Role of diagnostic hysteroscopy in abnormal uterine bleeding

Swati Singh, Bal Krishan Taneja, Prem Singh, Ravinder Ahlawat

Abstract


Background: The objective of the study was to correlate hysteroscopic findings with histopathological findings in women with abnormal uterine bleeding and to study the accuracy of hysteroscopy in abnormal uterine bleeding.

Methods: Settings: tertiary care hospital. Study design: prospective study. A prospective study was carried out in the Department of Obstetrics and Gynaecology at MMIMSR, Mullana, Ambala, from May 2011 to September 2013. 100 cases were selected for this study from patients who were admitted with history of abnormal uterine bleeding. Hysteroscopic examination was done in all patients post-menstrually, whenever possible, except in those cases where menstrual cycles were grossly irregular or patients came with continuous bleeding per vaginum. The patients then underwent dilatation and curettage and curettings was sent for histopathological examination. The correlation between findings on hysteroscopy and histopathological examination was done.

Results: On hysteroscopy, 48% of the patients had either proliferative or secretory picture which was grouped as normal. The rest 52% of patients had some abnormality. Hyperplasia was the most common finding which was seen in 26% patients. The other findings included endometrial polyp 8%, myoma or myomatous polyp 7%, atrophic endometrium 4%, endometrial carcinoma, misplaced IUCD, and synechiae comprising 2% each and tubercular endometritis 1%.

Conclusions: Hysteroscopy has a high sensitivity i.e. it can supplement and enhance the accuracy of tissue diagnosis. So, hysteroscopically directed biopsy would be an ideal procedure in abnormal uterine bleeding wherever facilities are available.


Keywords


Abnormal uterine bleeding, Dilatation and curettage, Hysteroscopy

Full Text:

PDF

References


Prentice A. When does heavy flow merit treatment? Practitioner. 2000;244:179-82.

Nicholson WK, Elison SA, Grason H, Powe NR. Patterns of ambulatory care use for gynaecologic conditions: a national study. Am J Obstet Gynaecol 2001;184(4):523-30.

Goodman A. Abnormal genital tract bleeding. Clin Cornerstone. 2000;3(1):25-35.

Baggish MS, Valle RF, Guedj H. Office hysteroscopy. In: Baggish MS, Valle RF, Guedj H, eds. Visual Perspectives of Uterine Anatomy, Physiology and Pathology. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2007: 213- 225.

Word B, Gravlee LC, Wideman GL. The fallacy of simple uterine curettage. Obstet Gynaecol. 1958;12(6):642-8.

Baggish MS. Operative hysteroscopy. In: Rock JA, Jones HW III, eds. Telinde’s Operative Gynaecology. 9th ed. Philadelphia: Lipincott Williams & Wilkins; 2003: 339-411.

Siegler AM, Kemmann EK, Gentile GP. Hysteroscopic procedures in 257 patients. Fertil Steril. 1976;27(11):1267-73.

Sciarra JJ, Valle RF. Hysteroscopy: a clinical experience with 320 patients. Am J Obstet Gynaecol. 1977;127(4):340-8.

Barbot J, Parent B. Contact hysteroscopy: another method of endoscopic examination of the uterine cavity. Am J Obstet Gynaecol. 1980;136(6):721-6.

Velle RF. Hysteroscopic evaluation of patients with abnormal uterine bleeding. Surg Gynaecol Obstet. 1981;153(4):521-6.

Wamsteker K. Hysteroscopy in the management of abnormal uterine bleeding in 199 patients. In: Seigler AM, Lindemann HJ, eds. Hysteroscopy: Principles and Practice. 1st ed. Philadelphia: JB Lippincott; 1984: 128-131.

Mencaglia L, Pernio A, Hamou J. Hysteroscopy in peri-menopausal and postmenopausal women with abnormal uterine bleeding. J Reprod Med. 1987;32(8):577-82.

Gimpelson RJ, Rappold HO. A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage. A review of 276 cases. Am J Obstet Gynaecol. 1988;158(3):489-92.

Loffer FD. Hysteroscopy with selective endometrial sampling compared with D and C for abnormal uterine bleeding: the value of a negative hysteroscopic view. Obstet Gynaecol. 1989;73(1):16-20.

Sheth SS, Nerurkar NM, Mangeshkar PS. Hysteroscopy in abnormal uterine bleeding. J Obstet Gynaecol India. 1990;40:451.

Parasnis HB, Parulekar SV. Significance of negative hysteroscopic view in abnormal uterine bleeding. J Postgrad Med. 1992;38(2):62-4.

Saraiya S, Sherian N, Walvekar UR. Hysteroscopy in abnormal uterine bleeding. J Obstet Gynaecol India. 1994;44(6):950-9.

Panda A, Parulekar SV, Gupta A. Diagnostic hysteroscopy in abnormal uterine bleeding and its histopathological correlation. J Obstet Gynaecol India. 1999;175:74-6.

van Trotsenburg M, Wieser F, Naegle F. Diagnostic hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal patients. Contrib Gynaecol Obstet. 2000;20:21-6.

Madan SM, Al-Zufairi ZA. Abnormal uterine bleeding: diagnostic value of hysteroscopy. Saudi Med J. 2001;22(2):153-6.

Gianninoto A, Morana C, Campione C. Diagnostic hysteroscopy in abnormal uterine bleeding. Five year's experience. Minerva Gynaecol. 2003;55(1):57-61.

deWit AC, Vleugels MP, deKruif JH. Diagnostic hysteroscopy: A valuable diagnostic tool in the diagnosis of structural intra-cavital pathology and endometrial hyperplasia or carcinoma? Six year's of experience with nonclinical diagnostic hysteroscopy. Eur J Obstet Gynaecol Reprod Biol. 2003;110(1):79-82.

Jyotsana, Manhas K, Sharma S. Role of hysteroscopy and laparoscopy in evaluation of abnormal uterine bleeding. J K Sci. 2004;6:23-7.

Barati M, Masihi S, Maroamezi F. Office hysteroscopy in patients with abnormal uterine bleeding and normal transvaginal sonography. Royal Inst Int J Fertil Steril. 2008;1:175-8.

Patil SG, Bhute SB, Inamdar SA, Acharya NS, Shrivastava DS. Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathologic correlation. J Gynaecol Endosc Surg. 2009;1:98-104.

Gita G, Surpreet S, Arvind L, Shashi K. Hysteroscopy in evaluation of abnormal uterine bleeding. J Obstet Gynaecol India. 2011;61(5):546-9.

Loverro G, Bettocchi S, Cormio G, Nicolardi V, Porreca MR, Pansini N et al. Diagnostic accuracy of hysteroscopy in endometrial hyperplasia. Maturitas. 1996;25(3):187-91.