Diagnostic comparison of ultrasonography, hysteroscopy and histopathology in abnormal uterine bleeding

Background: The objective of the study was to do diagnostic comparison of ultrasonography, hysteroscopy and histopathological examination in evaluation of abnormal uterine bleeding.Methods: An observational prospective study is conducted amongst 219 married women between age of 25 years to 59 years with Abnormal uterine bleeding admitted for diagnostic hysteroscopy at Obstetrics and Gynecology Department, Apollo Hospital, Bilaspur, Chhattisgarh from November 2022 to October 2023. Statistical analysis was assessed by chi square test.Results: Myoma is best diagnosed by Sonography. The exact size, shape, type of fibroid and location can be accurately diagnosed by USG. Endometrial hyperplasia, endometrial polyp, submucous fibroid, growth, septum, flimsy adhesions, focal lesions and intracavitary intrauterine lesions are best diagnosed by hysteroscopy. Endometrial carcinoma is best diagnosed by histopathology.Conclusions: Hysteroscopy has important role in diagnosis of intrauterine and endocervical canal abnormalities. Addition of hysteroscopy with histopathological examination of endometrial and cervical biopsy sample along with transvaginal ultrasonography enhances the accuracy of diagnosis. Use of hysteroscopy, ultrasonography and histopathology were not competitive rather complementary for diagnosing patients with abnormal uterine bleeding. Diagnostic tools like ultrasonography, hysteroscopy and histopathology helps in accurate, early diagnosis of endometrial and cervical cancer which prevents further damage and further spread and metastasis of disease to adjacent tissues/ organs. Early diagnosis and cure increases life expectancy and decreases morbidity and mortality.

Operative hysteroscopy assisted evacuation of a non-viable pregnancy in the setting of a congenital uterine anomaly - bicornuate bicollis

The uterus is formed during embryogenesis by the fusion of the two paramesonephric ducts (mullerian ducts). The two mullerian ducts normally fuse to form the single uterine body. A didelphis uterus will have a double cervix and a double vagina. This case report describes the successful removal of retained products of conception following a spontaneous miscarriage in the setting of a bicornuate bicollis anomaly with a non-viable pregnancy using operative hysteroscopy. The successful removal of the retained products of conception is an essential step in the management of a spontaneous miscarriage. Gynaecologists should be aware of the potential complications associated with this condition and refer patients with a diagnosis of uterine didelphys to an expert in gynaecology for further evaluation and management.

Comparison of chromohysteroscopy findings with histopathological findings in abnormal uterine bleeding

Background: Aim was to compare histological diagnosis of differently stained endometrial tissue on chromohysteroscopy.Methods: A total of 80 patients diagnosed with AUB and satisfying the study design were included in the study. Hysteroscopy followed by chromohysteroscopy was done using 1% methylene blue. Staining patterns were observed and guided biopsies were taken from differently stained areas and sent for histopathology.Results: On chromohysteroscopy, out of the 80 participants, 53 (66.3%) had focal staining and 27 (33.7%) had diffuse staining. The overall sensitivity, specificity, PPV and NPV of TVS in diagnosing uterine abnormalities was 51.7%, 45.1%, 34.9%, 62.2% respectively. The overall sensitivity, specificity, PPV and NPV for hysteroscopy were 96.6%, 41.2%, 48.3%, 95.5% respectively. The indices for chromohysteroscopy were as follows: sensitivity-69% for focal and 31% for diffuse staining, specificity-49.0% for focal staining and 69.7% for diffuse staining, PPV-43.5% for focal and 33.3% for diffuse staining, NPV-73.5% for focal staining and 62.3% for diffuse staining.Conclusions: The idea of staining of endometrium and taking a guided biopsy is exciting and is undoubtedly, better than a blind sampling. However, subjecting all the patient of AUB to chromohysteroscopy in order to find a major histopathological difference is questionable and needs larger trials to reach to concrete decision.

