Evaluation Of Abnormal Bleeding Research Articles

Frequency of Common Histopathological Findings among Patients Having Endometrial Thickness ≥5mm

Aim: To determine the frequency of common histopathological findings among patients having endometrial thickness >5mm and having atypical bleeding of uterus. Study design: Descriptive and cross sectional study Study settings: Department of Obstetrics & Gynaecology, Kishwer Fazal Teaching Hospital, Sheikhupura from 1st October 2020 to 31st March 2021. Methodology: One hundred and twenty patients were enrolled. Patients were aged between 45 to 60 years. Patient’s detailed demographics including age, parity, socioeconomic grade and body mass index were recorded post written informed consentreceival. Patients having endometrial thickness >5mm with abnormal uterine bleeding were included in this study.All the patients were undergone for transvaginal ultrasonography (TVS). Outcomes were histopathological findings observed. Results: The patients mean age was found to be 51.16±4.88 years with mean body mass index 27.24±4.63 kg/m2. Thirty five (29.2%) patients had parity I and 85 (70.8%) patients had parity II. Forty two (35%) patients had high socioeconomic status and 78(65%) were from low socio economic status. Majority of the patients 80(66.7%) were from rural areas. Secretory and proliferative were the most common histopathological findings found in (45.83% and 26.7%) patients. Frequency of endometrial carcinoma was found among 97(80.8%) cases. Conclusion: The most common histopathological findings were secretory and proliferative and frequency of endometrial carcinoma was too high. Endometrial anomalies can be excluded by transvaginal ultrasonography and is strongly useful in the evaluation of abnormal bleeding from the uterine. Keywords: Endometrial, Transvaginal ultrasonography, Uterine bleeding

Evaluation of Abnormal Bleeding in Children

Abnormal bleeding or bruising is a relatively common clinical concern, frequently causing parents to seek care from their children's primary care provider. Although ecchymosis from playful trauma, occasional epistaxis, and heavy menstrual bleeding around the time of menarche and beyond are common occurrences, it can be difficult for pediatricians and other primary care providers to determine if their patient has age-appropriate symptoms versus abnormal or excessive bleeding. This review discusses considerations for abnormal bleeding in pediatrics and discusses an initial approach for evaluation of hemostasis in a child with bleeding symptoms. [Pediatr Ann. 2020;49(1):e36-e42.].

Endometrial Biopsy and Sonography in the Evaluation of Abnormal Bleeding After Endometrial Ablation

Currently, there is little data to guide clinicians in the evaluation of a uterine cavity in the setting of abnormal bleeding after endometrial ablation. Our objective was to compare the accuracy of transvaginal 2D ultrasound and endometrial biopsy in identifying uterine causes for postablative vaginal bleeding to pathology findings at hysterectomy.

Endometrial thickness screening in premenopausal women with abnormal uterine bleeding

We read with interest the analysis by Getpook and Wattanakumtornkul on endometrial thickness screening in premenopausal women. However certain issues need to be clarified: Endometrial biopsy has replaced dilatation and curettage (D&C) as the diagnostic tool in the evaluation of abnormal bleeding with equivocal efficacy (level 3 evidence). This minimally invasive modality is safe convenient and low-risk. In-office sampling of the endometrial lining can be performed with the Novak or Kevorkian curet the Pipelle endometrial-suction curet and the Vabra aspirator. Studies reveal that endometrial biopsy has sensitivities ranging from 83 to 96% for the detection of endometrial cancer in comparison to hysterectomy specimens. Can the authors kindly comment on why they preferred D&C over endometrial biopsy? Studies that examined large populations in Scandinavia Italy and the United States showed the accuracy of using transvaginal sonography (TVS) as a predictor of the presence or absence of endometrial disease. A meta-analysis confirmed the use of TVS as a means of excluding endometrial carcinoma. Could the authors comment on the incidence of abnormal endometrial sonographic texture in their population? Endometrium becomes progressively thicker during the normal menstrual cycle. Menstruating endometrium will always be thinner. The authors did not mention the time/phase of menstrual cycle when D&C was conducted. Exogenous hormone use has an influence on endometrial thickness. The authors did not mention the percentage of women who were already receiving exogenous hormones. We therefore seek the authors clarification on the points listed above and hope further discussion and suggestion will contribute to the advancement and popularity of the authors findings among practicing gynecologists. (full text)

