Title: Hysteroscopic Evaluation of Abnormal Uterine Bleeding- Vaginoscopic Approach
Authors: Major (Dr) Rahul Mahajan, Colonel (Dr) Prasad Lele, Brigadier (Dr) Manash Biswas
DOI: http://dx.doi.org/10.18535/jmscr/v4i1.42
Abstract
Introduction: Abnormal uterine bleeding, a common but complicated clinical presentation accounting for almost 20% of gynecologic outpatient visits1, reported 25% of gynecologic surgeries.2Easily accomplished in an office setting with little or no analgesia or anesthesia, office hysteroscopy provides direct access to the uterine cavity giving an accurate diagnosis directing surgical or medical treatment for the specific pathology and may avoid the need for major surgery
Aims & Objectives: Hysteroscopic evaluation of the cervical canal & uterine cavity in women with AUB to evaluate various causes and to perform diagnostic or therapeutic intervention whenever possible to reach the actual diagnosis and relieve the symptoms in office setting.
Method: 100 cases diagnosed with various presentations of AUB in reproductive and postmenopausal group were evaluated prospectively by office hysteroscopy with vaginoscopy approach between Jan 2014 to Jun 2015 in tertiary care hosp of Pune (Maharashtra). Histopathology examination of endometrium and/or pelvic ultrasound was done in selective cases to reach a final diagnosis.
Results: Office hysteroscopy was successfully carried out in 98 of 100 women, 42 % of these had normal cavity, 13% had fibroid, 12% had polyp, 7% had hyperplastic endometrium, 7% had adenomyosis, 3% foreign bodies, 7% intrauterine adhesions, 2% tubercular endometritis, 1 % retained products, 1 case of endometrial CA and 2 cases of uterine anomalies.
Total 12 cases (12.24%) of AUB were treated in the same setting, including six cases of weak intrauterine adhesions, three cases each of small intrauterine polyps and three cases of foreign bodies, in two cases CuT thread was missing whereas the other woman having AUB was unaware about CuT inserted in her uterus long back.
Conclusion: Diagnostic hysteroscopy performed with vaginoscopy approach in an office setting with little discomfort to the patient, enabled the physician to search for organic intrauterine abnormalities and to select the proper form of therapy based on the findings reducing requirement of unnecessary surgical intervention in patients with normal cavity. A small proportion of patients were treated in the same setting for the underlying pathology to relieve the symptoms. With the invention of modern thin caliber, cordless and portable devices, office hysteroscopy will definitely be used as a first step in evaluation of AUB.
Keywords: Abnormal uterine bleeding, Office hysteroscopy, Vaginoscopy, Menorrhagia, Polyp, Fibroid.
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