Practice of hysteroscopy at the Hospital for Applied Research, Endoscopic Surgery, and Human Reproduction, Yaounde Cameroon

Background: This study was done to describe the practice of hysteroscopy at the Hospital Centre for Applied Research, Endoscopy, Surgery and Human Reproduction (CRACERH).Methods: It was a descriptive retrospective cross section study between January 2015 to December 2020.All patients who underwent either an operative or diagnostic hysteroscopy during the study period were included. Data was collected from postoperative reports, patients medical files and registered on a pre-established data collection form. The indications for surgery, the operative findings were also noted. Any unexpected incident during the procedure or postoperative was considered a complication.Results: During the study period, 1876 patients underwent a surgical procedure, of which 287 had a hysteroscopy making a percentage of 15.29%. The average age of the 287 patients was 39.38±6.36 years. Majority of the patients were still menstruating with only 3.8% (n=11/287) were menopaused. The most frequent pathology found during diagnostic hysteroscopy was the polyp with a ratio of 65.6%, and uterine myoma with a ratio of 43.7% (87).Conclusions: Our study highlights the fact that hysteroscopy occupies a preponderant role in the diagnosis of intra uterine pathology especially in the context of infertility.

Outcome of office hysteroscopy in postmenopausal women with red flag signs: a single centre-based study from Northern Ireland

Background: Assessment of postmenopausal women with red flag signs like postmenopausal bleeding/ endometrial thickness ?5 mm is needed for early detection of any pathology. Early-stage endometrial cancer detection through office hysteroscopy is one of crucial modality for effective management. Objective was to assess the outcome of office hysteroscopy in postmenopausal women with red flag sign and correlated with histopathology findings. Methods: A prospective observational study at a single facility in Northern Ireland involving 122 post-menopausal women aged ?45 years subjected to AUB/increased endometrial thickness. Advance diagnostic examination by office hysteroscopy followed by histopathology to detect and rule out endometrial cancer and related ailments.Results: The mean age of the study population was 63.07±10.317 SD years and 91.8% were over-weight. 71.3% women had endometrial thickness <5 mm. Hysteroscopic reported for 8.2% (10 cases) endometrial cancers having diagnostic accuracy of 98.36%. The histological and hysteroscopic diagnoses were having significantly similar outcomes. Office hysteroscopy has 100% specificity and positive predictive value in detecting normal endometrium whereas 98.25% specificity and 100% negative predictive value in case for cancer detection.Conclusions: In Irish women, office hysteroscopy proved helpful in determining the pathologies that cause postmenopausal bleeding. Correlating hysteroscopic and histological findings with red flag indications should be the focus of future explorations.

Design of heating and pressurizing flushing device and effectiveness assessment in hysteroscopic surgery / 中国医学装备

Objective:To design a heating and pressurizing flushing device and to assess its application effect in hysteroscopic surgery.Methods:The heating and pressurizing flushing device was composed of a heating and pressing device,a liquid crystal control panel module,flushing pipeline,heating pipeline and a support frame.A total of 100 female patients who underwent gynecological hysteroscopic surgery at Shengjing Hospital of China Medical University from May 2021 to April 2022 were selected and divided into observation group and control group by random number table method,with 50 cases in each group.The observation group adopted a heating and pressurizing device to perform heating and pressurizing operations during hysteroscopic surgery,the control group adopted manual inflatable pressurized infusion bags to perform heating and pressurizing operations during hysteroscopic surgery by inflating and squeezing the air bag.The clarity of dilated uterus,operation time,preoperative,intraoperative and postoperative body temperature of the patients,and satisfaction of doctors and nurses were compared between the two groups.Results:The clarity rate of dilated uterus and satisfaction of doctors and nurses in the observation group were significantly higher than those in the control group,the difference was statistically significant(x2=7.862,8.392,P<0.05).The operation time of the observation group was significantly lower than that of the control group,the difference was statistically significant(t=51.099,P<0.05).The body temperature of the patients at 15 minutes during operation and 20 minutes after operation in the observation group were higher than those in the control group,the difference was statistically significant(t=-13.153,-17.911,P<0.05).Conclusion:The use of heating and pressurizing device in gynecological hysteroscopic surgery can increase the clarity of dilated uterus,effectively shorten operation time,save human resources,reduce complications and improve the satisfaction of medical staff.The clinical application effect is good.

