Diagnosis Of Intrauterine Abnormalities Research Articles

Value of Ultrasonographic Guidance For Operative Hysteroscopy on the Safety and Outcome of the Procedure: Randomized Control Trial

Abstract Background Hysteroscopy is a minimally invasive intervention that can be used to diagnose and treat many intrauterine and endocervical problems. Hysteroscopic polypectomy, myomectomy are just a few of the commonly performed procedures. Hysteroscopy has nearly replaced standard D&C for the management of abnormal uterine bleeding (AUB), as it allows for direct visualization and diagnosis of intrauterine abnormalities, and it often offers an opportunity for simultaneous treatment. Operative hysteroscopy is a safe procedure resulting in complication in 0.95-3% of cases. The most frequently observed complications include hemorrhage (2.4%), uterine perforation (1.5%), and cervical laceration (1-11%). Another rare complication is excessive fluid absorption with or without resultant hyponatremia. Can use of ultrasound guidance during operative hysteroscopy decrease the rate of the operative complication? Objective To assess the value of ultrasound guidance for operative hysteroscopy on decreasing the complication and improving the success rate of the procedure. Patients and Methods It is estimated that a sample size of 88 patients that were divided to 44 patients in the Ultrasound guidance group and 44 patients in the group that didn’t perform ultrasound. The patients were encountered from those presented at the gynecology clinic of the Ain Shams university hospital or those presented at ECDU with the inclusion criteria in the period between December 2017 to November 2018. The patients were approached to participate on study and a written informed consent was taken from all the patients. Results Comparative study between the 2 groups revealed; highly significant increase in success rate in ultrasound guided hysteroscopy (USH) group; compared to conventional hysteroscopy (CH) group; with highly significant statistical difference (p < 0.01) and non-significant difference as regards failure and complications rates (p > 0.05). Conclusion Our study found that ultrasound assistance for difficult hysteroscopy reported that ultrasound appears to be a safe and reliable method of assistance.

L’HYSTÉROSCOPIE DIAGNOSTIQUE

Introduction : It is an essential and necessary tool in the management of intrauterine pathologies. Indeed, it allows a better diagnosis and better distribution of therapeutics, more precisely targeted. It is a quick, minimally invasive, reproducible and reliable. Methods : Retrospective study on a series of 174 cases of diagnostic hysteroscopy performed between january 2004 and december 2006. Results : The mean age was 42,6 years; abnormal uterine bleeding is the main symptom in 110 patients (63%), followed by infertility in 30 patients (17,2%), the abortive disease (7,5%), removal of the intrauterine device (6,9%), and others (5,1%). Nine patients (5%) had a normal examination; intrauterine abnormalities found were: polyps (31,6%), endometrial hypertrophy (32%), submucous adenomyomas (13,8%), synechiae (12%), endometrial atrophy (9,7%), the intrauterine device (6,9%), uterine septum (6,3%), trophoblast retention (3,5%), intraluminal neoplasms (1,7%), and adenomyosis (1,7%). Discussion : The hysteroscopy is accurate, safe, with a low failure rate in the diagnosis of intrauterine abnormalities. It has better sensitivity and specificity compared with sonography and hysterosalpingography. It involves certain risks, but generally remains rare. Conclusion : This examination is currently the gold standard as a diagnostic technique for intracavitary uterine lesions.

Diagnostic hysteroscopy and saline infusion sonography in the diagnosis of intrauterine abnormalities: an assessment of patient preference

This study was conducted to assess whether women would prefer to undergo saline infusion sonography (SIS) or office hysteroscopy for the investigation of the uterine cavity. In a randomised controlled trial, 100 patients underwent SIS or office hysteroscopy for assessing patients' pain scores. After the investigation, 92 of them were asked to fill out an anonymous questionnaire addressing their preference regarding the method of evaluation and treatment of the uterine cavity. A control group, consisting of 50 women who never underwent SIS or office hysteroscopy, was also asked to complete an identical questionnaire. The questionnaire was completed by 113 women (83.7%). Twenty-four (21.2%) women would opt for SIS, whereas 52 (46.0%) would opt for office hysteroscopy, and 37 (32.7%) had no preference. If therapy would be necessary, 48.7% of the women would opt for an outpatient treatment, whereas 33.0% of the women would prefer treatment under general anaesthesia. Despite the fact that SIS is less painful, the majority of the women prefer office hysteroscopy. Additionally, therapy in an outpatient setting is preferred to a day case setting.

Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta‐analysis

This study was conducted to assess the accuracy and feasibility of diagnostic hysteroscopy in the evaluation of intrauterine abnormalities in women with abnormal uterine bleeding. Electronic databases were searched from 1 January 1965 to 1 January 2006 without language selection. The medical subject heading (MeSH) and textwords for the following terms were used: hysteroscopy, diagnosis, histology, histopathology, hysterectomy, biopsy, sensitivity and specificity. University Hospital. The inclusion criteria were report on accuracy of diagnostic hysteroscopy in women with abnormal uterine bleeding compared to histology collected with guided biopsy during hysteroscopy, operative hysteroscopy or hysterectomy. Electronic databases were searched for relevant studies and references were cross-checked. Validity was assessed and data were extracted independently by two authors. Heterogeneity was calculated and data were pooled. Subgroup analysis was performed according to validity criteria, study quality, menopausal state, time, setting and performance of the procedure. The pooled sensitivity, specificity, likelihood ratios, post-test probabilities and feasibility of diagnostic hysteroscopy on the prediction of uterine cavity abnormalities. Post-test probabilities were derived from the likelihood ratios and prevalence of intrauterine abnormalities among included studies. Feasibility included technical success rate and complication rate. One population of homogeneous data could be identified, consisting of patients with postmenopausal bleeding. In this subgroup the positive and negative likelihood ratios were 7.9 (95% CI 4.79-13.10) and 0.04 (95% CI 0.02-0.09), raising the pre-test probability from 0.61 to a post-test probability of 0.93 (95% CI 0.88-0.95) for positive results and reducing it to 0.06 (95% CI 0.03-0.13) for negative results. The pooled likelihood ratios of all studies included, calculated with the random effects model, were 6.5 (95% CI 4.1-10.4) and 0.08 (95% CI 0.07-0.10), changing the pre-test probability of 0.46 to post-test probabilities of 0.85 (95% CI 0.78-0.90) and 0.07 (0.06-0.08) for positive and negative results respectively. Subgroup analyses gave similar results. The overall success rate of diagnostic hysteroscopy was estimated at 96.9% (SD 5.2%, range 83-100%). This systematic review and meta-analysis shows that diagnostic hysteroscopy is both accurate and feasible in the diagnosis of intrauterine abnormalities.

OP18.06: Comparison of saline infusion sonohysterography and 3D transvaginal sonography in diagnosis of intrauterine abnormalities

OP18.06: Comparison of saline infusion sonohysterography and 3D transvaginal sonography in diagnosis of intrauterine abnormalities

R-155. Accuracy of hysterosalpingography in infertile patients for the diagnosis of intrauterine abnormalities

R-155. Accuracy of hysterosalpingography in infertile patients for the diagnosis of intrauterine abnormalities