Hysteroscopy: an effective tool in post-menopausal bleeding

Background: Postmenopausal bleeding is a condition where endometrial carcinoma is to be ruled out. Traditionally, D and C is the preferred method for diagnosis in such condition. Other diagnostic modalities like trans vaginal ultrasonography (TVS) and hysteroscopy are being used for diagnosis in the cases of PMB. The objective of this study is to evaluate the efficacy and accuracy of TVS and hysteroscopy in women with postmenopausal bleeding (PMB).Methods: One hundred postmenopausal women with vaginal bleeding underwent TVS and hysteroscopy. Endometrial tissue was obtained by curettage and sent for histopathology examination. The results of TVS and Hysteroscopy were compared against HP report.Results: Hysteroscopy was successful in 98 patients. Endometrial histopathology revealed proliferative, secretory and atrophic endometrium in 26, 7 and 23 patients respectively. Polyp was diagnosed in 13 patients. Endometrial hyperplasia was detected in 11 patients and endometrial malignancy in 14 patients. All patients with endometrial hyperplasia and malignancy had ET (endometrial thickness) more than 4 mm, except one patient with endometrial malignancy who had 4 mm ET. The sensitivity and specificity of TVS for suspecting endometrial pathology at ET 4mm were 93% and 69.6%, respectively. Hysteroscopy had sensitivity of 95.2%, specificity of 92.8%, with diagnostic accuracy of 93.8%.Conclusions: Hysteroscopy was found to be the more sensitive and specific than Transvaginal sonography for diagnosing endometrial pathologies. Hysteroscopy is safe and effective for detecting endometrial pathologies in patients with PMB.

Cervical Evaluation By Transvaginal Ultrasonography as a Predictor of Preterm Labour

Aims and Objective:  To determine the efficacy of TVS ultrasonographic evaluation of cervical biometry in predicting preterm delivery in asymptomatic low risk pregnant women. Material and Methods - a prospective analysis of low- risk pregnant patients at 22-24 weeks attending antenatal OPD at a tertiary level teaching hospital over a period of one year. There were 200 antenatal patients overall equally divided into two groups GrA with 100 patients and cervical length< 2.5cm and GrB with 100 patients having cervical length >/= 2.5cm. Transvaginal ultrasonography was performed and cervical evaluation done by measuring cervical length and recording presence or absence of funnelling. These women were followed till delivery and results analysed by finding p-value. Results: The results proved that with cervical length, 2.5cm the preterm deliveries were 88% while term deliveries were only 12%. This was statistically significant with a P-value of < 0.001. Of the 88 patients that had preterm delivery, in 36 patients there was presence of funneling and only 2 of these could carry their pregnancies till term and 34 of them ie.  94.4% had preterm deliveries. In patients with cervical length >/= 2.5cm the total preterm delivery rate was only 8% in asymptomatic pregnant women and the term deliveries were 92%. Of the Preterm deliveries in this group 2 (25%) had funneling while in 6 (75%) it was absent. Conclusion: This study has re-established the relevance of TVS in cervical assessment for prediction of preterm labour.

Efficacy of TVS colour doppler in comparison of primary infertility with endometrial biopsy

Background: Accurate prediction and diagnosis of uterine abnormalities has become a core part of the fertility work-up. A variety of modalities can be used for the diagnosis of uterine abnormalities Transvaginal ultrasonography (TVS) is one among all. Aim: To determine the efficacy of TVS ultrasonography in screening for endometrial disease and studied the concordance of abnormal endometrial thickness, as measured by ultrasonography, with diagnoses based on histopathological examination of endometrial biopsy specimens. Materials and methods: A total 200 Subjects were elected from OPD of ESIC Hospital, Hyderabad. All subjects were undergone to the routine clinical and blood investigation, ultrasound, transvaginal and colour doppler investigations. Results: Study of primary infertility the diagnosis by transvaginal ultrasound and histopathology matched in 82% cases, while in 18% cases there was a disparity among the two modes of investigation. Conclusion: TVS can play an effective role in diagnosis and management of primary infertility, as it has a greater patient compliance with non-invasive technique and without necessitating full bladder. It can replace the EB in the diagnostic work up of female infertility.