Interaction between remimazolam and propofol for sedation during hysteroscopy / 中华麻醉学杂志

Objective:To evaluate the interaction between remimazolam and propofol for sedation during hysteroscopy.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 20-45 yr, with body mass index of 18-28 kg/m 2, scheduled for elective hysteroscopy, were included. The test was conducted in two steps. Up-and-down sequential allocation was used to determine the median effective dose (ED 50) of remimazolam (group A) and propofol (group B). The ED 50 obtained in A and B groups were then used as the standard to determine the combination regimen in group C (0.25×ED 50 of remimazolam+ 0.75×ED 50 of propofol as the initial dose), in group D (0.5×ED 50 of remimazolam+ 0.5×ED 50 of propofol as the initial dose), and in group E (0.75×ED 50 of remimazolam+ 0.25×ED 50 of propofol as the initial dose). Up-and-down sequential allocation was used to determine the ED 50 of propofol when propofol and remimazolam were combined in C, D and E groups. The interaction between the sedative effects of two drugs was analyzed using the isobolographic analysis method, and the interaction coefficient and synergistic dose ratio of two drugs were calculated. Results:The ED 50 of remimazolam was 0.180 mg/kg in group A, and the ED 50 of propofol was 1.167 mg/kg in group B. The results of isobolographic analysis showed that remimazolam and propofol had a synergistic effect. When remimazolam 0.045, 0.090 and 0.135 mg/kg were combined with propofol 0.546, 0.288 and 0.160 mg/kg, the interaction coefficients were 1.393, 1.339 and 1.127 respectively. The synergistic dosage ratio of remimazolam and propofol was 1.0∶(3.2 to 12.0). Conclusions:Remimazolam and propofol have a synergistic effect on sedation when used for hysteroscopy, and the dose ratio is 1.0∶(3.2-12.0).

Clinical analysis of different hysteroscopic methods combined with drugs in the treatment of uterine septum / 中国现代医生

@#Objective To investigate the uterine septum clinical treatment effects by hysteroscopy different ways of excision.Methods The treatment effects of 90 uterine septum cases were analyzed retrospectively.Those patients were divided into two groups,One group 45 cases accepted hysteroscopy electrosurgical excision,Another group 45 cases was implemented uterine septum cut off with hysteroscopic miniature scissors.Their operative time,blood loss were recorded and compared,and their mediastinal residual and intrauterine adhesions were retreated again in second hysteroscopy checking after 3 months of the first opration.Results All cases were finish the operation sccssefly without complication happens.The total average surgical time was(20.3±6.8)minutes,the average bleeding volume was(11.2±3.1)ml,and the hospital stay was 1 to 5 days,average of 3.5 days.There was no significant difference between the electric resection and cold knife groups in operation time,intraoperative bleeding,mediastinal residual,uterine cavity adhesion,pregnancy rate and abortion rate(P>0.05).There was no significant difference between the two groups in the sequential treatment of intrauterine adhesions and pregnancy rates with simple estrogen and progesterone(P>0.05),the difference of abortion rate was statistically significant(P<0.05).There was no significant difference between the two groups in the sequential treatment of intrauterine adhesion,pregnancy rate and abortion rate with the combination of intrauterine cross-linked sodium hyaluronate gel and oral estrogen and progesterone(P>0.05).Conclusion There was no clear correlation at intrauterine adhesions,mediastinal remnants in resection methods.The sequential treatment of intrauterine cross-linked sodium hyaluronate gel plus oral estrogen and progesterone after operation is conducive to reducing the adhesion rate and improving the pregnancy rate.

Prevalencia de endometritis crónica en mujeres infértiles establecida mediante histeroscopia y biopsia endometrial con CD138 / Prevalence of chronic endometritis in infertile women by hysteroscopy and endometrial biopsy with CD138

Resumen OBJETIVO: Determinar, mediante histeroscopia de evaluación y biopsia de endometrio, con análisis histológico endometrial e identificación de células plasmáticas con inmunohisdtoquímica con CD138 positiva, la prevalencia de endometritis crónica en pacientes infértiles. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, efectuado de marzo de 2016 a noviembre del 2021 en el Centro de Reproducción Asistida de Saltillo (CREAS), Coahuila, México, en pacientes que consultaron por infertilidad. El diagnóstico de endometritis crónica se estableció mediante histeroscopia y biopsia de endometrio con inmunohistoquímica CD138. Se analizaron la prevalencia y precisión diagnóstica de la histeroscopia y la biopsia de endometrio. Además, la relación entre las características histeroscópicas específicas y la endometritis crónica confirmada por biopsia con CD138 positiva. RESULTADOS: La prevalencia de endometritis crónica por biopsia de endometrio CD138 positiva en las 170 pacientes estudiadas fue de 36% (n = 62) y por histeroscopia del 48.8% (n = 83), esta última con una sensibilidad del 48.3%, especificidad del 50.9%, valor predictivo positivo y negativo del 36.1 y 63.2%, respectivamente. En relación con las características histeroscópicas, la hiperemia endometrial tuvo una relación estadísticamente significativa con la prevalencia de endometritis crónica (p-value = 0.008; RM = 0.357; IC95%: 0.14-0.81) y con ≥ 2 características sugerentes de endometritis crónica (p-value = 0.015; RM = 3.63; IC95%: 1.15-12.69). CONCLUSIONES: En el procedimiento diagnóstico de la paciente infértil es importante descartar la endometritis crónica. Para ello es decisivo recurrir a herramientas diagnósticas, como la histeroscopia y confirmar el diagnóstico con una biopsia de endometrio con inmunohistoquímica CD138 positiva para que de esta manera pueda dirigirse el tratamiento.

