European Journal of Molecular & Clinical Medicine

Uterine Arterio Venous Malformation is defined as the rare pathology and difficult to quantify, with approximately 100 cases reported in the literature. Yazawa & O'Brien suggested pelvic sonographies of patients to rule out cause of  uterine bleeding, reported variable incidences of Arterio Venous Malformation 4.5% and 0.6% respectively.(2) Main Pathophysiology is formation of  direct communication amongst uterine arteries and veins & absence of intervening capillaries. It is life-threatening as profuse bleeding per vagina is the typical presentation. In this article, 32 year female G2P1L1 (Urine Pregnancy Test was done in the hospital) with amenorrhea since 2 months followed by vaginal bleeding since 20 days. Ultrasound of pelvis -increased vascularity with involving vessels of sub-endothelium and myometrial and Retained Products Of Conception, which complicated the diagnosis. She was investigated. As she was hemodynamically stable, she underwent expectant management and responded well

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%.