Complaints Of Abnormal Bleeding Research Articles

Red cell distribution width and mean platelet volume detection in patients with endometrial cancer and endometrial hyperplasia.

Endometrial cancer is the most common malignancy in women in developed countries, and its incidence is increasing annually. Due to the availability and cost-effectiveness of serum markers of red cell distribution width (RDW), and mean platelet volume (MPV), we decided to investigate these two important markers in patients with endometrial cancer and assess their role in diagnosing the tumor and differentiate it from endometrial hyperplasia and other causes of bleeding. This is a case-control study that examined the data of patients who were referred to Al-Zahra Hospital during 2022-2023 with complaints of abnormal bleeding and underwent diagnostic curettage. Based on the pathology findings, the patients were divided into 3 groups, including endometrial cancer, endometrial hyperplasia, and control. The clinical characteristics and results of MPV and RDW were compared in these three groups. The IBM SPSS Statistics for Windows, Version 21.0. was used for data analysis. In this study, 87 women were examined in three groups endometrial cancer, endometrial hyperplasia, and control with a mean age of 52.70 ± 11.63 years. The results showed that the endometrial cancer group, had higher gravida, underlying disease, history of radiation therapy, anticoagulant therapy, blood transfusion, surgery, and family history of cancer (p < 0.05). Meanwhile, the endometrial cancer group had lower menstrual age and history of using contraceptives than other groups (p < 0.05). In addition, in this study, the results indicated that the levels of MPV and RDW in the endometrial cancer group were significantly higher than in the endometrial hyperplasia and control groups (p < 0.05). Since MPV and RDW are cheap and accessible and can be easily obtained from complete blood count panels, they can be used as suitable diagnostic markers for endometrial cancer. However, conducting comprehensive multicenter prospective studies with a larger sample size can be helpful.

Comparison of transabdominal sonography and transvaginal sonography in evaluation of endometrial thickness in the setting of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a common complaint in women of reproductive age for which they consult their gynecologist and is the direct cause of a significant health-care burden for women. Imaging plays a pivotal role in diagnosing and helping the clinicians choose an appropriate management strategy at the earliest possible juncture, thus relieving patients of their symptoms and preventing complications. This tertiary care hospital-based study aims to assess the role transabdominal sonography in comparison with transvaginal sonography in evaluation of endometrial thickness in the setting of AUB in of in female population of Kancheepuram and West Chennai district of Tamil Nadu. Materials and Methods: It is a prospective study conducted in the Department of Radiology, of a tertiary care hospital in Kancheepuram district of Tamil Nadu, India. One hundred adult females who presented with complaints of abnormal bleeding per vaginum underwent both transabdominal (TAS) and transvaginal ultrasonography (TVS). In addition, they were evaluated for AUB through assessment of endometrial thickness and the presence of other uterine and adnexal pelvic pathologies. Result: The results of the present study show that TVS is superior to TAS in assessing endometrial thickness accurately and has a slightly better role in diagnosing endometrial pathologies such as endometrial polyp, hyperplasia, endometrial carcinoma, and number and location of Submucosal/intramural leiomyomas. Conclusion: TVS is superior to TAS in assessing endometrial thickness accurately and have high sensitivity and accuracy in the diagnosis of pelvic pathologies and determination of the type of pelvic mass was improved significantly when a transvaginal study was performed after TAS in cases of AUB.

Improving the performance of reflex Human Papilloma Virus (HPV) testing in triaging women with atypical squamous cells of undetermined significance (ASCUS): A restrospective study in a tertiary hospital in United Arab Emirates (UAE)