Abstract OBJECTIVE: To determine the prevalence of chronic endometritis in infertile patients by evaluating hysteroscopy and endometrial biopsy with endometrial histologic analysis and identification of plasma cells by CD138-positive immunohistochemistry. MATERIALS AND METHODS: Observational, retrospective study performed from March 2016 to November 2021 at the Center for Assisted Reproduction of Saltillo (CREAS), Coahuila, Mexico, in patients who consulted for infertility. Chronic endometritis was diagnosed by hysteroscopy and endometrial biopsy with CD138 immunohistochemistry. The prevalence and diagnostic accuracy of hysteroscopy and endometrial biopsy were analysed. The association between specific hysteroscopic features and chronic endometritis confirmed by CD138-positive endometrial biopsy was also investigated. RESULTS: The prevalence of chronic endometritis by CD138-positive endometrial biopsy in the 170 patients studied was 36% (n = 62) and by hysteroscopy 48.8% (n = 83), the latter with a sensitivity of 48.3%, specificity of 50.9%, positive and negative predictive values of 36.1 and 63.2%, respectively. In relation to hysteroscopic features, endometrial hyperemia had a statistically significant relationship with the prevalence of chronic endometritis (p-value = 0.008; RM = 0.357; 95%CI: 0.14-0.81) and with ≥ 2 features suggestive of chronic endometritis (p-value = 0.015; RM = 3.63; 95%CI: 1.15-12.69). CONCLUSIONS: In the diagnostic process of infertile patients, it is important to exclude chronic endometritis. It is crucial to use diagnostic tools such as hysteroscopy and to confirm the diagnosis by endometrial biopsy with positive CD138 immunohistochemistry in order to guide treatment.

Preoperative promestriene for hysteroscopy: a randomized clinical trial

SUMMARY OBJECTIVE: Intraoperative complications of hysteroscopy, such as the creation of a false passage, cervix dilatation failure, and uterine perforation, may require suspension of the procedure. Some patients refuse a new procedure, which delays the diagnosis of a possible serious uterine pathology. For this reason, it is essential to develop strategies to increase the success rate of hysteroscopy. Some authors suggest preoperative use of topical estrogen for postmenopausal patients. This strategy is common in clinical practice, but studies demonstrating its effectiveness are scarce. The aim of this study was to evaluate the effect of cervical preparation with promestriene on the incidence of complications in postmenopausal women undergoing surgical hysteroscopy. METHODS: This is a double-blind clinical trial involving 37 postmenopausal patients undergoing surgical hysteroscopy. Participants used promestriene or placebo vaginally daily for 2 weeks and then twice a week for another 2 weeks until surgery. RESULTS: There were 2 out of 14 (14.3%) participants with complications in the promestriene group and 4 out of 23 (17.4%) participants in the placebo group (p=0.593). The complications were difficult cervical dilation, cervical laceration, and vaginal laceration. CONCLUSION: Cervical preparation with promestriene did not reduce intraoperative complications in postmenopausal patients undergoing surgical hysteroscopy.

Reporte de caso: síndrome de absorción intravascular en histeroscopia, intoxicación por glicina / Case report: Intravascular absorption syndrome in hysteroscopy, glycine intoxication

El síndrome de absorción intravascular en histeroscopia se origina por la rápida absorción vascular de soluciones isotónicas e hipotónicas utilizadas en irrigación intrauterina, ocasionando hipervolemia y dilución de electrolitos, especialmente hiponatremia. Cuando este síndrome es debido a intoxicación por glicina al 1,5% causa acidosis severa y neurotoxicidad. La incidencia de este síndrome es baja pero puede aumentar por factores como: falta de control de altura de bolsas de irrigación, ausencia de equilibrio de fluidos de soluciones de irrigación, tejidos altamente vascularizados como miomas uterinos y uso de sistema de electrocirugía monopolar. Se reporta el caso de una paciente con miomas uterinos, programada para resección mediante histeroscopia que cursa con síndrome de absorción intravascular por glicina, el temprano diagnóstico y rápido tratamiento intraoperatorio y postoperatorio permitió una evolución favorable. El manejo se basó en el uso de diuréticos, restricción de fluidos y soluciones hipertónicas de sodio.

