The health aspects in postmenopausal women including postmenopausal bleeding have gained importance in the present days as the life expectancy has increased. AIMS To compare the diagnostic accuracy of Pipelle biopsy and hysteroscopic-guided biopsy in the detection of endometrial pathologies in women with postmenopausal bleeding and to calculate sensitivity, specificity, predictive values for Pipelle endometrial sample in comparison to hysteroscopic-guided biopsy. MATERIALS AND METHODS This was a prospective comparative study carried out in the Department of Obstetrics and Gynaecology over a period of one year nine months in 100 postmenopausal women attending Gynaecology Outpatient Department and having postmenopausal bleeding as the chief complaint. RESULTS In our study, mean age of women presented with postmenopausal bleeding was 54.76±8.02 years. The mean duration of menopause was 7.95±5.40 years. 66% cases were para 4 or above. 62 cases (62%) had one or more risk factors hypertension being the most common present in 22 cases (22%). Majority of women with postmenopausal bleeding had endometrial thickness between 5-8 mm (44%) on TVS. Histopathological findings of Pipelle endometrial biopsy compared with hysteroscopic-guided biopsy in diagnosing polyps showed statistically significant difference with p value 0.0, whereas, for atrophic, proliferative endometrium, hyperplasias, carcinoma, it was statistically insignificant (p value >0.05). Sensitivity of Pipelle for detecting focal endometrial lesions is lesser than hysteroscopic biopsy. CONCLUSION Endometrial sampling with Pipelle alone is not effective for diagnosing focal endometrial lesions. Hence, Pipelle can be used as a first line investigation for histopathological evaluation of postmenopausal bleeding. Whenever focal lesions are suspected as on a TVS, a hysteroscopic biopsy is preferable.
Introduction: Prelabour rupture of membranes (PROM) is defined as the membrane rupture at term without spontaneous uterine contractions. In 10% of term pregnancies and 30-40% preterm pregnancies, foetal membranes fail to maintain their structural integrity resulting in their prelabour rupture. Study aimed to compare the safety and efficacy of misoprostol by two different route's of administration i.e., oral and buccal in women with PROM at term. Material and Methods: 100 patients with PROM were divided into oral and buccal group equally. Both the groups received 25µg of misoprostol every 4 th hourly, either orally with water or it was held in the cheek in the buccal group, maximum upto 6 doses in either group. Result: The prevalence of PROM in the present study was 7%. All demographic varaiables are insignificant in both groups. oxytocin augmentation required was found to be statistically significant in both groups. Mean induction delivery interval was shorter in buccal group (13.966±4.68) compared to oral group(17.126±5.10) which was statistically significant. The change in the pre-induction Bishop score after 12 hours was slightly higher in the buccal group compared to oral group which was statistically. Tachysystole was higher in buccal group (8%) compared to oral group(2%), There were no cases of still births and neonatal deaths in both groups. No significant differences were found in hospital stay and NICU admissions in both the groups. Conclusion: Buccal misoprostol is more efficacious than oral misoprostol. Women who received buccal misoprostol experienced shorter induction to delivery interval, required fewer doses of misoprostol and required oxytocin augmentation less frequently than those who received oral misoprostol.
BACKGROUND Abnormal uterine bleeding is the most common complaint in gynaecology and an important source of morbidity. This study evaluates the usefulness of hysteroscopy in the diagnosis of abnormal uterine bleeding in comparison to dilatation and curettage in reproductive age group. MATERIALS AND METHODS Between September 2011 to July 2013, women with AUB attending Gynaec OP were subjected to hysteroscopy and subsequent dilatation and curettage. Data was collected and analysed. RESULTS AUB was more common in 30-34 yrs. The most common presenting complaint was menorrhagia. Normal hysteroscopic view was seen in 50% cases. Abnormalities seen were endometrial hyperplasia, polyps, submucous myoma synechiae and rue. Both hysteroscopy and curettage gave specificity of 70%, but the ability to diagnose focal lesion (sensitivity) was more with hysteroscopy in comparison to curettage 70 vis. 36. 43 patients had the same tissue diagnosis in both hysteroscopy and curettage. Hysteroscopy revealed more information than curettage in 42% and curettage had more information in 15% cases, 100% accuracy was seen in case of myoma, IUCD, adhesions and polyps with hysteroscopy. CONCLUSION This study confirms the conclusion of many others that hysteroscopy is superior to dilatation and curettage in evaluating patients with abnormal uterine bleeding.
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