Role of transvaginal sonography and diagnostic hysteroscopy in abnormal uterine bleeding

Introduction : A prospective study was carried out in Department of Obstretics and Gynaecology in KIMS Hospital Bangalore, India, for a period of 18 mnth from 2005-2008. Sixty cases were selected for this study from patients who were above the age of 40 y and who were presented with a history of abnormal uterine bleeding (after excluding pregnancy and its complications, Patients with local causes of bleeding, patients with carcinoma cervix and PID). All women underwent transvaginal sonography and hysteroscopy. Dilatation and curettage was done in cases with abnormal endometrial findings and sample sent for histopathology examination. Performance of TVS pick up rate in relation to hysteroscopy were analysed by various statistical methods.

In the present study, transvaginal ultrasound showed an accuracy of 83.3% in detecting the proliferative phase and 66.67% in detecting the secretory phase. TVS has a sensitivity of 0% for a local lesion (intra-cavitary) of endometrial cavity. TVS was also preferable in case of post-menopausal patients with endometrial thickness less than 4mm.

Both TVS and hysteroscopy can detect endometrial intracavitary abnormalities with varying accuracies. These can supplement and enhance the accuracy of tissue diagnosis. Thus, the first procedure to which patients with AUB are to be subjected should be TVS followed by hysteroscopy and hysteroscopically directed biopsy, wherever required.