Intravascular absorption syndrome in hysteroscopy is caused by rapid vascular absorption of isotonic and hypotonic solutions used in intrauterine irrigation, causing hypervolemia and electrolyte dilution, especially hyponatremia. When this syndrome is due to 1.5% glycine toxicity, it causes severe acidosis and neurotoxicity. The incidence of this syndrome is low but may increase due to factors such as: lack of control of the height of irrigation bags, lack of fluid balance in irrigation solutions, highly vascularized tissues such as uterine myomas and use of a monopolar electrosurgery system. The case of a patient with uterine myomas, scheduled for resection by hysteroscopy, who presents with intravascular glycine absorption syndrome, is reported. Early diagnosis and rapid intraoperative and postoperative treatment allowed a favorable evolution. Management was based on the use of diuretics, fluid restriction, and hypertonic sodium solutions.

Hysterolaparoscopy as a comprehensive diagnostic and therapeutic tool in modern art

Background: Infertility affects about 10-15% of reproductive age couple and is increasing globally. None of the laboratory findings alone are conclusive in diagnosing infertility. The ability to visualize and simultaneously treat the identified pathology makes hysterolaparoscopy an essential part of infertility management. Aim of the study was to evaluate hysterolaparoscopy as a comprehensive diagnostic and therapeutic tool in female infertility management. Objective of the study was to evaluate various etiological factors in infertility and the therapeutic interventions done during hysterolaparoscopy.Methods: A cross-sectional study of 250 cases over one year from October 2021 to September 2022 at a teritiary care hospital. Women with primary or secondary infertility aged between 20-40 years were included. Patients with contraindications for general anaesthesia and active pelvic infection were excluded.Results: Out of 250 patients, 195(78%) had primary infertility and 55(22%) had secondary infertility. In primary infertility group 69% and in secondary infertility group 87.7% had abnormal laparoscopy findings. The most common laparoscopic abnormality is tubal factor both in primary infertility (58%) and secondary infertility (58%) group and on hysteroscopy, endometritis is the commonest abnormality in both.Conclusions: In experienced hands, hysterolaparoscopy is a very safe operation. The abnormalities of pelvic and uterus can be diagnosed and also resolved in hysterolaparoscopy at the same time. Also, the future plan of management can be taken in time after the evaluation.

Radiofrequency Endometrial Ablation with Hysteroscopic Verification: Report of Four Cases Conducted in Brazil / Ablação Endometrial por Radiofrequência e Verificaçao Histeroscópica: Relato de 4 Casos Conduzidos no Brasil

Endometrial ablation (EA) is a minimally invasive surgical procedure to reduce abnormal uterine bleeding contemplated for women who have achieved their reproductive goals. EA consists of the destruction of the endometrial layer with preservation of the uterus, although EA has lower complication rates than hysterectomy, it may be associated with metrorrhagia recurrence. One of the major causes of treatment failure is incomplete ablation of the endometrium. Thanks to techniques that have been developed in recent years, endometrial ablation can be performed on an outpatient basis, including by radiofrequency ablation. The main objective of this case series was to report four cases in which Radiofrequency Endometrial Ablation (RFEA) was used to treat abnormal uterine bleeding at a single ambulatory surgical center in Brazil. Hysteroscopic evaluation of the uterine cavity was performed immediately prior to the RFEA to diagnose possible endometrial pathologies and again at the conclusion of the procedure to assess the aspect of the newly treated endometrium. Verification of the completeness of the ablation was assessed by a third hysteroscopy 30 or 60 days after the ablation. In this case series RFEA was efficacious and safe for outpatient use. Although radiofrequency endometrial ablation can be performed without the use of the hysteroscope, we believe it is an important tool for the timely verification of the completeness of the endometrial ablation. (AU)

