Study of the role of hysteroscopy with dilation and curettage in post- menopausal bleeding: a cross sectional study

Background: Abnormal uterine bleeding is defined as any type of bleeding in which the duration, frequency or amount is excessive for an individual patient. Hysteroscopy has ushered a new era in the evaluation of abnormal uterine bleeding. With this background, we conducted a study to find the role of hysteroscopy with dilation and curettage in post-menopausal bleeding.Methods: It was an observational study conducted in the department of obstetrics and gynecology of a tertiary care hospital in Maharashtra. Post-menopausal patients with abnormal uterine bleeding, admitted in the period of March 2018 to September 2019 were included in the study. A pretested and predesigned questionnaire was used to collect the data. Hysteroscopy with dilation and curettage was done and samples were sent for histopathology.Results: Bleeding was present in all the 30 cases. About 33.33% had pain abdomen, 56.67% had hot flushes, 10.00% had mass and 10% had other symptoms in the present study. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of hysteroscopy in diagnosing malignancy was 75%, 96.15%, 75%, 96.15% and 93.33% respectively.Conclusions: To conclude the most common cause of abnormal uterine bleeding in post-menopausal women in our study was polyp. The sensitivity and specificity of the hysteroscopy in diagnosing the malignant lesions is 75% and 96.15% respectively which corroborated with other study findings. Hysteroscopy with dilation and curettage is better alternative to hysterectomy and biopsy in most of the cases.

Hypervascular retained products of conception: dilemma of diagnosis and management

Retained products of conception (RPOC) are a partial retention of placental tissue after dilation and curettage (D&C) procedures or vaginal deliveries. Ultrasound scan reports sometimes mention the presence of increased endometrial / sub‐endometrial vascularity in the context of retained products of conception. This raises the possibility of serious intra‐operative haemorrhage because of the possibility of arterio‐venous malformation. The aim of this article is to discuss the diagnosis and management options of retained products of conception (RPOC) with increased vascularity where simple dilatation and curettage may lead to life threatening haemorrhage and endanger the life of the patient and to enlighten the importance of evaluation of vascularity in all cases of RPOC prior to dilatation and curettage in order to avoid the dreaded complication of massive haemorrhage.

Correlation Between D&C, USG and Hysteroscopy Findings in Diagnosing a Cause for Abnormal Uterine Bleeding.

Introduction: Abnormal uterine bleeding (AUB) is the most often encountered gynecological problem. A newly coined term describes the condition wherein there is any deviation from a normal menstrual pattern. An estimated 5% women aged 30-49 years consult a gynecologist each year for treatment. This makes it imperative to accurately diagnose and treat the cause. This study aims at judging the place of diagnostic hysteroscopy in obtaining an accurate diagnosis of the etiology of AUB and amp; outlining a mode of treatment. This is done by correlating the findings on hysteroscopy and those found on a dilation and curettage (D&C) and ultrasonography (USG). Material and methods: This prospective study was performed in the Dept. of Obstetrics and Gynecology, National Institute of Medical Sciences, Jaipur. Fifty cases of AUB were chosen based on inclusion and exclusion criteria. The patients were subjected to routine investigations, USG, D&C and hysteroscopy. The findings of the three were compared and analyzed. Results: AUB was most common between 30-39 years (44%). Maximum patients had complaints since 3-6 months (50%). Menorrhagia was the most common presenting complaint (46%). Normal findings were observed in 40% cases with D&C, 16% with USG, 22% with hysteroscopy. Abnormal findings were seen in 60% cases with D&C, 84% with USG, 78% with hysteroscopy. The over-diagnostic role of USG is also highlighted. Conclusion: This study reveals the superior ability of hysteroscopy in evaluating patients with AUB, when compared to D&C and USG. These findings are in agreement with those of many other studies.

Cardiac Arrest Caused by Intramyometrial Infiltration of Vasopressin during Dilation and Curettage under General Anesthesia: A case report / 대한마취과학회지

Vasopressin, an extremely potent vasoconstrictor, has been widely used for surgical hemostasis in gynecological practices. But, Intramyometrial infiltration of vasopressin is not free of side effects and may cause lethal complications including pulmonary edema, myocardial infarction, and cardiac arrest in spite of infrequency of reported cases. Sudden cardiac arrest was encountered just after intramyometrial injection of vasopressin in our patient undergoing dilation and curettage. We believe that this awful complication was due to baroreflex-mediated regulation of blood pressure, caused by unintentional penetration of vasopressin into the vessels. We herewith discuss the complications of the local injection of vasopressin and the safe dose of vasopressin for intramyometrial injection.