Evaluation Of Abnormal Uterine Bleeding Research Articles

Correlation of Abnormal Uterine Bleeding (AUB) with Thyroid Profile and Endometrial Biopsy

Abnormal uterine bleeding (AUB) is defined as any change in the frequency of menstruation, duration of flow or amount of loss. Menstrual disturbances and different endometrial pattern may accompany and precede thyroid dysfunction. The objective of the study was to correlate thyroid profile with endometrial biopsy in cases of AUB. This study was conducted on 74 patients who presented with AUB, had undergone TFT and endometrial biopsy/hysterectomy. Among 74 patients, thyroid disorders were identified in 26 patients. Maximum number of patients with AUB belonged to the category of hypothyroidism (27%) and 8.1% of cases had hyperthyroidism. In the present study 29 (39.1%) had proliferative endometrium, followed by secretory pattern in 21 (28.4%) patients. Hormone induced changes was seen in 3 (4.1%) patients. Disordered proliferative endometrium and endometrial hyperplasia was observed in 6 patients (8.1%) each. Malignant lesion was not common and it comprised of only 1.4% cases. AUB is frequently seen in patients with thyroid dysfunction. Thyroid function test is a cost effective, easily available test and can detect a possibly curable cause of AUB and avoid unnecessary intervention like hormonal treatment and hysterectomy. AUB due to endometrial cause is an age related pathology. Histopathological examination of endometrial biopsy is a major diagnostic tool in evaluation of AUB. It helps the physician to plan therapy for successful management of AUB.

Costs for diagnostic evaluation of abnormal uterine bleeding are high, vary greatly in the USA

Costs for diagnostic evaluation of abnormal uterine bleeding are high, vary greatly in the USA

PULMONARY ROCKS! A CASE OF PULMONARY ALVEOLAR MICROLITHIASIS

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Pulmonary alveolar microlithiasis (PAM) is an extremely rare lung disease characterized by the development of calcium phosphate deposits (microliths) within the alveolar spaces. Genetic mutations in the SLC34A2 gene (solute carrier family 34 member 2 gene), which encodes for a sodium-phosphate co-transporter, have been described as the cause of the disease. This co-transporter is located on type II alveolar pneumocytes and is responsible for removing phosphate ions from the alveolar space. Without effective transport, phosphate ions bind to calcium ions leading to calcium phosphate deposits within the alveoli. Over time this often leads to pulmonary fibrosis and progressive respiratory failure. Here, we present a case of pulmonary alveolar microlithiasis that was initially suspected to be metastatic endometrial carcinoma. CASE PRESENTATION: A 37-year-old female presented to gynecology clinic for evaluation of abnormal uterine bleeding. Endometrial biopsy showed endometrioid adenocarcinoma of the uterus. Staging CT scans revealed bilateral adnexal masses, metastatic disease in the liver, peritoneal carcinomatosis, and concern for lymphangitic carcinomatosis in the lungs due to calcification of the pleura and diaphragm. Liver biopsy confirmed metastatic disease of ovarian primary consistent with synchronous stage IV ovarian cancer. She underwent chemotherapy with carboplatin and paclitaxel as well as abdominal hysterectomy and debulking surgery with good response; however, repeat CT chest showed persistent pulmonary disease with innumerable calcified micronodules and extensive pleural, fissural, and interlobular calcifications. Transbronchial biopsies were obtained and revealed diffuse intra-alveolar laminated concentric deposits consistent with microliths and diagnostic of pulmonary alveolar microlithiasis. At the time of diagnosis her pulmonary function testing showed mild restriction. She has no family history of pulmonary disease and had no pulmonary symptoms. Calcium supplements were discontinued, and she was treated with a low phosphorus diet. She continues to undergo monitoring for the development of symptoms as well as monitoring of her pulmonary function. DISCUSSION: PAM is an extremely rare genetic disease caused by a defective sodium-phosphate co-transporter that leads to the accumulation of microliths within the alveolar spaces. Pulmonary fibrosis and progressive respiratory failure is the typical cause of death, although the rate of progression is variable. There is no known effective treatment except for lung transplant. A low phosphorus diet, bisphosphonates, and repeated bronchoalveolar lavage have been studied without clear clinical benefit. CONCLUSIONS: (See Discussion) REFERENCE #1: Castellana G, Castellana G, Gentile M, Castellana R, Resta O. Pulmonary alveolar microlithiasis: review of the 1022 cases reported worldwide. Eur Respir Rev. 2015 Dec;24(138):607-20. REFERENCE #2: Saito A, McCormack FX. Pulmonary Alveolar Microlithiasis. Clin Chest Med. 2016;37(3):441-448. doi:10.1016/j.ccm.2016.04.007. DISCLOSURES: No relevant relationships by Carlos Cardenas, source=Web Response No relevant relationships by Sakda Sathirareuangchai, source=Web Response No relevant relationships by Andrew Tomlinson, source=Web Response