A ablação endometrial (AE) é um procedimento cirúrgico minimamente invasivo destinado a mulheres com prole estabelecida visando redução do sangramento uterino anormal. A AE consiste na destruição da camada endometrial com a preservação do útero, apesar da AE possuir menores índices de complicação do que a histerectomia, pode estar associada a recorrência do sangramento. Uma das causas da falha de tratamento é a ablação incompleta do endométrio. Atualmente, a ablação endometrial pode ser realizada ambulatorialmente graças às técnicas que vêm sendo desenvolvidas nos últimos anos, as quais incluem o uso de radiofrequência. O objetivo dessa série de casos é descrever 4 casos de Ablação Endometrial por Radiofrequência (AERF) para o tratamento de sangramento uterino anormal realizados em um mesmo ambulatório especializado no Brasil. Uma avaliação histeroscópica da cavidade uterina foi realizada imediatamente antes da AERF para diagnosticar possíveis patologias endometriais e imediatamente ao final do procedimento, para avaliar o aspecto do endométrio recém tratado e a necessidade de nova aplicação de radiofrequência. A integralidade da ablação foi verificada por uma terceira histeroscopia após 30 ou 60 dias depois da ablaçao. A técnica mostrou-se adequada para uso ambulatorial. Embora a ablação endometrial por radiofrequência possa ser realizada sem o uso do histeroscópio, acreditamos que seja uma ferramenta importante para a verificação oportuna da integralidade da ablação endometrial. (AU)

Hysteroscopic findings and intrauterine pathology treatment in Mexican infertile women

Background: Hysteroscopy is a minimally invasive approach in gynecologic surgery and one of the main procedures performed on women undergoing fertility treatments. Intrauterine pathology negatively affects fertility by decreasing endometrial receptivity and embryo implantation success, and its prevalence has been reported between 19% and 62%. The aim of our study was to describe the hysteroscopic findings, prevalence of intrauterine pathology, the instruments used for the treatment of structural lesions in Mexican infertile women; and to compare the relationship of positive findings with the type of infertility.Methods: This was a descriptive, cross-sectional study conducted at fertility clinic at a private hospital.Results: We evaluated 191 hysteroscopies; the mean age of women was 35.5+3.2 years and the mean time of infertility 5.7+3.2 years. Primary infertility was the most prevalent (79.1%). In 118 cases (61.8%), uterine cavity abnormalities were diagnosed, the most frequent findings were: polyps (n=51, 26.7%), endometritis (n=30, 15.7%), fibroids (n=15, 7.6 %), synechiae (n=12, 6.5%), and müllerian anomalies (n=10, 5.3%). For structural pathology treatment, cold scissors and bipolar energy were used in 65.5% and 34.5%, respectively.Conclusions: Overall intrauterine pathology prevalence in our study population was 61.8%. Cold scissors and bipolar energy were used for structural lesions treatment. When comparing the relationship of hysteroscopic findings, no statistically significant difference was found in the presence of positive findings, with the type of infertility.

Hysteroscopic findings and intrauterine pathology treatment in Mexican infertile women

Background: Hysteroscopy is a minimally invasive approach in gynecologic surgery and one of the main procedures performed on women undergoing fertility treatments. Intrauterine pathology negatively affects fertility by decreasing endometrial receptivity and embryo implantation success, and its prevalence has been reported between 19% and 62%. The aim of our study was to describe the hysteroscopic findings, prevalence of intrauterine pathology, the instruments used for the treatment of structural lesions in Mexican infertile women; and to compare the relationship of positive findings with the type of infertility.Methods: This was a descriptive, cross-sectional study conducted at fertility clinic at a private hospital.Results: We evaluated 191 hysteroscopies; the mean age of women was 35.5+3.2 years and the mean time of infertility 5.7+3.2 years. Primary infertility was the most prevalent (79.1%). In 118 cases (61.8%), uterine cavity abnormalities were diagnosed, the most frequent findings were: polyps (n=51, 26.7%), endometritis (n=30, 15.7%), fibroids (n=15, 7.6 %), synechiae (n=12, 6.5%), and müllerian anomalies (n=10, 5.3%). For structural pathology treatment, cold scissors and bipolar energy were used in 65.5% and 34.5%, respectively.Conclusions: Overall intrauterine pathology prevalence in our study population was 61.8%. Cold scissors and bipolar energy were used for structural lesions treatment. When comparing the relationship of hysteroscopic findings, no statistically significant difference was found in the presence of positive findings, with the type of infertility.

