الفهرس 
Abnormal uterine bleedingOnly 14 pages are availabe for public view
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Abstract
Abnormal uterine bleeding (AUB) is a change in frequency of menses, duration of flow, or amount of blood loss. It is a common gynecological problem. Up to 33% of women referred to Gynecological outpatient clinics have this problem and the proportion raises more in pre-and postmenopausal women. This condition has enormous consequences with regard to social life, morbidity and clinical workload. AUB may be due to various causes, common are endometrial polyp, leiomyoma, adenomyosis, endometrial hyperplasia, ovulatory dysfunction, and endometrial carcinoma.
Various diagnostic techniques have been evolved over the periods to determine the etiology of abnormal uterine bleeding like dilatation and curettage (D&C), hysteroscopy, transvaginal ultrasonography and saline infusion sonography but their sensitivity and specificity has not been compared adequately. Ultrasonography used to look for ovarian or uterine disease and endometrial biopsy (EMB). Transvaginal Sonography (TVUS) is 80% sensitive and 69% specific for fibroids and polyps and is superior to transabdominal ultrasound (TAS). If possible, TVUS should be performed on days 4 to 6 of the menstrual cycle
So, the purpose of this study is to evaluate the accuracy of 2-D transvaginal ultrasonography in diagnosing endometrial polyps during uterine bleeding.
To elucidate our aim, this prospective study was conducting on 111 patients presenting with abnormal uterine bleeding attended to gynecological outpatient clinics in Menoufia University Hospital, Obstetrics & Gynecology Department from February 2021 to July 2022.
All selected patients were subjected to detailed clinical history and examination, and then TVUS underwent during bleeding attack followed
Summary
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by hysteroscopic examination and resection of any detected pathology and
histopathological examination of resected specimens.
Complete history taking included personal history, obstetric history,
gynecological history, family history and a detailed history of abnormal
uterine bleeding. Physical examination included general examination and
pelvic examination. Laboratory investigations included complete blood
picture, bleeding time and coagulation time and complete urine analysis.
Ultrasonography: vaginal 2-D ultrasonography done during bleeding
attack to assess uterine cavity then hysteroscopy investigation done after
bleeding episodes stops or diminished and send resected specimens for
histopathological examination.
The result of this study could be summarized as follow:
Mean age of studied cases was (40.60±6.28) and age of menarche was
(10.59±0.99). Also, the most studied cases had menorrhagia bleeding
(78.4%), and 21.6% had metrorrhagia bleeding.
Mean longest mass dimension of studied cases was 10.55±15.85 mm,
mass area was 190.07±455.89 mm2 and endometrial thickness was
10.47±5.15mm. Also, the studied cases that have echogenic mass
compared to endometrium (n=14, 12.61%), isoechoic compared to
endometrium (0%), hypoechoic compared to endometrium (n=6,
5.4%). Also, the studied cases that have Single feeding vessel (n=10,
9%), and have > 1 feeding vessel (n=2, 1.8%), have interrupted
mucosal sign (n=21, 18.91%) and had echogenic endometrium
(100.0%).
There were no significant differences among studied groups regarding
normal, polyp, endometrial hyperplasia, and sub mucous fibroid
(p>0.05).
Endometrial polyp by TV/US had Sensitivity (61.11%), Specificity
(100%), PPV (100%), NPV (93%) and Accuracy (93.69%). While,
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Hysteroscope had Sensitivity (94.44%), Specificity (100%), PPV (100%), NPV (98.93%) and Accuracy (99.09%).
Sensitivity 64.28%, specificity 100%, positive predictive value 100% and negative predictive 95.09% for detection of submucosal fibroid by TV/US. Also, sensitivity 100%, specificity 100%, positive predictive value 100% and negative predictive value 100% for detection of submucosal fibroid by hysteroscopy.
Sensitivity 100%, specificity 96.15%, positive predictive value 63.63% and negative predictive 100% for detection of endometrial hyperplasia by TV/US. Also, sensitivity 100%, specificity 94.23%, positive predictive value 53.84% and negative predictive value 100% for detection of endometrial hyperplasia by hysteroscopy.