Aliya Islam, Ghazala.
TRANSVAGINAL SONOGRAPHY.
Professional Med J Jan ;16(1):127-34.

Objective: (1) To evaluate predictive values of non-invasive transvaginal sonography in abnormal uterine bleeding. (2) Correlate results of transvaginal sonography with hysteroscopy and biopsy in abnormal uterine bleeding. Design: Descriptive study. (Validity study for TVS). Setting: Gyny/Obs Deptt, Military Hospital Rawalpindi. Period: One year - from January 2006 to December 2006. Subjects & Methods: Women of any age presenting with abnormal uterine bleeding. Total number of cases included were two hundred. Patients were evaluated in OPD by taking detailed gynaecological history. Clinical examination was carried out to find any local source of bleeding from genital tract. Pap smear was taken at that time. Transvaginal ultrasound was performed in OPD basis. The results were noted on a pre-designed proforma. Routine investigations were performed on outpatient basis at the time of patient selection which included complete blood picture, urine analysis, random blood sugar, renal function tests and hepatitis B and C screening. Then the patients were admitted for hysteroscopy and histopathology. Hysteroscopic findings were noted on the proforma. Later histopathology report was also entered into proforma. Hysteroscopy and biopsy were considered gold standard in our study. Thus the procedure was considered 100% accurate and sensitivity, specificity, PPV and NPV for TVS were calculated. Results. It was found that at less than 14 mm endometrial thickness no serious pathology was found. Sensitivity, specificity, negative predictive value and positive predictive value for TVS was found as follows; 1.For endometrial hyperplasia 100%, 93%, 100%, 79% respectively. 2. For endometrial polyp 100%, 97%, 100%, 25% respectively. 3. For carcinoma 100%, 99%, 100%, 33% respectively. 4. For proliferative endometrium 79%,100%, 78% and 100%. 5. For secretary phase endometrium 100%,96%.100%,79%respectively. 6.For sub mucus fibroid 100%, 98%, 100%, 60% respectively. Conclusion: .Difference between values of hysteroscopy and TVS is not very significant so TVS should be used as 1st line investigation. At less than 14mm endometrial thickness no major pathology is detected.

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