Online ISSN: 2515-8260

Keywords : AUB


COMPARISON OF PIPELLE ENDOMETRIAL SAMPLING VERSUS DILATATION AND CURETTAGE IN CASES OF ABNORMAL UTERINE BLEEDING

Kesavachandra Gunakala, P.M. Rekharao, Seshadri Sahaja, Vennela Mude

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2338-2359

Background: Pipelle endometrial sampling versus Dilatation and curettage in collecting a sufficient endometrial sample for histopathological diagnosis was the subject of this observational clinical correlation diagnostic study. Aim: The present study is done in our hospital to know if Pipelleaspiration endometrial sampling can replace D&C for histological examination in cases of AUB.
Materials and Methods: This was an observational clinical correlation diagnostic study designed to compare the efficacy of Pipelle endometrial sampling with Dilatation and curettage in obtaining an adequate endometrial sample for histopathological diagnosis. After obtaining informed consent to participate and determining fitness for the procedure, 100 patients who reported with AUB to the Department of Obstetrics &Gynaecology at Government Medical College, Kadapa, were enrolled in the study. The study was carried out from October 2019 to September 2021. The patient underwent a thorough clinical evaluation in the outpatient department, which included a history, physical examination, and baseline investigations. Prior to the procedure, TAS/TVS were done. Endometrial sampling was performed using the Pipelle device, followed by a diagnostic reference standard and D&C endometrial sampling under anaesthesia.
Results: The most common age group presented with AUB is between 41 and 45 years. Most of the patients (45%) had < 6months duration of AUB. Pre and perimenopausalwomen made up 94% of the study population, whereas postmenopausal women made up 6%. Among the study group, 4% were nulliparous, and the remaining 96% were parous women. Of the study group, the ET thickness varies as - 13 had < 6mm, 18 had ET between 6.1- 9mm, 50 had ET between 9.1-12mm, 13 had ET between 12.1-15mm, 4 constitute between 15.1-18mm, 2 had >18mm ET. In Pipelle and D & C, sampling inadequacy was significantly more in menopausal women compared to pre-menopausal women. (P<0.05). In 16 cases, Pipelle sampling was deemed challenging. Sampling was difficult in nulliparous women when compared to parous women. Histopathology reports were obtained in 93 of the 100 Pipelle samples and 94 of the 100 D&C samples in current study.  The most frequent endometrial pattern observed was Hyperplasia without atypia (21%) , followed by proliferative phase of the endometrium (20%), no evidence of malignancy (14%), Secretory phase (11%),  disordered proliferative phase (11%), atrophic endometrium (4%), nonsecretory phase in (4%), endometrial polyp (2%), Hyperplasia with atypia (2%), early secretory phase (1%), endometrial carcinoma (1%), late secretory phase (1%), Endometrial glandular hypertrophy (1%). When comparing Pipelle to D&C, the chi-square test shows that Pipelle has a sensitivity of 98.9% for retrieving sufficient tissue and a specificity of 100%. The positive predictive value is 100 percent, while the negative predictive value is 85.7%. The p-value estimated is< 0 .001, which is statistically significant. Out of 100 cases that had Pipelle sampling, 91 had no complications. 5 had pain, and 4 had bleeding. Out of 100 cases that had D & C, 59 had no complications, 29 had pain, 5 had bleeding, and 7 had both pain and bleeding.
Conclusion: Pipelle sampling can be used as an effective screening procedure in the outpatient department.

Comparative study of pipelle device versus conventional dilatation and curettage for endometrial sampling in diagnosis of endometrial pathology causing abnormal uterine bleeding or infertility in women > 25 years of age

Dr. Samita Bhat, Dr. Rooma Sinha, Madhumati Sanjay, Bana Rupa, Dr. Fozia Jelani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1588-1596

