Endometrial pathology in abnormal uterine bleeding (AUB) & role of different techniques of endometrial sampling in evaluation of AUB: A cross-sectional study

Abstract

: Abnormal uterine bleeding (AUB), traditionally defined as uterine bleeding that is abnormal in volume, regularity, and/or timing. It affects 14–25% of women of reproductive age. AUB has a major impact on quality of life of women. Aetiology of AUB may be structural and functional and varies with the age group. Histology of endometrium remains the mainstay in diagnosis of pathology and management of AUB. Various techniques such as endometrial sampling by pipelle, dilatation and curettage (D & C) and hysteroscopy are used to obtain endometrium for histological diagnosis. A single center prospective cross-sectional study at teaching institute was carried out to include 150 females from 18-70 years presenting with abnormal uterine bleeding. Objective of study was to analyse prevalence of various endometrial pathologies in AUB, symptomatology as well as age wise distribution of various endometrial pathologies in AUB and compare feasibility of different techniques of collecting endometrial sample. Endometrial sample was obtained either by OPD Pipelle brush or Surgical Dilatation and Curettage method or hysteroscopy. Statistical Analysis was done by using Epi-Info-7 software.Commonest age group presenting with AUB was 41-50 (40%) years, 64% were para 3 or more, Proliferative and secretary changes, 53(35.3%) and 24(16%) cases while endometrial hyperplasia without atypia 18 (12%) cases and with atypia 7 cases (4.7%), endometrial carcinoma 5 cases (3.3%) while endometrial polyp was seen in 8 cases (5.3%). Heavy menstrual bleeding with normal duration was the commonest presentation in 64%. Endometrial sampling technical failure was seen in 2 cases with pipelle biopsy while in 7 cases inadequate sample was obtained with pipelle and dilatation and curettage. Uterine perforation was seen in one case which was managed conservatively.Technical failure and inadequate sample needs to be addressed considering background high risk factors, TVS imaging, repeat sample and use of hysteroscopy may be offered case to case basis.