The efficacy of transvaginal ultrasonography and office hysteroscopy in evaluation of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a prevalent issue in women of child bearing age group. AUB can be uncomfortable and have a considerable impact on health-related quality of life. AUB is reported to occur in 9 to 14% women between menarche and menopause and reported prevalence in India is around 17.9%.Methods: It is a prospective observational study done in 75 patients with abnormal uterine bleeding attending the gynaecology outpatient department (OPD) at Shri B. M. Patil Medical College, Vijayapura, Karnataka. Patient was thoroughly examined and then transvaginal sonography (TVS) was done after obtaining consent. This was followed by office hysteroscopy(OH) and endometrial biopsy was taken for histopathological examination. Data were gathered and examined and cost analysis of each procedure was done.Results: The most frequent presenting symptom was heavy menstrual bleeding (49.3%). For proliferative and secretory endometrium, the sensitivity of TVS was 81.48% and for the detection of polyps, endometrial hyperplasia, and submucous fibroid it was 45.45%, 42.86%, 100% respectively. The sensitivity of OH for detection of polyps, endometrial hyperplasia, and submucous fibroid which was 46.15%, 100%, 100% respectively. The p value was <0.05 which shows the statistical significance of both tests. TVS demonstrated low correlation for intracavitary diseases. OH was costlier when compared to TVS.Conclusions: TVS has more sensitivity and accuracy in detecting intramural pathologies. OH had showed greater diagnostic accuracy in identifying intra cavitary pathologies of uterus and doing intervention in the same setting.

Istmocele: incidencia por ecografía e histeroscopia y síntomas clínicos asociados en pacientes con antecedente de cesárea / Istmocele: incidence by ultrasound and hysteroscopy and associated clinical symptoms in patients with a history of cesarean section

Objetivo: Determinar la incidencia de istmocele por ecografía e histeroscopia. Método: Se realizó un estudio observacional y transversal, de tipo descriptivo mediante la aplicación de una matriz de registro a pacientes sintomáticas que acudieron a la consulta ginecológica del IAHULA en el periodo entre enerojunio 2019 a quienes se les realizo ecografía pélvica e histeroscopia. Resultados: Se obtuvo una muestra de 24 pacientes. La edad promedio fue 37 años. 91,7 % presento dolor pélvico, 54,2 % dispareunia, 50 % SUA y 4,2 % infertilidad. Del total de la muestra 18 pacientes reporto istmocele por ecografía y 20 por histeroscopia. Conclusión: Es importante que, ante síntomas como dolor pélvico, sangrado uterino anormal, infertilidad y dispareunia, se considere el istmocele como posible causa y diagnóstico diferencial, siendo esté un defecto fácil de diagnosticar y tratar. Este estudio demuestra muy buena correlación entre los resultados, reportando la ecografía una sensibilidad del 100 % y especificidad del 67 %. La incidencia de istmocele fue 75 % por ecografía y 83,3 % por histeroscopia(AU)

Objective: To determine the incidence of isthmocele by ultrasound and hysteroscopy. Methods: An observational and cross-sectional, descriptive study, was carried out by applying a registration matrix to symptomatic patients who attended the IAHULA gynecological consultation in the period between January-June 2019 to those who underwent pelvic ultrasound and hysteroscopy. Results: A sample of 24 patients was obtained. The average age was 37 years. 91.7 % had pelvic pain, 54.2 % dyspareunia, 50 % SUA and 4.2 % infertility. Of the total sample 18 patients reported isthmocele by ultrasound and 20 by hysteroscopy. Conclusion: It is important that before symptoms such as pelvic pain, abnormal uterine bleeding, infertility and dyspareunia, isthmocele is considered as a possible cause and differential diagnosis, being an easy defect to diagnose and treat. This study demonstrates a very good correlation between the results, with ultrasound reporting a sensitivity of 100 % and specificity of 67 %. The incidence of isthmocele was 75 % by ultrasound and 83.3 % by hysteroscopy(AU)

SUCCESSFUL HYSTEROSCOPY GUIDED SUCTION & EVACUATION OF PRODUCT OF CONCEPTION ALONG WITH REMOVAL OF UTERINE SEPTUM IN SAME SITTING