Spectrum of endometrial pathology in patients with abnormal uterine bleeding

Introduction: Abnormal uterine bleeding (AUB) is one of the most common problems among women of all age groups. Endometrial sampling is a frequently performed procedure by the gynecologist that offers an opportunity to diagnose pathological conditions in the endometrium to accurately evaluate and diagnose the etiology. A study of the endometrium will establish the underlying cause and thereafter help the gynecologist to plan for the management. Aims: To study the histopathological pattern and spectrum of lesions in a patient with AUB. To analyze various pathological conditions and to highlight the importance of endometrial histology. Materials and Methods: This is a retrospective study that evaluated 83 patients with AUB by dilatation and curettage and/or endometrial biopsy of the rural population. Results: The most common endometrial pattern found to be hyperplasia without atypia (19/83) 22.9% followed by disordered proliferative (17/83) 19.27% and later by endometrial polyp (8/83) 9.63%, atypical hyperplasia/endometrioid intraepithelial neoplasia (1/83) 1.2% and lastly one case each of chronic non-specific endometritis, tuberculous endometritis, and histiocytic endometritis. There were 2/83 that is 2.4% case of endometrial adenocarcinoma with age range falling between above 50 years. Conclusion: Endometrial biopsy or curettage could be a safe and effective diagnostic step in the evaluation of AUB after ruling out medical causes with a detailed workup of the patient. This could help the clinician to design therapy for successful management.

Endometrial biopsy is an important diagnostic tool for the evaluation of abnormal uterine bleeding

In this study 100 biopsies were taken from the endometrium of childbearing women (18-50 yrs. of age) suffering from abnormal vaginal bleeding from Jan 2019-Dec 2019. Endometrial Biopsy (EB) is safe, an outpatient procedure, low cost, carries out without general anesthesia & the incidence of hemorrhage, infection & uterine perforation are less common than with D&C. EB is an alternative to dilatation & curette (D&C) for the evaluation of infertile & abnormal vaginal bleeding or dysmenorrheic patients. There are two main groups of causes to irregular vaginal bleeding. 1. Organic disease (74% of the cases), in this group there are obvious lesion such as, endometrial polyp, endometrial hyperplasia & chronic endometritis. The most common cause was endometrial hyperplasia 48%, it is commonly seen during the perimenopausal period (40-50yr). Less common causes include chronic endometritis 8%, hydatidiform mole 7%, and endometrial polyp 7%. 2. non-organic disease comprises 19% of all cases, anovulatory period 13% or Luteal phase insufficiency 6%. They are commonly seen from age of 18-40yrs. 6% of the cases found to have normal endometrium. 5 endometrial biopsies were inadequate & unsatisfactory for histopathological interpretation. The aim of this study is to evaluate the usefulness & disadvantages of EB & to compare it with the traditional method of endometrial curette.

13. Contraceptive Implant-associated Abnormal Uterine Bleeding in Adolescents and Young Adults: Predictors, Management, and Rates of Continuation

