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...

100% of samples obtained by conventional D&C, while 98.2% of the samples obtained by Tao Brush were adequate for histopathology examination. In this study; Tao Brush had 100% sensitivity, 100% specificity, 100% predictive values and accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium, also, it had 86.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 99% negative predictive value (NPV) and accuracy for diagnosing endometritis (no significant difference compared to conventional D&C), while, it had 77.8% sensitivity, 100% specificity, 100% PPV and 99% NPV and accuracy for diagnosing endometrial polyps (no significant difference compared to conventional D&C) CONCLUSION: Endometrial sampling using endometrial brush cytology (EBC) is safe, accurate, cost-effective outpatient procedure, avoids general anesthesia with high sensitivity and specificity for detection of endometrial hyperplasia and endometrial carcinoma. EBC could be used as complementary diagnostic tool when hysteroscopic biopsies or other blinded procedures for endometrial sampling are unwanted or not available.

Detection of the PAMG-1 in the vaginal fluid using AmniSure(®) test is an accurate method to diagnose rupture of the fetal membranes, with high sensitivity, specificity, negative and positive predictive values.

Palpation method is widely used in clinical practice to identify the puncture site during combined spinal-epidural (CSE) blocks. Tuffier's line, is an anatomical landmark between two iliac crests (inter-cristal), which is widely used to identify the puncture site during CSE blocks is not always an indicator for specific vertebral level or inter-vertebral space. One hundred and Ten (110) women were scheduled for normal vaginal delivery and were randomized into two equal groups; palpation group and an ultrasound guided group to detect the efficacy of puncture ultrasound before CSE blocks to increase chances of successful CSE procedure on the first attempt and to reduce the number of attempts or punctures during insertion of CSE catheter. There were no significant differences between two studied groups regarding; maternal age, weight and height, while, there was a significant difference between two studied groups regarding; parity. Percentage of successful CSE procedure on the first attempt was significantly higher (67.27%) in ultrasound compared to palpation group (40%). Number of punctures (attempts) were significantly less in ultrasound (1.2 ± 0.6) compared to palpation group (2.3 ± 0.8) and the number of redirections was also significantly less in ultrasound (1.4 ± 0.5) compared to palpation group (2.8 ± 1.6). Although, time to identify puncture site was significantly longer in ultrasound compared to palpation group and total procedure time was longer in ultrasound (9.1 ± 1.5 min) compared to palpation group (6.2 ± 1.2 min), there was no significant difference between two studied groups regarding; time to identify puncture site and total procedure time. Two cases of dural puncture in palpation versus no cases in ultrasound group and two cases of intravascular catheter placement (one in each group), with no significant difference between two groups. Pre- puncture ultrasound guided epidural insertion before vaginal delivery, increases the chance of a successful CSE procedure on the first attempt and reduces the number of attempts during insertion of CSE catheter.