Outpatient endometrial biopsy with Pipelle vs diagnostic dilatation and curettage.

BACKGROUND: Pipelle is a silastic curette which does not require a tenaculum or straightening of the cervical fundus axis because of its flexibility and does not require general anaesthesia, whereas Dilatation and curettage (D&C) requires hospitalization and general anaesthesia along with the problem of postoperative pain. The objective of the study was to assess the effectiveness of Pipelle sampling in terms of adequate specimen collection and patients' knowledge and perception about Pipelle and compare it D&C. METHODS: In this randomized control trial, 203 women presenting with abnormal uterine bleeding were enrolled. The patients were randomly assigned to one of the two procedures. In group A 102 patients were subjected to Pipelle endometrial sampling and in group B 101 patients were enrolled for D&C. Frequencies of adequacy of histopathology reports and cost effectiveness of both groups were compared. Patient's knowledge, perception, pain and acceptability of the procedure of both groups were also assessed and compared. RESULTS: The mean age of the patients was 46.3 ± 4.45 years. Tissue obtained for histopathology was 100% adequate when the procedure was D&C while it was 98% in Pipelle group. In group-A 92% patients experienced no discomfort, with only 2% experiencing severe pain and 6% mild pain. On the other hand in group-B, 45% patients experienced moderate and 5% experienced severe pain up to 9 on visual analogue scale (VAS) postoperatively arid requiring post-operative analgesia. The acceptability for the Pipelle suction curette was 98% and for the D&C group was 34%. Regarding previous knowledge of procedure none of patients (100%) knew about Pipelle procedure but 98% patients were aware of D&C procedure. Pipelle was eight times more cost effective as compared to D&C. CONCLUSIONS: The results of obtained by endometrial sample by Pipelle and D&C are compareable. Pipelle significantly produced less pain than D&C.

Low amniotic fluid index in high-risk pregnancy and poor apgar score at birth.

OBJECTIVE: To determine the accuracy of antepartum Amniotic Fluid Index (AFI) of < or = 5 cm as a predictor of adverse outcome at birth in high-risk pregnancies. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Obstetrics and Gynaecology Unit I, Holy Family Hospital and Railway Teaching Hospital Complex, Rawalpindi, from February 2003 to January 2004. METHODOLOGY: One hundred pregnant women at term gestation were studied. Each high-risk woman at term with an AFI of < or = 5 cm admitted for delivery through emergency or outpatient department was labeled as predictor of poor outcome. The next high-risk pregnant woman at term with the same pregnancy complication but an AFI of > 5 cm was labeled as predictor of good outcome at birth. The subjects in both the groups were demographically matched and fulfilled the inclusion and exclusion criteria. The Apgar score was calculated at 5 minutes of birth. The newborns, with Apgar score < or = 6 at 5 minutes of birth were labeled as diseased and > 6 were labeled as healthy. AFI was compared with Apgar score, using Chi-square and a p-value was calculated to determine the statistical significance. Sensitivity, specificity, efficiency and the predictive values of AFI at a cut off point of < or = 5 cm as a predictor of adverse outcome at birth (Apgar score of < or =6 at 5 minutes of birth) in high-risk pregnancy were calculated. RESULTS: Only 8 neonates of 50 women with low AFI had low Apgar score. Similarly, 6 neonates of 50 women with normal AFI had poor Apgar score. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and efficiency of AFI as test were 57.1%, 51.3%, 16%, 88% and 52% respectively. CONCLUSION: Low AFI is a poor predictor of adverse outcome for high-risk term patients. AFI is not a good screening test for high-risk pregnant women at term for birth of an infant with low Apgar score.

Impact of new diagnostic criteria of diabetes mellitus.

OBJECTIVE: To compare the frequency of diabetic individuals diagnosed by fasting plasma glucose (FPG) > or = 7.0 mmol/L with previous value i.e. > or = 7.8 mmol/L and to determine the diagnostic accuracy of FPG > or = 7.0 mmol/L. DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: The Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from April to July 2003. PATIENTS AND METHODS: FPG of 5250 subjects was checked to compare the frequency of diabetic subjects diagnosed by FPG > or = 7.0 mmol/L with > or = 7.8 mmol/L. Of them, 301 symptom-free subjects were subjected to 75 g Oral Glucose Tolerance Test (OGTT) and their 2 hours post glucose (2-h PG) challenge level was taken as "gold standard" to determine the diagnostic accuracy of FPG at > or = 7.0 mmol/L. RESULTS: By lowering the cut off point of FPG from 7.8 mmol/L to 7.0 mmol/L, the percentage of diagnosed diabetic subjects increased from 35% to 42%. Statistical analysis revealed a significant increase (p < 0.0001). FPG > or = 7.0 mmol/L had a diagnostic sensitivity of 70%, specificity 91%, the predictive value of positive and negative diagnosis was 84% and 80% respectively. CONCLUSION: FPG at cut off point of >7.0 mmol/L, will greatly facilitate the early diagnosis of diabetes mellitus (DM). An early diagnosis can be further facilitated by a combination of FPG and 2-h PG estimation.