In PALM-COEIN classification of abnormal uterine bleeding (AUB), the acronym PALM represents structural causes. A 38-year-old with AUB found to have an intracavitary pedunculated fibroid causing submucous involvement of >50% of its diameter is classified as:

• A PALM-C (Coagulopathy) as fibroids affect the coagulation cascade
• B PALM-L0 (Leiomyoma — submucosal pedunculated) by FIGO PALM-COEIN ✓
• C PALM-L1 (Leiomyoma — submucosal) according to FIGO PALM classification
• D PALM-L2 (Leiomyoma — other than submucosal)

Explanation

FIGO's PALM-COEIN classification (2011, revised 2018) divides leiomyomas into: SM (submucosal) and O (other). Within SM, the FIGO leiomyoma subclassification system: Type 0 = pedunculated intracavitary (no intramural component); Type 1 = submucosal with <50% intramural; Type 2 = submucosal with ≥50% intramural. A pedunculated intracavitary fibroid is Type 0 (L0). Type 0 and Type 1 fibroids most commonly cause AUB and are amenable to hysteroscopic resection. In the PALM-COEIN acronym, PALM = Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia; COEIN = Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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