Evaluation of endometrial causes of postmenopausal bleeding with it's correlation with endometrial thickness and hysteroscopy findings and endometrial tissue histopathology

Background: Postmenopausal bleeding (PMB)accounts for 5% of gynecology visit. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma since this potentially lethal disease is the cause of bleeding in approximately 10 percent patients (range 1 to 25 percent, depending upon risk factors). The aim of the study was to evaluate endometrial causes of postmenopausal bleeding (PMB) with it's correlation with endometrial thickness (ET)and hysteroscopy findings and endometrial tissue histopathology.Methods: A total 50 consecutive cases of PMB fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) in which uterus, adnexa and endometrial thickness (ET) was assessed. Then hysteroscopy and/or dilation and curettage was scheduled at subsequent visit. Endometrial sample was sent for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for ET by TVS and hysteroscopy findings, considering histopathological diagnosis as the gold standard.Results: Most common endometrial cause of PMB was atrophic endometrium (44%). The other causes were endometrial carcinoma (18%), endometrial hyperplasia (18%), endometrial polyp (12%), endometritis (4%), and leiomyoma (4%). The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.Conclusions: Being relatively cheap, easily accessible, non-invasive, TVS with ET measurement should first line investigation in the evaluation of women with postmenopausal bleeding with suspected endometrial pathology. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with ill-defined endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.

Operative Hysteroscopy in Infertility Patients and Its Complications.

The problem of infertility is increasing over the years and so are the couples seekingmedical help for it. Estimates of infertility in India goes to around 10 - 15 percent.Hence evaluation of the couple with the help of history and accompanyinginvestigations are foremost required. Various modalities are available foridentifying the cause. One such cause is abnormalities in the uterine cavity. Thisstep is important because its inner layer, called endometrium is responsible forimplantation of the embryo in the blastocyst stage. For such assessment of theuterine cavity, the gold standard procedure is the diagnostic hysteroscopy. Itinvolves direct visualization of the cavity and simultaneous correction of theintrauterine pathology. Hysteroscopy is a simple procedure with low risk ofcomplication; moreover, complications occur with operative procedures mostcommonly. This study aims to evaluate these complications and critically appraisethe changes in trend of complications.METHODSThis is an observational study. Study included 32 patients with infertilityundergoing operative hysteroscopy at obstetrics and gynaecology department inour hospital.RESULTSAmong the 32 patients, the most common hysteroscopic procedure was lateral wallmetroplasty (40.6%) followed by septal resection (25%). Polypectomy, adhesiolysisand tubal cannulation. Complication rate was 6.25 percent, among which post-opinfection and bleeding per vaginum were the most important