications/Task-Force-and-Work-Group-Reports/Power-Morcellation-and-Occult-Malignancy-in-Gynecologic-Surgery
Food and Drug Administration. Quantitative Assessment of the Prevalence of Unsuspected Uterine Sarcoma in Women Undergoing Treatment of Uterine Fibroids. Summary and Key Findings. April 17, 2014. Available in: http://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM393589.pdf
AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: Morcellation during uterine tissue extraction. J Minim Invasive Gynecol. 2014;21(4):517-30. https://doi.org/10.1016/j.jmig.2014.05.010
Advancing A, Invasive M, Worldwide G. AAGL Practice Report: Practice Guidelines for the Diagnosis and Management of Submucous Leiomyomas. J Minim Invasive Gynecol [Internet]. Elsevier Ltd; 2012;19(2):152-71. https://doi.org/10.1016/j.jmig.2011.09.005
Falcone T, Parker WH. Surgical management of leiomyomas for fertility or uterine preservation. Obstet Gynecol [Internet]. 2013;121(4):856-68. https://doi.org/10.1097/AOG.0b013e3182888478
Byrne H, Miskry T, Gomez CM. Using vasopressin for myomectomy. Obstet Gynecol. 2009;114(1):169-70 https://doi.org/10.1097/AOG.0b013e3181ac3f43
Frishman G. Vasopressin: if some is good, is more better? Obstet Gynecol. 2009;113(2 Pt 2):476-7. https://doi.org/10.1097/AOG.0b013e31819698bb
Exacoustòs C, Rosati P. Ultrasound diagnosis of uterine myomas and complications in pregnancy. Obstet Gynecol. 1993;82(1):97-101.
2Aydeniz B, Wallwiener D, Kocer C, Grischke EM, Diel IJ, Sohn C, et al. [Significance of myoma-induced complications in pregnancy. A comparative analysis of pregnancy course with and without myoma involvement]. Z Geburtshilfe Neonatol. GERMANY; 1998;202(4):154-8.
Sunkara SK, Khairy M, El-Toukhy T, Khalaf Y, Coomarasamy A. The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: A systematic review and meta-analysis. Hum Reprod. 2010;25(2):418-29. https://doi.org/10.1093/humrep/dep396
Ministerio de Salud y Protección Social. Manual de implementación de guías de práctica clínica basadas en evidencia, en instituciones prestadoras de servicios de salud en Colombia. 2014. Disponible en: http://gpc.minsalud.gov.co/recursos/SitePages/manual_implementacion.aspx