IntroductionCervical cancer is the second commonest cancer in women worldwide. Infection with oncogenic types of human Papillomavirus (HPV) is the most important risk factor for developing cervical cancer. Reflex High risk HPV (HR-HPV) testing is of significant value in the assessment of Papanicolaou (Pap) smear results where ASCUS are identified. ObjectiveTo improve the performance of reflex HR-HPV testing in triage of ASCUS and analyze the factors impacting it. MethodologyIn this study, we generated a database of 9641 women who had cervical smears collected during the study period from the cytopathology record in a large tertiary hospital in UAE. These included 297 smears with ASCUS diagnosis. All cases were retrospectively followed up with a mean duration of 2.44 years. We analyzed data according to the outcome based on several follow-up Pap smear analysis as the reference assessment. ResultsWe detected HR-HPV infection in 17.9% of cases. 9.1% <25, 28.8% 25–34 and 62.1% ≥35 years old. HR-HPV prevalence was higher among premenopausal women (20.7%) compared to postmenopausal women (9.5%) (P-value=0.044). The rate of progression to high grade lesions was also higher (28.7%) in the premenopausal group compared to (12.8%) in the postmenopausal group. Reflex HPV testing had an overall sensitivity of 41.1%, specificity of 88.2%, positive predictive value (PPV) of 62.1%, and negative predictive value (NPV) of 75.9% in detection of cervical lesions. These figures were higher on combining premenopausal status and complaint of abnormal bleeding or discharge/itching (66.7%, 93.3%, 66.8% and 93.3% respectively). ConclusionsThe sensitivity, specificity and NPV of reflex HPV testing in the triage of ASCUS cases can be more accurate in premenopausal women upon adding age group and presenting complaint as a triage item. This improves the performance of reflex HPV testing and the subsequent selection of high risk patients for colposcopy.

Asymptomatic cervical polyps: can we just let them be?

Routine polypectomy is still practiced in many settings. The objective of this study was to establish the frequency of dysplasia or malignancy found in cervical polyps from a multiyear sample after abnormal specimens performed for indication were excluded. This is a retrospective study of the pathology results from 2006-2013, inclusive. The study included 898 polyps from 854 nonpregnant women, after the 17 abnormal specimens from women who presented with complaints of abnormal bleeding or for evaluation of abnormal cytological tests were excluded; none of the 898 specimens showed any significant abnormalities. The results did not vary by patient age or polyp size. Routine removal of cervical polyps in asymptomatic women with current, normal cervical cytology testing is unwarranted because it adds little to their management and it has the potential to cause harm.

Evaluation and histopathological correlation of abnormal uterine bleeding in perimenopausal women

Objectives: To study the causes of abnormal uterine bleeding in perimenopausal women and to correlate their clinical evaluation with ultrasonographic and histopathological examination. Method: This is a retrospective study of 100 perimenopausal women with complaint of abnormal bleeding in the age group ranging from 40 years till 1 year within the menopause, who underwent hysterectomy at Lok Nayak Hospital. The age, parity, menstrual complaints of these patients were noted & clinical diagnosis and ultrasonography were analysed. Finally, histopathology report of the hysterectomy specimen was correlated with the clinical profile of the patient and ultrasonographic findings. Results: Maximum frequency of abnormal uterine bleeding was seen in the age group 40– 45 years. Most of the patients were para 3. Menorrhagia was the commonest complaint & fibroid uterus was responsible for abnormal uterine bleeding in 53% of women. Out of 39 women labelled clinically as dysfunctional uterine bleeding, 8 patients were diagnosed with fibroid uterus on ultrasound & in rest of the 31 patients, no organic cause was found. Out of these 31 patients, 4 patients were diagnosed to have adenomyosis on histopathology & in rest, no gross pathology was detected. Suspected malignancy in all the 3 patients was confirmed on histopathology. Simple endometrial hyperplasia without atypia was present in 19% patients. Conclusion: Clinical, radiological & pathological evaluation correlated well to diagnose fibroids, however clinically as well as ultrasound proved to be of little help in diagnosing adenomyosis.

Directed laparoscopic cryomyolysis: A possible alternative to myomectomy and/or hysterectomy for symptomatic leiomyomas

Objective The purpose of this study was to develop a minimally invasive, safe, and effective technique for managing symptomatic uterine myomas. Study design Twenty patients with symptomatic uterine fibroids were treated. All had complaints of abnormal bleeding and/or pelvic pain/pressure and/or urinary frequency. Myoma diameters were 4 to 8 cm. Power color Doppler imaging was performed preoperatively and postoperatively to determine the effectiveness of cryomyolysis in reducing or eliminating the primary blood supply, as well as regression of the myomas. Laparoscopic cryomyolysis was performed with use of the Her Option Cryoablation System (American Medical Systems Gynecology, San Diego, Calif). Patients were evaluated at 1, 3, and 6 months postoperatively. Results All patients were discharged within 24 hours of treatment. No intraoperative or postoperative complications occurred. Of the 20 patients treated, 19 had complete resolution of their complaints. Myomas regressed up to 80%, and major blood supply to the myomas was eliminated. Conclusion Directed laparoscopic cryomyolysis is an effective and safe technique for symptom relief from leiomyomas.