Objective To report a case of early pregnancy loss with septate uterus, successfully managed by hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum in same sitting. Case report. Tertiary care hospital. One woman with early pregnancy loss with septate Design Setting Patient uterus. Hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum Intervention in same sitting. Hysteroscopy guided suction & evacuation of product of conception followed by septum removal with Result hysteroscopic scissor was performed, with minimal blood loss, in same sitting. Products of conception were sent for pathologic examination. There were no intra-operative or postoperative complications. Even though the role of septum as a Conclusion contributing factor to miscarriage in not certain, early pregnancy loss may be seen in patients with septate uterus. Blind removal of POCs with dilatation & curettage, may be complicated with retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Also removal of septum, which may or may not be the cause, is often performed before further pregnancy. This requires another admission & exposure to anaesthesia, along with added cost. Hysteroscopy guided resection of POC with septum removal in same sitting has been associated with complete tissue removal under vision, less damage to surrounding endometrium, cost effective combination of two surgical procedures & earlier time to conception compared with 2 sitting procedure (dilation and curettage than septum removal). Thus, hysteroscopy guided suction & evacuation of POC & septum removal in same sitting can be considered as an alternative surgical technique for management of early pregnancy loss in patients diagnosed with septate uterus. This case report demonstrates the successful application of hysteroscopic procedure in a case of early pregnancy loss with septate uterus.

Hysteroscopic evaluation of menorrhagia and correlation with saline infusion sonography and histopathology of the endometrium

Background: This study aimed to evaluate and compare the diagnostic utility of hysteroscopy and saline infusion sonography in patients presenting with abnormal uterine bleeding, using the International Federation of Gynaecology and obstetrics classification system.Methods: The study included 97 women with menorrhagia attending the department of obstetrics and gynaecology, R. D. Gardi Medical College, Ujjain, from September 2011 to February 2013. All the participants underwent hysteroscopy, saline infusion sonography (SIS), and endometrial histopathology. The sensitivity, specificity, positive predictive value, and negative predictive value of each diagnostic method was calculated and compared.Results: Both hysteroscopy and SIS demonstrated high sensitivity and specificity in detecting structural lesions from the PALM group of abnormal uterine bleeding (AUB) aetiologies. For endometrial polyps, hysteroscopy had a sensitivity of 89.47% with a specificity of 87.17%, while SIS had a sensitivity of 100% and specificity of 88.46% (p<0.01). For submucous fibroids, hysteroscopy had a sensitivity of 82.35% and specificity of 91.25%, while SIS had a sensitivity of 88.23% and specificity of 88.75% (p<0.01). However, neither method was as effective for endometrial hyperplasia and the COEIN group. Hysteroscopy-guided biopsy could improve the sensitivity and specificity of hysteroscopy in detecting endometrial hyperplasia.Conclusions: Hysteroscopy and SIS are valuable tools in the diagnosis and management of AUB, with both methods demonstrating significant efficacy in detecting structural lesions, such as endometrial polyps and submucous fibroids. Further research is needed to refine these techniques and determine their optimal use in clinical practice, especially for the detection of endometrial hyperplasia and conditions within the COEIN group.

Evaluation of intrauterine pathologies by hysteroscopy in abnormal uterine bleeding

Background: Hysteroscopy is the gold standard for uterine cavity evaluation because it allows direct visualization of the uterine cavity, mitigate characteristics of lesions such as nature, size, shape, location and vascular pattern.Methods: This was a prospective observational study conducted in department of obstetrics and gynecology at Chirayu Medical College and Hospital, Bhopal (MP). Patients presenting to general gyne OPD with abnormal uterine bleeding at Chirayu Medical College and Hospital between January 2021 to May 2022 were studied. All patients selected for study had a thorough evaluation with detailed history, clinical examination, lab tests and sonography followed by hysteroscopy and endometrial biopsy.Results: Mean age of patients in our study was 44 years with majority of patients in 41-50 years age group. Predominant complaint reported was heavy menstrual bleeding (HMB) (47.50%) followed by HMB with frequent cycle (11.25%). Hysteroscopy detected intrauterine abnormality in 42.50% cases. Most common finding on hysteroscopy in our study was hyperplastic endometrium in 17.50% patients followed by endometrial polyp in 15% of patients. Atrophic endometrium was seen in 2.5% and 2.5% had submucous fibroid.Conclusions: Hysteroscopy allows diagnosis or exclusion of intracavitary pathologies, which are underdiagnosed on routine pelvic sonography. It also enables treatment in the same sitting with accurate tissue biopsy from the representative areas and facilitates planning of further management. When combined with endometrial biopsy and pelvic ultrasonography, it can establish an accurate diagnosis in a majority of patients thereby reducing the burden of hysterectomy.