<h3>Background</h3> Abnormal uterine bleeding (AUB) is commonly experienced by adolescents and young adults (AYA) following contraceptive implant placement. We assessed for predictors of AUB, factors contributing to AUB management, and differences in implant continuation rates by AUB management approach. <h3>Methods</h3> We analyzed data from a long-acting reversible contraception database from 3 AYA sites in tertiary care institutions. We included patients with the contraceptive implant placed from 7/1/2014-12/31/2018 and follow-up data through 12/31/2019. We excluded patients with ≥3 years since insertion without follow-up. Variables included age at insertion, comorbid conditions, menstrual history, prior contraceptive use, patient-reported AUB after implant placement, AUB evaluation and management, and implant discontinuation. We included data from insertion, follow-up, and removal visits. We assessed AUB predictors with logistic regression. Descriptive statistics, chi-square, and t-tests compared patient demographic and clinical variables by AUB status. Survival analysis examined predictors of time to discontinuation. This study was IRB approved. <h3>Results</h3> Our sample included 609 patients, average age was 19 years (SD=2.5). Prior to implant placement 37% reported irregular menses, and after insertion 25% reported AUB. In those with AUB, 67% had evaluation and management including laboratory studies (32%), pelvic ultrasound (4%), or medication therapy (86%). Medication initiation occurred at first AUB report for the majority of patients. Of those prescribed a medication, 60% received a combined oral contraceptive or progestin-only pill. AUB was associated with polycystic ovary syndrome (PCOS) in bivariate analysis (p-value=0.006), 57% of patients with PCOS (n=14) reported AUB after implant insertion. This association persisted after adjusting for age, medical comorbidities, menstrual history, and prior contraceptive use. Bivariate analyses did not identify any predictors for AUB evaluation and management. Implant discontinuation was low: 16% at 1 year, 27% at 2 years, and 35% at 3 years. Early discontinuation was significantly different between patients with and without AUB: 21% vs. 14% at 1 year (p-value=0.047), 38% vs. 23% at 2 years (p-value=0.000), 44% vs. 31% at 3 years (p-value=0.007). Medication for AUB management did not impact rates of or time to early discontinuation. <h3>Conclusions</h3> In this large cohort of AYA, PCOS was the only significant predictor of implant-associated AUB. There were no relationships between AUB and comorbid medical conditions or prior contraceptive use. There were no significant predictors of AUB evaluation and management following implant insertion, and such evaluation and management did not impact rates of early discontinuation.

A STUDY OF CLINICAL CORRELATION WITH HISTOPATHOLOGICAL DIAGNOSIS OF ABNORMAL UTERINE BLEEDING AT JLNMCH, BHAGALPUR, BIHAR

Background: Abnormal uterine bleeding in perimenopausal women accounts for about 70% of gynaecologic Outpatient Department visits. Perimenoppause, also called the menopausal transition, is the interval in which a woman's body makes a natural shift from more or less regular cycles of ovulation and menstruation toward permanent infertility, or menopause. Polymenorrhagia, intermenstrrual bleeding and metrorrhagia are other common disorders at perimenopause. Endometrial sampling is a safe and effective diagnostic step in evaluation of abnormal uterine bleeding after ruling out medical causes. The present study was aimed to review the causes of abnormal uterine bleeding in perimenopausal women establishing the correlation with clinical diagnosis and histopathological examinations. A total of 150 perimenopausal Material and Methods: women with abnormal uterine bleeding in the age group of 37-51 years for a period of 6 months were included. These women were evaluated clinically and ultrasonographically for the cause of abnormal uterine bleeding. Clinical impression and USG reports were correlated. These women underwent dilatation and curettage for endometrial sampling and specimen sent for histopathological examination. Histopathological reports were correlated with clinical diagnosis. Most of the patients with AUB were Results: between 37-41 years of age (56%). The incidence was high in parity-3 (26%) annd grand multipara (49.33%). The majority of the women were presented with menorrhagia (54.66%). Clinically, majority of the cases were diagnosed as broids 66 (44%) followed by dysfunctional uterine bleeding (DUB) 56 (37.33%). However, histopathological reports conrmed broid in 52 cases, DUB in 49, adenomyosis in 36 and polyp in 11 cases. Fibroi Discussion: ds are common nding in women with menorrhagia. Clinical, radiological and pathological evaluation correlated very well to diagnose broids and DUB. However clinically as well USG proved of little help to diagnose adenomyosis and carcinoma of cervix and endometrium. Thus, histopathological evaluation of endometrium is recommended in perimenopausal women.

Abstract PO035: Identification and validation of endometrial cancer specific miRNA biomarkers in endometrial fluid collected using saline infused sonohysterography techniques

