Evaluation of intrauterine pathologies by hysteroscopy in abnormal uterine bleeding

Sonam Dhakad; Sandhya Gadre; Gunjan Chaudhary

doi:10.18203/2320-1770.ijrcog20231234

Authors

Sonam Dhakad Department of Obstetrics and Gynecology, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
Sandhya Gadre Department of Obstetrics and Gynecology, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
Gunjan Chaudhary Department of Obstetrics and Gynecology, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20231234

Keywords:

AUB, Hysteroscopy, Intracavitary pathology

Abstract

Background: Hysteroscopy is the gold standard for uterine cavity evaluation because it allows direct visualization of the uterine cavity, mitigate characteristics of lesions such as nature, size, shape, location and vascular pattern.

Methods: This was a prospective observational study conducted in department of obstetrics and gynecology at Chirayu Medical College and Hospital, Bhopal (MP). Patients presenting to general gyne OPD with abnormal uterine bleeding at Chirayu Medical College and Hospital between January 2021 to May 2022 were studied. All patients selected for study had a thorough evaluation with detailed history, clinical examination, lab tests and sonography followed by hysteroscopy and endometrial biopsy.

Results: Mean age of patients in our study was 44 years with majority of patients in 41-50 years age group. Predominant complaint reported was heavy menstrual bleeding (HMB) (47.50%) followed by HMB with frequent cycle (11.25%). Hysteroscopy detected intrauterine abnormality in 42.50% cases. Most common finding on hysteroscopy in our study was hyperplastic endometrium in 17.50% patients followed by endometrial polyp in 15% of patients. Atrophic endometrium was seen in 2.5% and 2.5% had submucous fibroid.

Conclusions: Hysteroscopy allows diagnosis or exclusion of intracavitary pathologies, which are underdiagnosed on routine pelvic sonography. It also enables treatment in the same sitting with accurate tissue biopsy from the representative areas and facilitates planning of further management. When combined with endometrial biopsy and pelvic ultrasonography, it can establish an accurate diagnosis in a majority of patients thereby reducing the burden of hysterectomy.

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References

Elsersy MA. A comparative observational study of the use transvaginal ultrasound and hysteroscopy for the detection of uterine cavity pathologies in women with abnormal uterine bleeding. Open J Obstet Gynecol. 2017;7(05):511.

Bhingare P, Pagare S, Gadappa S, Ingle RA. Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathological correlation. N Indian J OBGYN. 2021;7(2):233-6.

Jain M, Kanhere A, Jain AK. Abnormal uterine bleeding: a critical analysis of two diagnostic methods. Int J Reprod Contracept Obstet Gynecol. 2014;3:48-53.

Gandotra N, Sunil I, Zargar S. Hysteroscopy in evaluation of intrauterine causes of abnormal uterine bleeding. Int J Res Med Sci. 2020;8:3694-7.

Srinivas K, Kulkarni S. Comparison of efficacy of TVS and hysteroscopy with histopathology of the endometrium in evaluating perimenopausal AUB(O). MOJ Women Health. 2017;4(4):153-8.

Veena BT, Shivalingaiah N. Role of transvaginal sonography and diagnostic hysteroscopy in abnormal uterine bleeding. J Clin Diagn Res. 2014;8(12):OC06-8.

Supriya M, Begum A. Abnormal uterine bleeding role of sonography and histopathology in endometrial study with emphasis on the organic causes. Indian J Pathol Oncol. 2018;5(2):262-8.

Van Den Bosch T, Verbakel JY, Valentin L, Wynants L, De Cock B, Pascual MA, et al. Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding. Ultrasound Obstet Gynecol. 2021;57(1):164-72.

Kostov S, Watrowski R, Kornovski Y, Dzhenkov D, Slavchev S, Ivanova Y, et al. Hereditary gynecologic cancer syndromes- a narrative review. OncoTargets Ther. 2022:381-405.

Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet. 2011;113(1):3-13.

Munro MG, Critchley HO, Fraser IS, FIGO Menstrual Disorders Committee, Haththotuwa R, Kriplani A, et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstet. 2018;143(3):393-408.

Aggarwal R, Mishra V. Hysteroscopy and 3D ultrasound for diagnosing uterine cavity abnormalities: a comparative study. New Hor Med Med Res. 2022;7:23-39.

