Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding

2001 ◽  
Vol 80 (12) ◽  
pp. 1131-1136 ◽  
Author(s):  
Elisabeth Epstein ◽  
Anette Ramirez ◽  
Lennart Skoog ◽  
Lil Valentin
Keyword(s):  
Uterine Cavity ◽  
Postmenopausal Bleeding ◽  
Focal Lesions ◽  
Dilatation And Curettage

Hysteroscopy

2020 ◽  
pp. 597-606
Author(s):  
O. A. O’Donovan ◽  
Peter J. O’Donovan
Keyword(s):  
Gold Standard ◽  
Uterine Cavity ◽  
Direct Visualization ◽  
Postmenopausal Bleeding ◽  
Endometrial Polyps ◽  
Current State ◽  
Technological Advances ◽  
Wide Range ◽  
Proper Training ◽  
Low Incidence

Hysteroscopy (direct endoscopic visualization) of the endometrial cavity is an exciting and rapidly developing field of gynaecological practice. The most dramatic advances have occurred during the last 20 years due to technological advances including miniaturization of equipment and improved optics. Hysteroscopy is used both diagnostically and therapeutically to treat a wide range of gynaecological problems (heavy menstrual bleeding, infertility, and postmenopausal bleeding). The most recent advances allow accurate direct visualization of the uterine cavity which provides a platform for targeted biopsies, safe removal of endometrial polyps, and treatment of fibroids, septa, and adhesions. Proper training has resulted in a low incidence of serious complications. The current consensus is that hysteroscopy provides a gold standard not only for evaluating and treating intrauterine pathology but also for allowing a minimalist approach which has resulted in improved patient outcomes. This chapter provides an overview of the current state of this exciting and evolving field.

Hysteroscopic Management of Intrauterine Pathologies: A Case Series of 296 Patients

2017 ◽  
Vol 5 (1) ◽  
pp. 35-40
Author(s):  
Rahul Manchanda ◽  
Charu Pathak ◽  
Garima Yadav
Keyword(s):  
Case Series ◽  
Uterine Cavity ◽  
Postmenopausal Bleeding ◽  
Secondary Infertility ◽  
Diagnostic Modality ◽  
Endometrial Polyps ◽  
Detection Rates ◽  
Primary Infertility ◽  
Endocervical Canal ◽  
Infertility Patients

ABSTRACT Aims To discuss the incidence of various hysteroscopic findings in patients of infertility, abnormal uterine bleeding (AUB), and postmenopausal bleeding and to compare the prevalence of various uterine pathologies in patients of primary and secondary infertility. Materials and methods This is a retrospective observational study, which evaluated 296 patients who underwent diagnostic hysteroscopy for evaluation of primary or secondary infertility, AUB, and postmenopausal bleeding over a period of 18 months in a Gynae-endoscopy Unit. Detailed hysteroscopic evaluation of the endocervical canal and uterine cavity in all recruited cases was done by the same surgeon and the data were collected by reviewing the case records. Results Among the 296 cases analyzed, 157 cases were of primary infertility, 81 cases were of secondary infertility, 45 cases were of AUB, and 13 cases presented with postmenopausal bleeding. Among the primary infertility patients, 58.6% had abnormal findings on hysteroscopy, while among the secondary infertility patients, hysteroscopy revealed abnormalities in as high as 72.5% cases. In the present study, uterine synechiae was the most common abnormality detected among the infertile patients. Endometrial polyps were the most common pathology detected among patients with AUB and postmenopausal bleeding. Conclusion Hysteroscopy is a minimally invasive and highly safe technique to directly visualize the endocervical canal, uterine cavity, and tubal ostia. It has an added advantage of treating the pathology in the same sitting, thus improving the clinical outcomes. Based on our findings, we conclude that uterine pathologies are a major contributor in causing infertility and menstrual irregularities, which are missed on blind modalities like hysterosalpingography and dilatation and curettage. Clinical significance This article stresses on the use of hysteroscopy as a primary diagnostic modality in evaluating patients of infertility, AUB, and postmenopausal bleeding in order to increase the detection rates of uterine pathologies. How to cite this article Yadav G, Manchanda R, Pathak C. Hysteroscopic Management of Intrauterine Pathologies: A Case Series of 296 Patients. J South Asian Feder Menopause Soc 2017;5(1):35-40.