Abstract Abnormal uterine bleeding is a common benign gynecologic complaint around the time of menopause, and is also the most common symptom of endometrial cancer. This complaint prompts in-office endometrial biopsy to exclude malignancy. Unfortunately, because only a limited portion of the lining tissue is sampled, the endometrial biopsy is not always accurate which can lead to delays in diagnosis and the potential for worsening of the disease and prognosis. Biomolecules have proven to be useful tools in cancer screening and early diagnosis. Liquid biopsy has been widely accepted as a less- or non-invasive way to obtain samples from patients, including blood, urine, saliva and other types of body fluids. However, no circulating biomarkers have been easily identified in the patient blood of endometrial cancer. MicroRNA are a class of small molecules and has shown promise in cancer detection. MicroRNAs may be detected in the biopsy tissue or by testing the fluid that cells secrete. Endometrial tissue is inherently difficult to sample in the office. Although direct sampling from the endometrium has limitations, but the fluid secreted by the lining endometrial epithelial cells can be easily sampled using a technique adapted from an in-office procedure known as a sonohysterography. This procedure is used in the evaluation of abnormal uterine bleeding by introducing saline solution into the endometrial cavity as a contrast material during transvaginal ultrasound. The infused saline is normally discarded, but can be collected for microRNA analysis. In this study, we report the preliminary results of potential miRNA biomarkers identified in 60 patient endometrial fluid collected using sonohystography technique. Patients were recruited who planned to undergo hysterectomy for either benign indication or for a known endometrial cancer diagnosis. The endometrial fluid was collected prior to surgery using a technique similar to that used in sonohysterography. The miRNA was extracted and quantitated. Following the reverse transcription, each sample was amplified on a customized microarray plate with known specific miRNA target primer printed in each well (miScrpt miRNA PCR Array). Patient demographic and health information was collected to be used in the final analysis along with the final pathology results of their surgery. In total, 60 patient samples have been collected and processed (30 cancer and 30 controls). Significant variations in expression were identified in several miRNA markers. Markers with at least a two-fold increase (e.g. miR-429, miR-146a-5p, miR-34b-3p) or decrease (e.g. miR-296-5p, miR-204-5p) in expression were considered candidates for validation. Twelve miRNA markers with the greatest variation in expression were chosen to be used on an additional set of patients to further validate the results. The results will be presented. The method developed here will provide a non-invasive way in early diagnosis and screening for endometrial cancer and therefore impact on improvement of women’s health. Citation Format: Jianing Yang, Joel Barkley, Kameron Firouzi, Bikash Bhattarai, Dean Coonrod, Frederic Zenhausern. Identification and validation of endometrial cancer specific miRNA biomarkers in endometrial fluid collected using saline infused sonohysterography techniques [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr PO035.

Validity of Hysteroscopy and Transvaginal Sonography in Evaluating Abnormal Uterine Bleeding- A Retrospective Study

Introduction: Abnormal Uterine Bleeding (AUB) affects 14-25% of women of reproductive age group and accounts for 66% of hysterectomies. Accurate diagnosis of the cause of AUB will reduce the hysterectomy burden, but the ideal evaluating tool to accurately diagnose the cause of the same is debatable. Aim: To evaluate the diagnostic accuracy of transvaginal sonography and hysteroscopy in the evaluation of abnormal uterine bleeding, using histopathological diagnosis as gold standard. Materials and Methods: This retrospective descriptive study was conducted on patients who underwent transvaginal sonography and hysteroscopy for evaluation of abnormal uterine bleeding from January 2017 to January 2020. Data including demographic details, sonographic details, pre-operative diagnosis, anaesthesia used, operative notes, complications and histopathological diagnosis were obtained from clinical record sheet of the patients. Sensitivity, specificity, diagnostic accuracy of TVS and hysteroscopy was calculated using MedCalc software version 19.2.6. Results: A total of 214 patients were enrolled in the study. Hysteroscopy reported &gt;95% diagnostic accuracy for all intrauterine pathology compared to TVS which revealed diagnostic accuracy of 73.13% for polyp, 77.1% for endometrial hyperplasia and 73.6% for all other pathology. Hysteroscopy revealed strong to almost perfect correlation with histopathological diagnosis for all pathology compared to TVS which demonstrated weak correlation for various intrauterine pathology. Conclusion: Hysteroscopy should be used as initial evaluating tool in AUB as it is simple and minimal-invasive with high diagnostic accuracy.

