Identification of Pelvic Congestion Syndrome Using Transvaginal Ultrasonography. A Useful Tool

The gold standard for the diagnosis of pelvic congestion syndrome (PCS) is venography (VG), although transvaginal ultrasound (TVU) might be a noninvasive, nonionizing alternative. Our aim is to determine whether TVU is an accurate and comparable diagnostic tool for PCS. An observational prospective study including 67 patients was carried out. A TVU was performed on patients, measuring pelvic venous vessels parameters. Subsequentially, a VG was performed, and results were compared for the test calibration of TVU. Out of the 67 patients included, only 51 completed the study and were distributed in two groups according to VG results: 39 patients belonging to the PCS group and 12 to the normal group. PCS patients had a larger venous plexus diameter (15.1 mm vs. 12 mm; p = 0.009) and higher rates of crossing veins in the myometrium (74.35% vs. 33.3%; p = 0.009), reverse or altered flow during Valsalva (58.9% vs. 25%; p = 0.04), and largest pelvic vein ≥ 8 mm (92.3% vs. 25%). The sensitivity and specificity of TVU were 92.3% (95% CI: 78.03–97.99%) and 75% (95% CI: 42.84–93.31%), respectively. In conclusion, transvaginal ultrasonography, with the described methodology, appears to be a promising tool for the diagnosis of PCS, with acceptable sensitivity and specificity.

Transvaginal ultrasonography versus hysteroscopy in endometrial pathology diagnosis among women with abnormal uterine bleeding

Objective: Abnormal uterine bleeding is any deviation from a normal menstrual pattern. Transvaginal ultrasonography is useful in determining endometrial thickness but cannot conclusively exclude sessile and pedunculated lesions. Hysteroscopy is an invasive procedure that detects discrete lesions. This study was aimed to evaluate the diagnostic accuracy of 2-dimensional transvaginal ultrasonography and hysteroscopy in evaluating endometrial lesions in women with abnormal uterine bleeding, by determining the sensitivity and specificity of the two methods in diagnosing the lesions. Methods: Eighty-four cases of abnormal uterine bleeding were chosen based on inclusion criteria. The patients were subjected to routine investigations. The findings of transvaginal ultrasonography, hysteroscopy, and dilatation and curettage were compared and analyzed. Results: Maximum incidence of abnormal uterine bleeding was observed in women between 41 and 50 years of age (73.8%). The most common presenting complaint was menorrhagia (76.1%). 76% of patients experienced symptoms for less than six months. The sensitivity and specificity of transvaginal ultrasonography were 60% and 96.3%, respectively. The sensitivity and specificity of hysteroscopy were 80.4% and 93.1%, respectively. The accuracy of transvaginal ultrasonography was 60.3%, and that of hysteroscopy was 83.3%. Conclusion: Transvaginal ultrasonography and hysteroscopy can be used as first-line diagnostic modalities to rule out and find the causes of abnormal uterine bleeding, which can aid in instituting prompt and appropriate medical treatment.

Clinical application of three-dimensional transvaginal ultrasonography in the diagnosis of intrauterine adhesions

Objective The present study aimed to evaluate the diagnostic accuracy of three-dimensional transvaginal ultrasonography (3D-TVS) for intrauterine adhesions (IUA). Methods We performed a retrospective cohort study. A total of 500 women aged 19 to 46 years with uterine lesions who received treatment from the Department of Obstetrics and Gynecology were enrolled. Endometrial 3D imaging was conducted to obtain the display plane and 3D-TVS parameters. Patients also underwent hysteroscopy for a definitive diagnosis. Results For diagnosing IUA, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of 3D-TVS were 98.8%, 90.8%, 91.4%, 98.7%, and 94.8%, respectively. For diagnosing a submucosal myoma, the sensitivity, specificity, PPV, NPV, and overall accuracy of 3D-TVS were 88.2%, 97.9%, 88.2%, 97.9%, and 96.4%, respectively. For diagnosing endometrial polyps, the sensitivity, specificity, PPV, NPV, and overall accuracy of 3D-TVS were 94.7%, 96.8%, 92.9%, 97.7%, and 96.2%, respectively. Conclusions Before hysteroscopy, 3D-TVS, as a method of screening, has great value for comparing differences before and after treatment, and for evaluating therapeutic effects.

Frequency of Common Histopathological Findings among Patients Having Endometrial Thickness ≥5mm

Aim: To determine the frequency of common histopathological findings among patients having endometrial thickness >5mm and having atypical bleeding of uterus. Study design: Descriptive and cross sectional study Study settings: Department of Obstetrics & Gynaecology, Kishwer Fazal Teaching Hospital, Sheikhupura from 1st October 2020 to 31st March 2021. Methodology: One hundred and twenty patients were enrolled. Patients were aged between 45 to 60 years. Patient’s detailed demographics including age, parity, socioeconomic grade and body mass index were recorded post written informed consentreceival. Patients having endometrial thickness >5mm with abnormal uterine bleeding were included in this study.All the patients were undergone for transvaginal ultrasonography (TVS). Outcomes were histopathological findings observed. Results: The patients mean age was found to be 51.16±4.88 years with mean body mass index 27.24±4.63 kg/m2. Thirty five (29.2%) patients had parity I and 85 (70.8%) patients had parity II. Forty two (35%) patients had high socioeconomic status and 78(65%) were from low socio economic status. Majority of the patients 80(66.7%) were from rural areas. Secretory and proliferative were the most common histopathological findings found in (45.83% and 26.7%) patients. Frequency of endometrial carcinoma was found among 97(80.8%) cases. Conclusion: The most common histopathological findings were secretory and proliferative and frequency of endometrial carcinoma was too high. Endometrial anomalies can be excluded by transvaginal ultrasonography and is strongly useful in the evaluation of abnormal bleeding from the uterine. Keywords: Endometrial, Transvaginal ultrasonography, Uterine bleeding