Study of endometrium by trans-vaginal sonography and it’s correlation with histopathology in perimenopausal women with abnormal uterine bleeding

Background: Objectives of the study were to study the endometrial patterns in cases of abnormal uterine bleeding (AUB) and anatomical (structural) lesions of uterus using transvaginal sonography (TVS) and endometrial histopathology and to determine the efficacy of TVS.Methods: Cross-section study of 50 perimenopausal age group with AUB in TNMC BYL Nair hospital from Nov 2017 to Nov 2018.Results: AUB was seen 40 to 45 years multiparous women TVS endometrial thickness (ET) T 6-10 mm (46%), ET 11-15 (22%), ET>15 mm (14%), <5 mm in (18%), showed 21 (42%) patients with endometrial hyperplasia on TVS, 12 (24%) simple hyperplasia 4 (8%) complex hyperplasia on histopathology fibroid 8%, adenomyosis 2%. endometrial polyp 6%.Conclusions: Endometrial lining exceeds 10 mm dilation and curettage to be done r/o endometrial hyperplasia, to study the endometrial patterns in cases of abnormal uterine bleeding and anatomical (structural) lesions of uterus using transvaginal sonography and endometrial histopathology.

Combination of pioglitazone and clomiphene citrate versus clomiphene citrate alone for infertile women with the polycystic ovarian syndrome

Background Anovulation is one of the common causes of infertility. Polycystic ovary syndrome (PCOS) is the most common disorder with chronic Anovulation. To the best of our knowledge, insulin resistance relates significantly to PCOS. Therefore administration of insulin-sensitizing drugs such as pioglitazone can be used for ovulation stimulation in PCO patients. Methods After obtaining approval from the Ethics Committee of Mashhad University of Medical Sciences, 61 patients with PCOS were enrolled in the study based on inclusion/ exclusion criteria. Patients were divided into two groups. The first group received 30 mg (mg) of pioglitazone daily from the second day of the menstrual period. The second one received a placebo. 150 mg clomiphene citrate was administered from the third to the seventh day of the menstrual cycle. Vaginal sonography was performed in all women, and in cases with the mature follicle, intrauterine insemination was conducted after human chorionic gonadotropin injection. Ovary stimulation and pregnancy rate were compared between groups. Results There were no differences between groups regard to demographic characteristics and infertility type. Body mass index was higher in the pioglitazone group (28.3 ± 3.8 versus 26.2 ± 3.5, P value = 0.047). The size of the follicle was not significantly different between groups (2.2 ± 1.4 versus 1.3 ± 1.1, P value = 0.742). pregnancy rate [4 (12.9%) versus 4 (13.3%), P value = 1] had no differences between groups. Conclusion Although the number of follicles was higher in the pioglitazone group, our study showed no differences in ovary stimulation and pregnancy rate.

Role of Sonography in the Evaluation of Endometrial Aetiology in Abnormal Uterine Bleeding

BACKGROUND Abnormal uterine bleeding is an important cause of morbidity in the female population, which can be attributed to several reasons. Trans-vaginal sonography and saline-infusion sonography are the mainstay of diagnosis and govern the further management of this condition. This study was conducted to evaluate the thickness and pattern of endometrium with transvaginal sonography and determine any abnormality in the uterine cavity which can be attributed to saline infusion sonography (SIS) in cases of abnormal uterine bleeding (AUB). METHODS The study was conducted among 122 women with complaints of abnormal uterine bleeding attending Outpatient Department and indoor cases of a tertiary care hospital over a period of twelve months. RESULTS The most common presenting complaint was heavy menstrual bleeding in 27.04 % cases. Maximum (44.26 %) cases had normal finding on transvaginal sonography; most common pathological finding was leiomyoma (22.31 %), and endometrial hyperplasia (15.5 %). More than one third (37.7 %) of patients had no abnormalities on saline infusion sonography; while 62.3 % had one or more pathologies; the most common lesion was fibroid in 25.4 % cases. Normal proliferative and secretary endometrium was found on histopathological examination in 50 % cases, while remaining half cases had one or more pathology, most common pathology detected was endometrial hyperplasia in 25.4 % cases. On trans-vaginal sonography (TVS), 11 cases of endometrial polyp were missed, which were detected after infusion of saline and confirmed by histopathological examination. The diagnostic indices of SIS were superior to TVS in diagnosis of any pathology. Sensitivity of TVS was 86.94 % and SIS was 91.94 %. Specificity of TVS (75.41 %) was greater than SIS (68.33 %). CONCLUSIONS TVS and SIS scanning techniques play a very important role in endometrial disorders in woman with AUB. KEYWORDS SIS, Transvaginal, AUB, Endometrium

Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion

Purpose To determine whether an increase in cul de sac (CDS) fluid after hysteroscopy is predictive of tubal patency. Methods In a prospective clinical cohort study, 115 subfertile women undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate. The primary outcome was determining whether an increase in fluid in the pouch of Douglas was reflective of unilateral or bilateral tubal patency. Vaginal sonography before and after hysteroscopy was performed to detect fluid in the pouch of Douglas, directly followed by laparoscopy with chromopertubation. Results Laparoscopic chromopertubation revealed bilateral Fallopian tube occlusion in 28 women (24.3%). Twenty-seven/40 patients (67.5%) with no fluid shift had bilateral occlusion during the consecutive laparoscopy (p < 0.001). One/75 patients (1.3%) showing a fluid shift had bilateral occlusion (sensitivity of a present fluid shift for uni- or bilateral patency 85.1%, 95% CI: 81.7–99.9, specificity: 96.4%, 95% CI: 75.8–91.8). Intracavitary abnormalities (odds ratio, OR, 0.038; p = 0.030) and adhesions covering one or both tubes (OR 0.076; p = 0.041) increased the risk for a false abnormal result, i.e., uni- or bilateral tubal patency despite the lack of a fluid shift. Conclusion When CDS fluid does not change after hysteroscopy, this is a sensitive test for tubal occlusion and further testing may be warranted. However, if there is an increase in CDS fluid after hysteroscopy, particularly for a patient without fluid present prior, this is both sensitive and specific for unilateral or bilateral tubal patency.

Evaluation of Biomarkers in Myoma Patients: A Prospective Study Investigating the Role of LDH, CA 125, and IGF-1 after Uterus-Preserving Surgical Therapy

<b><i>Objective:</i></b> Myomas are one of the most common tumors of the lower abdomen in women. At present, sonography and clinical examination are the prevalent diagnostic standards for these tumors, and no biomarkers have been established yet. The primary aim of this study was to determine if the surgical removal of myomas leads to a drop of lactate dehydrogenase (LDH), CA 125, and/or insulin-like growth factor (IGF-1) and therefore if these parameters are suitable as potential biomarkers for the presence or recurrence of a myoma. <b><i>Study Design:</i></b> The blood levels of LDH, CA 125, and IGF-1 were determined in 83 patients (age 18–50) with a verified diagnosis of myomas and surgical therapy at 3 different timepoints: preoperative (T0), 2 days postoperative (T1), and 6 months postoperative (T2). Vaginal sonography was performed preoperatively and once again at 6 months postoperatively. <b><i>Results:</i></b> The median (Q1–Q3) LDH values dropped significantly postoperatively: 239 (217–266) U/L at T0 versus 217 (190–255) U/L at T1, <i>p</i> &#x3c; 0.001. The median (Q1–Q3) IGF-1 values also dropped: 140.4 (118.6–179.0) ng/mL versus 112.4 (99.5–143.0), <i>p</i> &#x3c; 0.001. By contrast, the CA 125 values rose slightly but not significantly. At 6 months (<i>n</i> = 34), the LDH values were not significantly different from either the preoperative or the immediate postoperative values. This was observed both in patients with and without a recurrence of myoma. In contrast, the median (Q1–Q3) IGF-1 level at T2 was significantly elevated both in patients with sonographic evidence of new myomas (129.0 [116.0–163.1] ng/mL, <i>p</i> = 0.023) and in patients with sonographic proof of no new myomas (161.0 [130.2–198.5] ng/mL, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Both LDH and IGF-1 dropped significantly in the immediate postoperative days in women with myomas after uterus-preserving surgeries were performed. The postoperative concentration of IGF-1 was correlated with the evidence of new myomas and can be potentially used for further monitoring. Future studies should be able to confirm these results. This study concludes that myomas do influence LDH and IGF-1 and could possibly be suitable as biomarkers.

Rare case: enucleation of multiple fibroids after intraoperative vaginal sonographic detection of the solitary pelvic kidney by patient with Mayer-Rokitansky-Kuster-Hauser syndrome

Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is a congenital anomaly of the genital tract that occurs in about 1 in 4000 women. MRKH syndrome can be associated with renal, skeletal, heart and hearing abnormalities. The frequency of renal/urinary tract abnormalities is 33%. Only a few cases of fibroid development in MRKH syndrome have been described in the literature. The diagnosis and surgery of a fibroid in MRKH syndrome may be complicated in associated kidney abnormality by an atypical kidney position, as in this case: pelvic kidney on one side and renal agenesia on the contralateral side. Authors present the case of a 47-year-old female patient with a known MRKH syndrome and a pelvic kidney on the right side who had presented with an unclear tumour in the right lower abdomen. A completed CT scan revealed the tumour directly next to the pelvic kidney. A malignancy could not be excluded with certainty, so that a laparoscopy in laparotomy readiness was indicated and performed. During surgery, two rudimentary uterine horns were found; on the right side retroperitoneally, below the uterine horn, the tumour was located and directly below it there was a soft tissue alteration, probably the kidney. For safety, a vaginal sonography was performed in between, to clearly identify the only kidney and to avoid damaging it. The tumour could be extirpated laparoscopically without kidney injury. The two uterine horns were removed simultaneously. Histologically the fibroid could be confirmed. In addition, three other fibroids (one on the left side and two on the right side) were detected. Due to the high probability of a simultaneous kidney abnormality in the MRKH syndrome, authors suggest an accurate kidney diagnosis preoperatively. If necessary, in the case of a pelvic kidney and/or renal agenesia, as in this case, an additional intraoperative kidney check should be performed.

Hysteroscopy in one hundred cases of postmenopausal uterine bleeding, in the detection of uterine cancer and atypical endometrial hyperplasia

Background: Evaluation was done in 100 women presenting with postmenopausal bleeding, (PMB), to discuss the utility of hysteroscopy combined guided endometrial curettage in the diagnosis of uterine cancer and endometrial hyperplasia, and, treat benign lesions, like polyps, synechiae at the same sitting. At MGMH during the years, 2002 to 2006, there were 57 women, and at care, 40 women with PMB during 2011 to 2013, and three in a nursing home, Hyderabad, were investigated.Methods: Evaluation was done in 100 women presenting with PMB by hysteroscopy and curettage to diagnose the cause of PMB and benign lesions like polyps, synechiae were managed by operative hysteroscopy. Bettocchi 5 mm hysteroscope, monopolar instruments and glycine was used for excision of polyps.Results: In one hundred women with PMB, 19% had cancer. Endometrial adenocarcinoma in 14, endocervical carcinoma in 2, uterine carcinosarcoma in 3 cases. All 3 cases of uterine carcinosarcoma on hysteroscopy were large polyps measuring 5×5-6 cm size. Atypical hyperplasia endometrium in 7% and simple hyperplasia in 17%, was reported on histopathology, in cases with hyperplastic endometrium on hysteroscopy. Benign polyps in 41% were managed at the same sitting by operative hysteroscopy.Conclusions: Women with postmenopausal bleeding must have USG, trans vaginal sonography (TVS), endometrial thickness (ET) measurement, preferably endometrial echo complex (EEC). In women with PMB, the risk of uterine cancer would be 19%, i.e., 1 out of 5 women. Atypical hyperplasia in 7%. Hysteroscopy guided curettage, with histopathology, is the gold standard protocol in cases of PMB.

Role of trans vaginal sonography with hysteroscopy in detection of uterine causes of abortions

Background: Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the aetiology is often unknown and there are only few evidence-based diagnostic and treatment strategies. Objective of this study was to compare the role of trans vaginal sonography with hysteroscopy in detection of uterine causes of abortions.Methods: This prospective cohort study was conducted in the department of obstetrics and gynaecology, Kasturba Hospital, Daryaganj, Delhi. The study was conducted from January 2016 to December 2016.Results: On transvaginal sonography majority of women i.e. 39(78%) patients had normal ultra-sonographic findings. 11(22%) showed various abnormal findings. Most commonly diagnosed abnormal finding on TVS was polyp, seen in 5(10%) patients. It was seen as a well-defined, uniformly hyperechoic mass within the endometrial cavity. normal hysteroscopic findings were seen in 27(54%) patients. Rest 23(46%) patients had abnormal uterine factors as diagnosed by hysteroscopy.Synechiae was detected in 9(18%) patients. It was the most common abnormality detected on hysteroscopy. Out of 9 patients who had synechiae, 2 had severe dense adhesions. In 6 patients, the adhesions were mild and flimsy. While minimal adhesions were noted in 1 patient, seen near the cornua.Conclusions: hysteroscopy is still the gold standard for diagnosis and most definitive procedure of choice if any kind of operative intervention is required.

A STUDY OF ENDOMETRIAL THICKNESS IN TRANS VAGINAL SONOGRAPHY IN RELATION WITH HISTOPATHOLOGY REPORT IN DILATION & CURRATAGE IN AUB WOMEN

A study of of endometrial thickness on TVS in relation with histopathology report on dilation and curettage. AIM AND OBJECTIVE-To set a cut off limit of endometrial thickness on TVS for differtiating between normal and abnormal endometrium. MATERIAL AND METHOD-hospital based comparative study. RESULTS-TVS is non invasive ,simple first line procedure in AUB women. Mean endometrial thickness in normal endometrial group was 8.00±2.44 mm and in abnormal endometrial group was 15.16±33 mm.The difference was found highly significant (p value<.001)