Validation of Pipelle endometrial biopsy in patients with abnormal uterine bleeding in Kazakhstani healthcare setting

Background: Abnormal uterine bleeding is a common sign which cover various conditions e/o pathologies. Different approaches are used to evaluate this condition. The aim of this study was to investigate the validity of Pipelle biopsy for endometrial sampling in Kazakhstani women with abnormal uterine bleeding. For this reason, we carried out a prospective study of 120 patients who underwent endometrial sampling due to abnormal uterine bleeding in a tertiary hospital setting in Kazakhstan. Methods: Statistics included descriptive analysis to evaluate the frequency of various endometrial conditions. The validity of Pipelle biopsy sampling was calculated by estimating sensitivity, specificity, accuracy, and positive and negative predictive values. For the Pipelle sampling validity assessment, we analyzed 120 samples, as 21 patients with insufficient samples were excluded. Results: Overall, concordance in histopathologic results was 92.93%. Pipelle sampling identified two cases of adenocarcinoma in our group. Moreover, endometrial hyperplasia was detected with 71.43% sensitivity, 98.82% specificity, PPV of 90.91% and NPV of 95.45%. However, the Pipelle reliability was low in cases of endometrial polyps. In conclusion, the Pipelle method was found to be valid for the diagnosis of endometrial hyperplasia and adenocarcinoma with high SN, SP, PPV and NPV. Conclusions: The Pipelle technique for evaluation of abnormal uterine bleeding in the Kazakhstani health care setting is a useful method with the highest efficacy in ruling out endometrial hyperplasia and diagnosing adenocarcinoma. If endometrial polyp was suspected under ultrasound scan in patients with abnormal uterine bleeding, physicians should consider other tools for endometrial sampling.

Transvaginal Ultrasonography and Hysteroscopy in Evaluation of Abnormal Uterine Bleeding- A Cross-sectional Study

Introduction: In perimenopausal age group particularly, 70% of all gynaecological consultations are for Abnormal Uterine Bleeding (AUB). About 30% of women seek medical assistance for AUB during their reproductive age group and about one third of hysterectomies are carried out for AUB alone. Aim: To determine the sensitivity, specificity, positive predictive value and negative predictive value of Transvaginal Ultrasonography (TVS) versus hysteroscopy in detecting uterine abnormalities Materials and Methods: A cross-sectional study in patients with AUB, admitted to the Department of Obstetrics and Gynaecology at RGGWCH, Puducherry between February 2016 and February 2017 who met the inclusion criteria were included. Sample size was 85 cases. After taking detailed history and physical examination the patient was investigated to rule out organic causes of AUB and then TVS and hysteroscopy were done. Any intrauterine pathology was looked for and endometrial sampling was taken from the abnormal sites for Histopathological Examination (HPE). Both TVS and hysteroscopy results were compared with histopathology which is the gold standard. Results: The sensitivity of TVS in diagnosis of uterine fibroid in comparison to hysteroscopy was 94.74% and the specificity was 71.21%. The sensitivity of hysteroscopy in diagnosis of endometrial hyperplasia in comparison to HPE was 75% and the specificity was 87.01%. The sensitivity of TVS in diagnosis of endometrial hyperplasia in comparison to HPE was 37.5% and the specificity was 90.91%. The sensitivity of hysteroscopy in diagnosis of polyp in comparison to HPE was 100% and the specificity was 97.3%. The sensitivity and specificity of TVS in diagnosis of polyp in comparison to HPE were 9.09% and 93.24%, respectively. Conclusion: TVS had a high sensitivity to detect fibroids but its value in detecting hyperplasia and polyps was in question in this study. But hysteroscopy had a maximum sensitivity to detect polyps and high sensitivity to detect endometrial hyperplasia compared to histopathology which is a gold standard investigation.

Clinico-histomorphological spectrum of abnormal uterine bleeding

Introduction: Abnormal uterine bleeding is considered as one of the most common and perplexing problems both to the patient and gynecologist. Histopathological diagnosis of organic cause of menorrhagia plays an important for appropriate and accurate therapy. Aims and Objectives: The present study mainly aimed at correlating histopathological findings with age, parity and bleeding pattern presented by the patient and to study various associated organic lesions in abnormal uterine bleeding. Materials and Methods: A reterospective study of 111 hysterectomies in patients with complaints of abnormal uterine bleeding over a period of one year from June 2016-May 2017. The histopathological findings with clinical data that includes age, parity, presenting symptoms and other details of the patients with abnormal uterine bleeding was collected and analyzed. Results: In this study, majority of cases were in 4th & 5th decade (81.08%) and were multiparous (93.7%). Menorrhagia was the most frequent presenting complaint (58.57%) followed by metrorrhagia in 13.51%. Of the 111 cases, 51.35% of cases showed histological features of dysfunctional uterine bleeding followed by 48.65% cases with organic lesions. Among organic lesions maximum number of cases of adenomyosis followed by leiomyoma was observed. Conclusion: Clinico-histomorphological evaluation of abnormal uterine bleeding in our study showed maximum number of dysfunctional uterine bleeding followed by adenomyosis and leiyomyoma. Age has definite influence on endometrial histology. There is no constant relationship between the pattern of endometrium and the type of bleeding in cases of abnormal uterine bleeding. Keywords: Abnormal uterine bleeding, Histomorphology, Egnndometrium.

