Evaluation of endometrium by transvaginal ultrasonography and hysteroscopy and its correlation with histopathology in perimenopausal women with abnormal uterine bleeding at tertiary rural centre

Background: Abnormal uterine bleeding is one of the commonest clinical presentation ac-counts for 33% gynaecological consultations and this proportion rises to 70% in perimenopausal and postmenopausal age group in any gynaecology clinic. The most probable etiology of abnormal uterine bleeding relates to the patients reproductive age. Various diagnostic techniques have been evolved over the periods to determine the etiology of abnormal uterine bleeding in perimenopausal women, but their accuracy has not been compared properly. The aim of study is to evaluate the endometrium by transvaginal ultrasonography and hysteroscopy and its correlation with histopathology in perimenopausal patients with abnormal uterine bleeding.Methods: Total 96 patients in perimenopausal age group, admitted with chief complaints of ab-normal uterine bleeding were included. All patients underwent transvaginal ultrasonography and hysteroscopy, followed by hysteroscopy guided biopsy and histopathological examination. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated for both methods and compared, considering histopathological diagnosis as gold standard.Results: Mean age of patients was 44.05±3.29. Hysteroscopy has high accuracy, sensitivity, specificity, positive predictive value and negative predictive value than Transvaginal sonography for diagnosis of all endometrial and intrauterine pathologies.Conclusions: Hysteroscopy results are more consistent with the results of histopathology. Hysteroscopy and hysteroscopy guided biopsy has been proven as gold standard for endometrial evaluation of patients with abnormal uterine bleeding. TVS can be used as most cost effective first step investigation in cases of perimenopausal bleeding.

A case of endometrial tuberculosis complicated by Pott’s spine with paraplegia.

Extra-pulmonary tuberculosis has shown an increasing trend in developing countries and accounts for 15-20% of total tuberculosis cases in India. Extra-pulmonary cases are usually diagnosed late due to vague and subtle signs & symptoms at a stage when major irreversible tissue damage had occurred. Tuberculosis is a chronic disease with infection remaining dormant for years in body to get activated whenever the immunity decreases. Spinal and cranial TB has the gravest manifestations, while the abdominal, female genital or pelvic TB poses a challenge because of lack of specific diagnostic tests. Here we are reporting a case of endometrial tuberculosis which was diagnosed very late, followed by treatment default and finally got complicated with Pott’s spine with paraplegia due to haematogenous spread. Timely intervention and anti-tubercular treatment improved the symptoms. It stresses on keeping the high suspicion of tuberculosis in unresponsive and persistent general symptoms.

Parasitic acardiac twin: a rare anomaly of monochorionic TRAP sequence.

Acardiac twin is a rare complication of monozygotic multiple pregnancy. Vascular anastomosis between twins, with single placenta leads to transfer of deoxygenated blood from umbilical artery of donor to the recipient twin in reverse direction through its umbilical artery which is responsible for abnormal growth. Acardiac twin dies in utero or immediately after birth with a 50-75% mortality of normal donor twin due to congestive heart failure secondary to strain of perfusing acardiac twin.