Background: Abnormal Uterine bleeding (AUB) is a cause of significant healthcare burden for the women, common methods for endometrial assessment are USG, hysteroscopy, D&C, however multiple newer outpatient method are becoming popular due to their ease of application and cost effectiveness. Present study was aimed to compare the diagnostic accuracy and histopathological success of Pipelle verses conventional curettage in diagnosing endometrial pathology in AUB cases.
Material and Methods: Present study was single-center, Prospective and comparative single blind study, conducted women aged 25 years, with complaints of abnormal uterine bleeding with or without infertility. Initially, endometrial sample was collected by pipelle sampler in the outpatient department followed by endometrial biopsy by curettage under general anesthesia.
Results: Out of 106 patient’s majority were from 40-60 years age group, had 2 or more parity. Majority had abnormal uterine bleeding alone (77.36%), infertility alone (10.37%) & infertility with abnormal uterine bleeding (12.26%). Common USG findings were endometrial polyp (19.81%), fibroid uterus (10.38%), adenomyosis (3.77%), cystic endometrium (3.77%) and Thickened Endometrium (1.89%). In women with AUB & infertility the sensitivity of pipelle in picking up the endometrial pathology was 100% as compared to D&C and specificity was 99.02%. The negative predictive value was 100% and Positive predictive value was 80%. In the premenopausal women the sensitivity, specificity, NPV & PPV are all 100% for Pipelle sample as compared to curettage. In the postmenopausal women, specificity & PPV was 100%, however sensitivity was 66% and NPV was 95.2%.
Conclusion: In women with AUB & infertility the sensitivity of pipelle in picking up the endometrial pathology was 100% as compared to D&C and specificity was 99.02%. The negative predictive value was 100% and Positive predictive value was 80%.

Study of endomed sampler for endometrial biopsy, by comparing the histopathology reports as gold standard

Dr. Shibin K, Dr. Shivakumar, Dr. Sajitha AK, Dr. Nishi K, Dr. Chellamma VK

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2109-2114

Background: Abnormal uterine bleeding (AUB) is a major clinical problem in women of peri and post-menopausal age group. It accounts for 30%of outpatient population coming to a gynaecologist. Evaluation of AUB is important for ruling out endometrial carcinoma and its precursors. Endomed biopsy is an ideal method for obtaining endometrial sample with ease, low cost and without anaesthesia. To determine sensitivity, specificity, positive predictive value and negative predictive value of Endomed sampler, by comparing the histopathology reports of endometrial samplings with that of hysterectomy specimen, taken as gold standard. Methods: This study is carried out in 76 patients with abnormal uterine bleeding posted for hysterectomy. Endometrial sampling was done with Endomed in all patients. The histopathology report of endomed sample is compared with that of hysterectomy sample. Results: The mean age of study population in our study was 45.75 ± 7.19 years. The most common complaint was menorrhagia (39.5%), followed by polymenorrhagia (17.1%), dysmenorrhea and lower abdominal pain (14.5% each). Endomed sample was found to be adequate for 94.7% of the study population. Among the adequate samples, proliferative endometrium contributed to a 28.9%, followed by secretory endometrium (22.4%) and the least was hyperplasia with atypia (3.9%). Among the study population, 8 (10.5%) of them were found to have carcinoma endometrium with histopathology (HPR) report of hysterectomy specimen whereas 6 (7.9%) using Endomed sampling. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy was found to be 100%, 88.2%, 96.97%, 100% and 97.22% respectively for Carcinoma Endometrium. Conclusion: Endometrial sampling by endomed method is safe, easy to perform, highly sensitive and specific for diagnosis of endometrial carcinoma and its precursors. Endomed sampling can be used as an alternative to D&C for sampling of endometrium.

PATTERN OF ABNORMAL UTERINE BLEEDING IN HYPOTHYROID FEMALES OF REPRODUCTIVE AGE GROUP – A PROSPECTIVE STUDY

Dr. Sabha Malik; Dr. Saba Musharaf; Dr. Natasha Gupta

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 1, Pages 2204-2208

Introduction: Thyroid dysfunction may have profound effect on the female reproductive system. Hypothyroidism results in change in cycle length and amount of bleeding leading to oligomenorrhea, amenorrhea, polymenorrhea, and menorrhagia Objective: This study was conducted to see menstrual patterns in hypothyroid females of reproductive age group in Kashmir, Jammu & Kashmir. Study Design: Prospective cohort study Material and Methods: 50 patients who presented to OPD with complaints of abnormal uterine bleeding in Dept of Obstetrics & Gynaecology, SKIMS, Kashmir were recruited. Statistical Analyses: Data presented as percentages for qualitative variables. For continuous variable, student ‘t-test’ was applied and to see for association among the variables , chi-square test was used. P value less than 0.05 was considered as statistically significant. Results: In our study among hypothyroid reproductive women, most common pattern of AUB was menorrhagia that was around 58% (29/50) followed by polymenorrhea 22 % (11/50). Hypomenorhea, oligomenorrhea and amenorrhea were present in 8%, 6 % and 6 % respectively. Conclusion: In hypothyroid females presenting with AUB, menorrhagia is the most common abnormal pattern of bleeding followed by polymenorrhea. Hypomennorhea, oligomennorhea and amenorrhea were less common.