Current role of Pipelle endometrial sampling in early diagnosis of endometrial cancer.

Endometrial cancer is the most common gynecologic cancer in developed countries. The most prevalent, however not pathognomonic symptom of the disease is abnormal uterine bleeding. The diagnosis of endometrial cancer is based on the histologic results of endometrial sampling. Endometrial biopsy could be obtained using different modalities: hysteroscopy-directed endometrial biopsy, uterine curettage or office endometrial biopsy. Outpatient endometrial biopsy using different devices for the evaluation of abnormal uterine bleeding is gaining popularity. The most popular office-based device for endometrial sampling procedure is the Pipelle device. Currently, Pipelle endometrial sampling is widely used to diagnose endometrial cancer in women with abnormal uterine bleeding and/or postmenopausal bleeding. The method became very useful due to easiness and simplicity of the procedure, availability of a device, as well as high sensitivity in detecting endometrial cancer. Many studies compared the validity and accuracy of Pipelle biopsy with dilation and curettage in the detection of various endometrial pathologies. Published results state that Pipelle biopsy and uterine curettage are almost equally reliable in the evaluation of endometrial pathologies. Moreover, Pipelle biopsy appears more beneficial as it does not require hospital admission and anaesthesia. However, it is proven the Pipelle technique has a limited capacity to identify endometrial polyps, and some authors, based on their study, claim that dilation and curettage is a more reliable method in terms of correlation with the final histological results. In addition, there are many factors affecting the efficiency of the endometrial biopsy. Failure to get samples that are adequate for histological examination is one of the problems associated with Pipelle sampling. The above mentioned contradictory conclusions by different researchers and lack of guidance to avoid inadequate sampling present the demand for further studies on the comparison of Pipelle biopsy and uterine curettage efficiency and accuracy.

Study of endometrium in abnormal uterine bleeding at Patan Academy of Health Sciences, Patan Hospital Nepal

Introduction:Abnormal uterine bleeding (AUB) is considered as one of the most common and challenging problem presenting to the gynecologist. Establishing a cause of AUB is important, as medical therapy is effective in managing abnormal bleeding in most cases and should be attempted prior to surgical management. Endometrial biopsy is a safe and effective diagnostic step in evaluation of endometrium after ruling out any medical causes. The objective of this study is to evaluate the different histopathological patterns of the endometrial biopsy specimens in women presenting with AUBat Patan Hospital.&#x0D; Method: A two year retrospective study of AUB covering the year 2068 to 2069 . Patients charts were retrieved from the medical record section and reviewed.&#x0D; Result: The most common age group presenting with AUB was 41–50 years 58(49.1%).Among these patients,normal physiological patterns 62 (52.5%) with secretory endometrium(24.6%), proliferative endometrium 29 (22.9%) and menstrual phase 6 (5.1%) were observed. The commonest pathology irrespective of the age group was disordered proliferative pattern 23 (19.5%). Othercauses identified were endocervical polyp 8 (6.8%), hormonal effect 5 (4.2%), atrophic endometrium 5 (4.2%),endometrial carcinomas 5 (4.2%), complications of pregnancy 3 (2.5%), endometrial hyperplasias 3 (2.5%), endometritis 3 (2.5%) and endometrial polyp 1 (0.8%).&#x0D; Conclusion:Histopathological variations of the endometrium can detect the cause of the disorders taking into account the age and phase of a menstrual cycle. Timely evaluation of AUB by histopathology can be life saving diagnostic tool for early management.

Migration and Erosion of Coils from Previous Pelvic Embolization

This is the case of a 50-year-old, gravida 3 para 3-0-0-3, perimenopausal woman who presented for evaluation of abnormal uterine bleeding and was found to have uterine leiomyomas. Her medical history was notable for an unclear, self-reported diagnosis of pelvic congestion syndrome requiring pelvic embolization. The patient opted for definitive surgical management, and she underwent an uncomplicated total laparoscopic hysterectomy and bilateral salpingectomy. The intraoperative findings were notable for migration and erosion of her previously placed embolic coils along the left external iliac vessels (Figs.

