RESUMEN
The most frequent procedures performed on women with abnormal uterine bleeding are 2D and 3D ultrasound. The most common accepted approach for the management of abnormal uterine bleeding is 2D TV scan followed by therapeutic hysteroscopy. The purpose of this prospective study was to assess whether 3D saline infusion sonohysterography [3D SIS] could replace diagnostic hysteroscopy [DH] for the diagnosis of endometrial pathology, in patients with abnormal uterine bleeding. A prospective study in the ultrasound department of the Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia from January 2008 to February 2010. 0One hundred and one patients with abnormal uterine bleeding, suspected to have endometrial abnormality by 2D and 3D transvaginal scan, were prospectively studied. Of these, 55 patients had undergone both 3D SIS and DH, followed by verification of results with histopathology. Upon comparison of 3D SIS and DH individually with histopathology, specificity and sensitivity for 3D SIS were 67% and 100%, respectively, and for hysteroscopy 67% and 98%, respectively. In addition, the positive predictive value and negative predictive value were 98% and 100%, respectively, for 3D SIS, while for DH they were 98% and 67%, respectively. 3D SIS is a safe alternative to hysteroscopy. However, larger randomized controlled trials should be conducted to ascertain the validity and reliability of this advantageous, less-invasive procedure, for women with abnormal uterine bleeding, who require evaluation of the endometrial cavity
RESUMEN
Since cervical cancer is reportedly the seventh most frequent cancer in women in Saudi Arabia and the eighth most frequent cancer among women aged between 15 and 44 years, we wanted to determine the prevalence of abnormal cervical cytology among subfertile women attending the reproductive medicine unit of a tertiary care center in Saudi Arabia. This was a retrospective, cross-sectional, hospital based study. A Pap smear was done for 241 of 493 [48.9%] subfertile women from January 2008 through February 2009. The Pap smear was normal in 166 of 241 patients [67.9%], abnormal in 71 [29.5%], and unsatisfactory for evaluation in 4 [1.7%]. According to the revised Bethesda system, epithelial cell abnormality was found in 7 [2.9%], inflammation in 55 [22.8%], and infection in 9 [3.7%] patients. Epithelial cell abnormalities were further classified as atypical squamous cells of undetermined significance [ASC-US] [n=3, 42.8%], atypical squamous cells of high grade [ASC-H] [n=1, 14.3%], low-grade squamous intraepithelial lesion [LSIL] [n=2, 28.5%], and glandular cell abnormalities [AGS] [n=1, 14.3%]. The high prevalence of abnormal cervical cytology in our subfertile women accentuates the need for screening in patients eligible for in vitro fertilization. In addition, a well-organized screening program for cervical cell abnormalities at the national level should be implemented to allow identification of subfertile women at risk so that potentially life-saving measures can be undertaken early