Abnormal uterine bleedingTransvaginal sonography Hysteroscopy Endometrial polyp Submucous fibroid a b s t r a c t Background: Abnormal uterine bleeding (AUB) accounts for 33% of female patients referred to gynaecologists. Common causes of AUB include endometrial polyps, endometrial hyperplasia, submucous fibroids and anovulation. Accurate diagnosis of the cause of AUB can reduce the frequency of hysterectomy. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation. Methods: 100 female patients with AUB were enrolled in the study. Each patient was subjected to TVS where uterine cavity was studied in detail and hysteroscopy under anaesthesia using saline as distension medium. Sensitivity, specificity and predictive value of TVS as compared to hysteroscopy were calculated. Subgroup analysis within each group was also performed. Results: Menorrhagia was the commonest presenting symptom in the study population (n ¼ 58) followed by metrorrhagia, menometrorrhagia and continuous bleeding >21 days. 74 female patients had normal size uterus. In 57 patients, the uterine cavity was normal on TVS. Thickened endometrium, endometrial polyp and submucous fibroids were seen in 19, 16 and 6 patients respectively. Hysteroscopy showed normal cavity in 59 female patients and polypoidal endometrium, polyps or submucous fibroids in 41. TVS was found to have high sensitivity and specificity (95.23 and 94.82 respectively) and high positive and negative predictive value. Strength of agreement between TVS and hysteroscopy was high (kappa value 0.898). Conclusion: TVS is recommended as first line investigation in AUB. If TVS shows normal cavity, further evaluation can be omitted and patient started directly on medical treatment for her symptoms.© 2014, Armed Forces Medical Services (AFMS). All rights reserved. m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 1 ( 2 0 1 5 ) 1 2 0 e1 2 5http://dx

A 12-year-old pre-menarchal girl presented to our emergency department with acute urinary retention for last eight hours. She admitted having difficulty in micturition for last one month. She denied any other significant past medical or surgical history. During per urethral catheterization a non-tender lump which used to increase on Valsalva manoeuvre was noted in the perineum. Abdominal ultrasonography and magnetic resonance imaging (MRI) showed a large haematocolpos compressing the urethra. She underwent hymenotomy with evacuation of collected menstrual blood. Post procedure recovery was uneventful and she was able to pass urine with normal stream subsequently.