Details
Category: Volume 07 Issue 07 July 2019
Hits: 1203

Title: Role of Diagnostic Hysteroscopy in Abnormal uterine bleeding in perimenopausal females and its histopathological correlation

Authors: Dr Kalpana Tiwari, Dr Abhishek Pareek

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.175

Abstract

Background: Abnormal uterine bleeding is defined as any deviation from the normal menstrual cycle which includes any change in regularity, frequency of menses, duration or amount of bleeding during or in between periods. Objective of this study is to evaluate the diagnostic hysteroscopy in perimenopausal women with abnormal uterine bleeding.

Methods: This study was conducted in women presenting to the gynecological OPD with complain of abnormal uterine bleeding in perimenopausal age group. A total of 50 patients were subjected to diagnostic hysteroscopy.

Results: In this study the Mean age was 44.3 yr. Majority (48%) of patients were in age group of 40-44 yrs. 94% were multiparous. 50% presented with heavy menstrual bleeding. In 56% hysteroscopy was normal and remaining 44% showed abnormal endometrial finding, out of which endometrial hyperplasia seen in 20% cases, polyp in 16% and sub mucosal fibroid in 8% cases. Hysteroscopy has 100% sensitive and 100% specific for endometrial polyp and sub mucosal fibroid indicating that hysteroscopy is the best modality for diagnosing intrauterine pathologies. In the present study hysteroscopy had overall sensitivity, specificity, PPV, NPV 89.36%, 94.77%, 84% & 96.66%.

Conclusion: hysteroscopy is important tool for diagnosing various intrauterine lesions. It should be employed hand in hand in evaluation on AUB.

Keywords: AUB, Hysteroscopy, Endometrial pathology.

