European Journal of Cardiovascular Medicine

Introduction- Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. Aims And Objectives- compares the efficacy accuracy of hysteroscopy and transvaginal sonography in diagnosing the  pathology of AUB. The hysteroscopic and sonographic findings are correlated with the histopathological diagnosis of endometrium obtained by curettage. Material And Methods- The present study “A comparative study of hysteroscopy and transvaginal ultra sonography in the evaluation of AUB in reproductive age group” is a prospective study which was done in the department obstetrics and gynecology, Indore. 100 patients with the complain of AUB were selected at random from the Gynecology Out Patient Department of the Institute of obstetrics and gynecology medical college and MY hospital Indore. The age group of the selected patients ranged from 20 to 40 years. All the patients underwent TVS, Hysteroscopy followed by curettage and removal of abnormal lesions like Polyps and Submucous fibroid and the material was sent for histopathological analysis. The period of study was from September 2018 to Aug-2019. Patients with age group in the range of 20 to above and parous woman with AUB and who do not have any other medical or surgical complications and who do not require any emergency management were selected for this study. Patients with severe anemia, pregnancy, nulliparous, pelvic inflammatory disease, systemic cause of bleeding, vaginal and cervical cause of bleeding, thyroid disorder and coagulation disorder, unmarried girls and medical complications like uncontrolled diabetes mellitus or hypertension were also excluded from  study to preclude any anesthetic or surgical risks during hysteroscopy. After informed written consent and counselling, detailed clinical history was taken. obstetric history included parity, mode of delivery, abortion, history of IUCD, history of D and C, contraception history, detailed menstrual cycle history past and present in term duration, frequency, flow amount and type of abnormal bleeding, and duration of complain, any relevant preceding event.  Results- Total number of patients selected: 100. Among the reproductive age group, patients in the age group of  26 – 30 constitute 40%. Patients having 1 – 2 children constitute the majority - 48% of cases; whereas multiparous women having more than 4 children constitute only 10%. Kumari m et al and Patil et al, 61% and 71% patient with aub were multiparous respectively. Mishra et al study 65% multiparous 30% primiparous. 80% of patients sought medical advice within 6 months of illness; whereas only 2% of patients sought the medical advice after 1 year of illness. Commonest pattern of bleeding is menorrhagia accounting for                          42% of cases. By Histopathology 74 patients (74%) had normal endometrium. Histopathology diagnosed 8 cases of hyperplasia and 14 cases of endometrial polyp, 4 cases of Submucous fibroid. In the present study there were no malignancies detected. 8 out of 100 patients had simple hyperplasia, whereas in 74 out of 100 patients, endometrium was normal. Conclusion- This study confirms that hysteroscopy is superior to transvaginal sonography in evaluating abnormal uterine bleeding. Most of the patient presenting with aub are in reproductive age group. Higher incidence of intrauterine pathologies in this age group.  Both tvs and hysteroscopy will diagnose the condition of uterus. but both have different accuracies. Compare to tvs, hysteroscopic is direct visualization   of endometrial cavity and also a safe reliable and fast procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity, specificity, positive predictive value, negative predictive value with minimal complication. Additional opportunity of taking biopsy. Transvaginal sonography can be used as the first line diagnostic technique but hysteroscopy followed by histopathological examination should be considered as “Gold standard” for evaluation of abnormal uterine bleeding.