Objective: This study was designed to compare the diagnostic accuracy of Pipelle endometrial sampling with conventional dilatation & curettage in patients with abnormal uterine bleeding. Material and Methods:One hundred and forty patients with abnormal uterine bleeding were included in this comparative study; where endometrial sampling was carried out before cervical dilatation by Pipelle device followed by conventional dilatation & curettage (D&C). The histopathology report of the Pipelle sample was compared with that of the dilatation & curettage sample and the dilatation & curettage reports were considered as the gold standard.Results: 100% of the samples obtained by conventional D&C, while 97.9% of the samples obtained by the Pipelle device were adequate for histopathological examination. The histolopathological examination of 140 samples obtained by conventional D&C revealed proliferative endometrium in 37 specimens, secretory endometrium in 33 specimens, endometrial hyperplasia in 49 specimens (45 without atypia & 4 with atypia), endometritis in 8 specimens, endometrial polyps in 3 specimens and malignant endometrium in 10 specimens. In this study; the Pipelle device had 100% sensitivity, 100% specificity and 100% accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium. Also, it had 88.9% sensitivity, and 99.2% negative predictive value (NPV) and 99.3% accuracy for diagnosing endometritis and it had 60% sensitivity, 89.6% NPV and 98.6% accuracy for diagnosing endometrial polyps. Conclusion:The endometrial sampling using Pipelle is a safe, accurate, cost effective outpatient procedure, which avoids general anesthesia and has a high sensitivity and specificity for detection of endometrial hyperplasia and endometrial malignancy. Received: 06 November, 2012 Accepted: 12 December, 2012 Amaç: Bu çalışma anormal uterin kanaması olan hastalarda Pipelle endometriyal örnek alımının tanısal doğruluğunu geleneksel dilatasyon ve küretaj ile karşılaştırmak üzere tasarlandı. Gereç ve Yöntemler:Bu karşılaştırmalı çalışmaya anormal uterin kanaması olan 140 hasta dâhil edildi; Pipelle aleti ile servikal dilatasyondan önce endometriyal örnek alınmasının ardından geleneksel dilatasyon ve küretaj (D&C) yapıldı. Pipelle örneğinin histopatoloji raporu dilatasyon ve küretaj örneğininki ile karşılaştırıldı ve dilatasyon ve küretaj raporları altın standart olarak kabul edildi. Bulgular:Geleneksel D&C ile alınan örneklerin %100'ü, Pipelle aleti ile alınan örneklerin ise %97.9'u histopatolojik inceleme için yeterliydi. Geleneksel D&C ile alınan 140 örneğin histopatolojik incelemesi 37 örnekte proliferatif endometriyum, 33 örnekte sekretuar endometriyum, 49 örnekte endometriyal hiperplazi (45'inde atipi yok ve 4'ünde atipi var), 8 örnekte endometrit, 3 örnekte endometriyal polip ve 10 örnekte malign endometriyum gösterdi. Bu çalışmada, endometriyal hiperplazi, endometriyal karsinoma, proliferatif ve sekretuar endometriyum tanısında Pipelle aleti; %100 sensitivite, %100 spesi...
fFN bedside test is better than nitrazine and ferning tests in detection of PROM, but is not suited for identification of clinically difficult cases with suspected PROM, because, it is influenceable and can give false-positive results in preterm labor, women >34 gestational weeks and after any vaginal manipulation without PROM.
Introduction: Destruction of the basal endometrium layer causes intrauterine synechiae (IUS), known as Asherman's syndrome. Case description: A 37-year-old, P2+1 woman presented with hypo-menorrhea and infertility following dilatation and curettage done for evacuation of a first trimester missed miscarriage. Postmenstrual hysterosalpingography findings were suggestive for IUS, and she was scheduled for diagnostic and operative hysteroscopies in the same setting for synechiolysis. An intrauterine Foley catheter was inserted after synechiolysis for prevention of IUS recurrence. During follow-up, the studied woman reported significant improvement, and increased her menstrual flow days and amount. Two months after stopping the hormonal replacement therapy, she presented with positive pregnancy, and was admitted to the hospital at 37 weeks + 5 days gestation, and delivered a live baby weighing 2.860 kg. Conclusions: Hysteroscopy is the gold standard for diagnosis and treatment of IUS. The treatment of IUS associated with significant improvement in the reproductive outcome and menstrual disorders.
Introduction: Surgical evacuation of the uterine contents in first trimester missed miscarriage is a blind procedure, carrying a risk of complications. This study was designed to evaluate the outcome of the implemented protocol of ultrasound-guided surgical suction evacuation (US-SSE) for first trimester missed miscarriage. Material and methods: Two hundred and twenty women diagnosed with missed miscarriage in the first trimester of pregnancy were included in this study and classified in two groups: 124 women in the US-SSE group, and 94 women in the blind surgical suction evacuation (B-SSE) group. Outcome measures: operative time, hemoglobin loss, hospital stay, cervical trauma, uterine perforation, retained products of conception (RPOC) requiring repeat evacuation, and post-operative infection. Results: The hemoglobin loss was significantly lower in the US-SSE group compared to B-SSE (0.9 ±1.1 vs. 1.2 ±0.8 gms% ; respectively, p = 0.0006), and the hospital stay was significantly shorter in the US-SSE group compared to B-SSE (1.1 ±1.3 vs. 1.5 ±0.9 days; respectively, p = 0.0001). Cervical trauma was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 2 (2.08%); respectively, p = 0.05), and uterine perforation was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 2 (2.08%); respectively, p = 0.05). Post-operative endometritis was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 3 (3.13%); respectively, p = 0.02), and RPOC requiring repeat evacuation was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 4 (4.16%); respectively, p = 0.007). Conclusions: US-SSE for first trimester missed miscarriage is safer than the B-SSE method, and is associated with significant reduction of intra-operative and post-operative complications.
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