Sonohysterography in a suspected case of uterine perforation after dilatation and curettage for retained placenta

2017 ◽  
Vol 6 (2) ◽  
Author(s):  
Norihito Yoshioka ◽  
Junichi Hasegawa ◽  
Akiko Tozawa ◽  
Kentaro Nakamura ◽  
Tai Kawahara ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Pathological Examination ◽  
Emergency Laparotomy ◽  
Uterine Perforation ◽  
Suspected Case ◽  
Safe Procedure ◽  
Fast Evaluation ◽  
Retained Placenta ◽  
Dilatation And Curettage

Abstract A 35-year-old woman, gravida 3, para 2, spontaneously delivered an infant without any major complications. On the 38th day after delivery, she returned to the hospital due to irregular bleeding. Transvaginal ultrasound showed a mass in the cervix; therefore, dilatation and curettage was performed, using placental forceps, to remove the retained placenta. During the procedure, a uterine perforation was suspected. Sonohysterography was performed in order to confirm the uterine perforation. The sonohysterogram revealed that the high echogenic mass that was suspected to be retained placenta was adhered on the posterior uterine myometrium. Saline that had been injected into the uterine cavity escaped into the Douglas pouch via a small hole in the posterior uterine wall. An emergency laparotomy was performed. Pathological examination of the removed uterus revealed placenta increta in the posterior wall, as well as an adjacent perforated fistula. Sonohysterographic diagnosis of uterine perforation in the present case was not only validated with diagnosis, but also the residual placenta was clearly visible. The use of sonohysterography for detection of a suspected case of uterine perforation after dilatation and curettage was accurate and provided a safe procedure for fast evaluation.

scholarly journals Severe Clostridial Pyomyoma following an Abortion Does Not Always Require Surgical Intervention

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Daphna Stroumsa ◽  
Eliel Ben-David ◽  
Nurith Hiller ◽  
Drorith Hochner-Celnikier
Keyword(s):  
Abdominal Pain ◽  
Fluid Resuscitation ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Uterine Cavity ◽  
Blood Cultures ◽  
Laboratory Studies ◽  
Dilatation And Curettage ◽  
Clostridial Infection ◽  
Preservation Of Fertility

Background. Clostridial infection following pregnancy may be fatal, and surgery is considered as the treatment of choice. We suggest a conservative management in selected cases when preservation of fertility is of major importance.Case. A 41-year-old primigravida presented with abdominal pain and fever, one day following dilatation and curettage at 20 weeks of gestation. Her abdomen was diffusely tender, with a uterus enlarged to 20 weeks' gestation. Laboratory studies were consistent with sepsis and hemolysis. CT demonstrated a gas-containing mass compressing the uterine cavity, and presence of air in pelvic veins. Blood cultures were positive forClostridium perfringens. The patient was treated conservatively, with IV antibiotics and fluid resuscitation, and recovered.Conclusion. In selected cases of infected myoma complicated by clostridial sepsis, refraining from surgical intervention is a possible therapeutic approach.

scholarly journals A prospective study of comparison between transvaginal sonogram and histopathological examination in perimenopausal women with abnormal uterine bleeding

2019 ◽  
Vol 8 (11) ◽  
pp. 4233
Author(s):  
P. Rishma Priyanka ◽  
C. Rama Mani ◽  
A. Yamuna
Keyword(s):  
Histopathological Examination ◽  
Endometrial Thickness ◽  
Uterine Cavity ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Transvaginal Sonography ◽  
Main Concern ◽  
Dilatation And Curettage ◽  
Perimenopausal Women ◽  
Histopathological Report

Background: Abnormal uterine bleeding is one of the most frequently encountered conditions in gynaecology practice and forms about 10% of all gynaecological admissions, the main concern in perimenopausal bleeding is that the bleeding could be the only external manifestation of many hidden serious pathologies of uterine-cavity. The objective of this study was to compare the results of transvaginal sonography (TVS) and drug and cosmetic (D and C) with histopathological examination (HPE) report of hysterectomy specimen in perimenopausal women with AUB.Methods: A prospective comparative study where 100 perimenopausal women with AUB were subjected to TVS then D and C and then the results were compared with histopathological report of the hysterectomized specimen.Results: With an endometrial thickness less than or equal to 15 mm the histopathology report is normal endometrium. When the endometrial thickness more than or equal to 15 mm the histopathology report is hyperplasia or carcinoma. Findings of TVS correlated well with histopathological report after hysterectomy. 14 cases of adenomyosis, 16 cases of myomatous polyp, and 6 cases of endometrial polyp missed by dilatation and curettage.Conclusions: TVS is a simple, non-invasive test to indirectly visualize the endometrial cavity and is useful as a first step diagnostic procedure in the evaluation of perimenopausal bleeding. Dilatation and curettage lags in detecting adenomyosis, endometrial and myomatous polyps, When TVS combined with dilatation and curettage, it can supplement the shortcomings of dilatation and curettage.

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