Bettochi S, Nappi L, Ceci O. Office hysteroscopy. Obstetrics and gynecology clinics of North America: advances in laparoscopy and hysteroscopy techniques, Philadelphia: WB Saunders Company; 2004:641-654.

Patil SG, Bhute SB, Inamdar SA, Acharya N, Shrivastava DS. Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathologic correlation. J Gynecol Endosc Surg. 2009;1(2):98–104.

Vithal A, Nakum K, Patel D, Patel J. Hysteroscopy today: is it yet a conventional diagnostic technique in abnormal uterine bleeding?. Int J Reprod Contracept Obstet Gynecol. 2022;11:1667-71.

Puhan JN, Misra S, Satapathy RN. Use of Hysteroscopy in abnormal uterine bleeding: An edge over histopathological examination and blind D and C: an ambulatory procedure. JMSCR 2019;07(09).

Vitale SG, Watrowski R, Barra F, D’Alterio MN, Carugno J, Sathyapalan T, et al. Abnormal uterine bleeding in perimenopausal women: the role of hysteroscopy and its impact on quality of life and sexuality. Diagnostics. 2022;12(5):1176.

Yang LC, Chaudhari A. The use of histeroscopy for the diagnosis and treatment of intrauterine pathology. ACOG. 2020;135:138-48.

Carugno J, Grimbizis G, Franchini M, Alonso L, Bradley L, Campo R, et al. International Consensus Statement for recommended terminology describing hysteroscopic procedures. J Minimal Invas Gynecol. 2022;29(3):385-91.

Nagele F, O’connor H, Davies A, Badawy A, Mohamed H, Magos A. 2500 outpatient diagnostic hysteroscopies. Obstet Gynecol. 1996;88(1):87-92.

Hill MJ, Levens ED, Decherney AH. ACOG Practice Bulletin. Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197-206.

Nappi L, Sorrentino F, Angioni S, Pontis A, Litta P, Greco P. Feasibility of hysteroscopic endometrial polypectomy using a new dual wavelengths laser system (DWLS): preliminary results of a pilot study. Arch Gynecol Obstet. 2017;295:3-7.

Sardo AD, Bettocchi S, Spinelli M, Guida M, Nappi L, Angioni S, Fernandez LM, Nappi C. Review of new office-based hysteroscopic procedures 2003-2009. J Minim Invas Gynecol. 2010;17(4):436-48.

Vitale SG, Bruni S, Chiofalo B, Riemma G, Lasmar RB. Updates in office hysteroscopy: a practical decalogue to perform a correct procedure. Updates Surg. 2020;72:967-76.

Giampaolino P, Della Corte L, Di Filippo C, Mercorio A, Vitale SG, Bifulco G. Office hysteroscopy in the management of women with postmenopausal bleeding. Climacteric. 2020;23(4):369-75.

Vitale SG, Haimovich S, Riemma G, Ludwin A, Zizolfi B, De Angelis MC, et al. Innovations in hysteroscopic surgery: expanding the meaning of “in-office”. Minim Invas Ther Allied Tech. 2021;30(3):125-32.

Pandey D, Kunamneni S, Inukollu PR, Su H. Establishing patterns on hysteroscopy in abnormal uterine bleeding (AUB). Gynecol Minim Invas Ther. 2017;6(4):178-82.

Naik M, Ratnani R, Thaore S. Hysteroscopy in evaluation of intrauterine causes of AUB. Int J Reprod Contracept Obstet Gynecol. 2017;6:4835-9.

Guin G, Sandhu SK, Lele A, Khare S. Hysteroscopy in evaluation of abnormal uterine bleeding. J Obstet Gynecol India. 2011;61(5):546-9.

Sciarra JJ, Valle RF. Hysteroscopy: a clinical experience with 320 patients. Am J Obstetet Gynecol. 1977;127:340-8.

Hamou JE. Microhysteroscopy: a new procedure and its original applications in gynecology. J Reprod Med. 1981;26:375-82.

Saccardi C, Vitagliano A, Marchetti M, Lo Turco A, Tosatto S, Palumbo M, et al. Endometrial cancer risk prediction according to indication of diagnostic hysteroscopy in post-menopausal women. Diagnostics. 2020;10(5):257.

Clark TJ, Voit D, Gupta JK, Hyde C, Song F, Khan KS. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA. 2002;288(13):1610-21.