Hysteroscopy for Uterine Cavity Assessment in Infertility

Abstract Hysteroscopy is a surgical procedure that allows a direct view of the uterine cavity and the tubular ostium. This procedure can be performed for both diagnostic and curative purposes. Hysteroscopy have several indications including the evaluation of abnormal uterine bleeding, infertility or intrauterine tumours identified by ultrasound. The purpose of this paper is to evaluate the correlation between the diagnosis at admission and the intraoperative aspect of the uterine cavity following the hysteroscopic evaluation. We evaluated the patients admitted to the Obstetrics and Gynaecology Clinic of the Sibiu County Emergency Clinical Hospital during 1.01.2019-07.06.2019 who had the following criteria: age between 15-64 years, patients with infertility, patients who had vaginal bleeding or intrauterine tumours or structure identified by ultrasound.

Role of saline infusion sonohysterography in the evaluation of abnormal uterine bleeding

Role of saline infusion sonohysterography in the evaluation of abnormal uterine bleeding

Office-based Approach to Evaluation and Management of Abnormal Uterine Bleeding.

Evaluation and management of abnormal uterine bleeding (AUB) are possible in the office. Approaching AUB evaluation from an etiology-based perspective allows the gynecologist to focus evaluation efforts on the most probable causes of AUB for a particular patient and therefore customize the management accordingly. Developing skills with imaging such as transvaginal ultrasound, saline infusion sonography, and diagnostic hysteroscopy are important for AUB etiology diagnosis. Operative hysteroscopy experience can be developed for AUB management in the office and endometrial ablation provides a minimally invasive solution for some patients.

Management of MR Imaging in Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is a common condition that leads to increased health care costs and decreased quality of life. A systematic approach to AUB evaluation can simplify management and enhance women’s well-being. Objective: Management of MRI in women with AUB to detect any organic cause not detected with transvaginal ultrasonographic examination and if MRI add any advantage more than transvaginal ultrasound. Patients and methods: Fifty women with abnormal uterine bleeding were referred from the outpatient clinic and inpatients of OB/GYN Department at Sohag University Hospital was subject for this study. Results: MRI results in the diagnosis of fibroid had a sensitivity and specificity of 100% and the 2D TVS had a sensitivity of 80% and specificity 100 %. The falsely positive MRI was focal type adenomyosis miss diagnosed as interstitial fibroid. The sensitivity of the MRI for the adenomyosis in our results was 100% with specificity was 95%. Our results of adenomyosis using 2D transvaginal ultrasound had sensitivity 80% and specificity 97.5%. Our results using MRI had a sensitivity of 100% in endometrial polyp detection with specificity 90.47%. TVS had a sensitivity of 50% with specificity 100%. Conclusion: Management of MRI in abnormal uterine bleeding as equal as that of TVS but still TVS has the upper hand as the first imaging choice, real time imaging. patients also preferred TVS than MRI.

Modern evaluation of abnormal uterine bleeding

Abnormal uterine bleeding in women older than age 40 years, and certainly in menopausal patients, mandates evaluation, mainly to exclude cancer and hyperplasia, but also to better diagnose the source of the bleeding to appropriately manage the patient. In the past, dilation and curettage was the mainstay of diagnosis. This gave way to in-office suction pump-generated biopsies. Most recently, disposable biopsy instruments with their own internal piston to generate suction have become the standard of care. Rarely has such a technique received such widespread acceptance with such limited validation. Transvaginal ultrasonography, when technically feasible, is a noninvasive way to image the endometrial cavity. Saline-infusion sonohysterography is a subset of transvaginal ultrasonography reserved for patients in whom an adequate endometrial echo is not seen or when an endometrial echo is seen but not sufficiently thin. Appropriate understanding and use of transvaginal ultrasonography and addition of sonohysterography when necessary can allow a clinical algorithm that can triage patients with abnormal uterine bleeding to (1) no anatomic pathology best treated expectantly; (2) a global endometrial process, in which case random blind endometrial sampling is appropriate; or (3) a focal endometrial abnormality in which case endometrial sampling should be done with the visualization offered by hysteroscopy. Newer disposable office hysteroscopes finally allow office hysteroscopy to be done as a truly “point-of-care option.” Finally, the incidence of thick endometrial echo found incidentally in postmenopausal women with no bleeding is extremely high (10–17%) and should not trigger automatic invasive endometrial evaluation.