References

  1. Vilos GA, Tureanu V, Garcia M, Abu-Rafea B. The levonorgestrel intrauterine system is an effective treatment in women with abnormal uterine bleeding and anticoagulant therapy. Journal of minimally invasive gynecology. 2009 Aug 31;16(4):480-4.
  2. Speroff L, Fritz MA, editors. Clinical gynecologic endocrinology and infertility. lippincott Williams & wilkins; 2005.
  3. Euro pub med central PMID-10524483, Oriel KA, Shrageers university of wiscouin school of Medicine, Madison 53715, USA. American family physician (1999, 6095):1371 -80; discussion 1381-2).
  4. Munro MG, Critchley HO, Fraser IS, FIGO Menstrual Disorders Working Group. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years.Fertility and sterility. 2011 Jun 30;95(7):2204-8.
  5. Lefebvre G. Vilos, C. Allaire, J. Jeffrey. The management of uterine leiomyomas. Am J Obstet Gynecol, 2003;128:1–10.
  6. Özdemir S, Çelik Ç, Gezginç K, Kıreşi D, Esen H. Evaluation of endometrial thickness with transvaginal ultrasonography and histopathology in premenopausal women with abnormal vaginal bleeding. Archives of gynecology and obstetrics. 2010 Oct 1;282(4):395-9.
  7. Fleischer AC, Kalemeris GC, Machin JE, Entman SS, James AE. Sonographic depiction of normal and abnormal endometrium with histopathologic correlation.Journal of ultrasound in medicine. 1986 Aug 1;5(8):445-52.
  8. Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, Brand R, Grady D. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. Jama. 1998 Nov 4;280(17): 1510-7.
  9. de Vries LD, Dijkhuizen FP, Mol BW, Brölmann HA, Moret E, Heintz AP. Comparison of transvaginalsonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding. Journal of clinical ultrasound. 2000 Jun 1;28(5):217-23..
  10. Kotdawala P, Kotdawala S, Nagar N. Eevaluation of endometrium in peri-menopausal abnormal uterine bleeding. J Midlife Health. 2013 Jan-Mar; 4(1):16-21.
  11. Varadarajan R, Sreekantha SM. Role of hysteroscopy in abnormal uterine bleeding in perimenopausal age group. Journal of Evolution of Medical and Dental Sciences. 2013 Mar 11;2(10):1504-9.
  12. Veena BT, Shivalingaiah N. Role of transvaginalsonography and diagnostic hysteroscopy in abnormal uterine bleeding. Journal of clinical and diagnostic research: JCDR. 2014 Dec;8(12):OC06.
  13. Verma U, Garg R, Singh S, Yadav P, Rani R. Diagnostic Approach in Perimenopausal Women with Abnormal Uterine Bleeding. Journal of SAFOMS. 2014 Jan 1;2(1):12.
  14. Arnold JA, Saravanan S. A Two Year Clinicopathological Study of Non-Gravid Women with Abnormal Uterine Bleeding in A Rural Tertiary Care Centre in Tamilnadu: In Concurrence with The Figo Recommendations. Journal of Evolution of Medical and Dental Sciences-JEMDS. 2015Aug 6;4(63):10990-1000.
  15. Dasgupta S, Chakraborty B, Karim R, Aich RK, Mitra PK, Ghosh TK. Abnormal uterine bleeding in peri-menopausal age: Diagnostic options and accuracy. The Journal of Obstetrics and Gynecology of India. 2011 Apr 1;61(2):189-94.
  16. Pillai SS. Sonographic and histopathological correlation and evaluation of endometrium in perimenopausal women with abnormal uterine bleeding. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2014;3(1):113-7.
  17. Bolde SA, Pudale SS, Pandit GA, Matkari PP. Histopathological study of endometrium in cases of abnormal uterine bleeding. Int J Res Med Sci. 2014; 2(4): 1378-1381.
  18. Shobhitha GL, Kumari VI, Priya PL, Sundari BT. Endometrial Study by TVS and It’s Correlation with Histopathology in Abnormal Uterine Journal of Dental and Medical Sciences. 2015;14(4):21-32.
  19. Patil SG, Bhute SB, Inamdar SA, Acharya NS, Shrivastava DS. Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathologic correlation. Journal of gynecological endoscopy and surgery. 2009 Jul; 1(2):98.
  20. Neumann T, Astudillo J. Hysteroscopic study in patients with abnormal uterine bleeding. Revistachilena de obstetriciay ginecologia. 1993 Dec; 59(5): 349-52.
  21. Sciarra JJ, Valle RF. Hysteroscopy: a clinical experience with 320 patients. American journal of obstetrics and gynecology. 1977 Feb 15; 127(4):340-8.
  22. Loverro G, Bettocchi S, Cormio G, Nicolardi V, Porreca MR, Pansini N, et al. Diagnostic accuracy of hysteroscopy in endometrial hyperplasia. 1996; 25:187–91.
  23. Arslan S, Aytan H, Gunyeli I, Koi O, Tuncay G, Tapisiz OL. Office hysteroscopic evaluation of endometrium: Can we hit the target.Arch Gynecol Obstet. 2004; 271:200–2. 
  24. Haller H, Matejčić N, Rukavina B, Krašević M, Rupčić S, Mozetič D. Transvaginalsonography and hysteroscopy in women with postmenopausal bleeding. International Journal of Gynecology & Obstetrics. 1996 Aug 31; 54(2):155-9.
  25. Panda A, Parulekar SV, Gupta A. Diagnostic hysteroscopy in abnormal uterine bleeding and histopathological correlation. J Obstet Gynaecol India. 1999; 49:74–6.
  26. Acharya V, Mehta S, Randar A. Evaluation of dysfunctional uterine bleeding by TVS: Hysteroscopy and Histopathology. J Obstet Gynecol. 2003; 53:170-77.
  27. Chhikara A, Bharti A. Role of Hysteroscopy in the Evaluation of Abnormal Uterine Bleeding. Indian Journal of Applied Research. 2016 Jul 18; 6(6).
  28. Mishra R, Misra AP, Mangal Y. To compare the result of TVS and SIS with hysteroscopy and histopathological examination in perimenopausal and postmenopausal bleeding. Journal of Evolution of Medical and Dental Sciences. 2015; 4(7):1230-1237.

Corresponding Author

Dr Abhishek Pareek

Senior Consultant, Dept. of Surgical Oncology, HCG Hospital, Jaipur, India