Is Outpatient Diagnostic Hysteroscopy More Useful Than Endometrial Biopsy Alone for the Investigation of Abnormal Uterine Bleeding in Unselected Premenopausal Women? A Randomised Comparison

This article presents the results of a randomized, controlled trial comparing diagnostic hysteroscopy and endometrial biopsy in the evaluation of abnormal uterine bleeding. Between August 1996 and October 1999, premenopausal women who were referred to the Aberdeen Royal Infirmary for evaluation of abnormal uterine bleeding were offered the opportunity to participate in the trial. The study subjects were randomly assigned to have endometrial biopsy, which was performed at the first visit using a 3-mm flexible Pipelle, or hysteroscopy in a dedicated hysteroscopy clinic within 2 weeks of their initial clinic visit. There were a total of 370 final study participants. Hysteroscopy was not possible in 28 patients; 19 of these women were evaluated with endometrial biopsy. Cervical stenosis prevented endometrial biopsy in 11 patients, and 6 were unable to tolerate the pain associated with the procedure. The results of a patient questionnaire completed after the evaluation procedure found no significant difference in patient acceptability of either method. The results of the McGill Pain Assessment Questionnaire showed that patients found neither procedure much more uncomfortable than a regular gynecological examination. No endometrial atypia was found in any patient by endometrial biopsy. Of the 178 women who underwent hysteroscopy, a normal endometrial cavity was seen in 123, uterine fibroids were diagnosed in 21, a congenital abnormality was found in 2, and 1 was not evaluable. Further clinical investigation was carried out in nine women under general anesthesia, one of whom was found to have a polyp. Four of the women who were unable to complete endometrial biopsy underwent hysteroscopy under general anesthesia. A submucosal fibroid was found in one, and the findings were normal in the other three. In the 178 patients who underwent hysteroscopy, 11 were diagnosed with endometrial polyps, and 22 were diagnosed with uterine fibroids. There was no statistically significant difference in the rate of uterine abnormality between women with irregular bleeding patterns and those with regular patterns. Hysteroscopic findings had no influence on subsequent management of patients. There were no directed resections for fibroids or polyps identified by diagnostic hysteroscopy, and endometrial ablation or resection was performed only at the patient's request. Not all women with endometrial polyps or fibroids received further treatment. Five percent of the hysteroscopy group and 4% of the endometrial biopsy group underwent hysterectomy. At follow-up 6 months to 1 year after evaluation of abnormal bleeding, 11% women, equally represented in both groups, had changed their treatment program, either by stopping medication or undergoing endometrial ablation.

Uterine granulomas: clinical and pathologic features.

We retrospectively studied the clinical and pathologic features of uterine granulomas over a 10-year period. Granulomas were detected in 30 women, 22 to 81 years old, in the cervix (n = 12/1,090 cervical specimens; 1.1%) or uterine corpus (n = 18/12,000 uterine specimens; 0.15%). They were discovered during evaluation of abnormal bleeding, cytologic specimens, or other gynecologic conditions. None of the patients had constitutional symptoms. These granulomas were often focal (n = 25 [83%]), exhibiting features of foreign body-type (n = 17 [68%]); or they were diffuse (n = 5 [17%]), all with negative acid-fast bacilli or fungal stains and sometimes necrotizing (2 [40%]). Focal granulomas were highly associated with a preceding biopsy or surgery (22/25 vs 14/53 age-matched control subjects). Follow-up of 28 patients (median, 16 months) showed that 27 remained healthy; only 1 patient developed generalized lesions consistent with sarcoidosis 16 months later Uterine granulomas are rare. They are eitherfocal, related to previous biopsy or surgery, or diffuse, usually representing local reaction without an obvious cause. Association with infection or systemic granulomatous disorders is uncommon.

The uterus and endometrium.

Transvaginal sonography is useful for the identification of physiologic and pathologic changes within the myometrium and endometrium. Endometrial ultrasonography is simple to learn because of the reliable identification of the uterus. It is useful for monitoring fertility treatment, evaluation of abnormal bleeding and monitoring patients in the menopause.