الفهرس 
Abnormal uterine bleedingOnly 14 pages are availabe for public view
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Abstract
Summary
Abnormal Uterine Bleeding (AUB) is a common problem in
gynecological practice, accounting for 15% of office visits &25% of
gynecological operation.
Dysfunctional Uterine Bleeding (DUB) is diagnosed after the
exclusion of pregnancy or pregnancy-related disorders, medications,
iatrogenic causes, obvious genital tract pathology, and systemic
conditions.
DUB occurs mostly after puberty and before menopause
.However, DUB can also occur during reproductive years due to many
causes. FIGO adopted in 2011new classification for causes of AUB
during reproductive years known by the acronym “PALMCOEIN”. The
components of the “PALM” group are discrete structural entities while
the “COEIN” group comprises entities that are not defined by imaging
or histopathology – they are “nonstructural”.
DUB is diagnosed by exclusion after full history taking, clinical
examination, laboratory investigations and exclusion of any structural
causes of AUB.
Medical treatment is the first-line therapy once malignancy and
significant pelvic pathology have been ruled out including hormonal
therapy regimes such as oral contraceptive pills (OCP), progestin given
during luteal phase or in an extended regimen, Levonorgestrel intrauterine
device (L-IUD), and Gn-RH agonist. There are also
nonhormonal medical therapies: NSAIDs and tranexamic acid.Endometrial ablation and hysterectomy are the two surgical
options for DUB and performed when medical therapy fails or there is an
associated symptom such as pain. Also, some of the patients prefer
surgery instead of long-term use of medications.
Endometrial sampling is the gold stander of differentiating
endometrial pathologies.
TVS is a method which has proven its value in the diagnosis of
endometrial pathologies. Many authors have studied the significance of
measurement of endometrial thickness by TVS in the diagnosis of
abnormal uterine bleeding. The various studies performed in this aspect
have proven that, measurement of endometrial thickness is significant in
differentiating normal and abnormal endometrium. Other studies focused
on the value of color Doppler ultrasound in the assessment of
endometrial pathology.
The aim of this study is to evaluate the diagnostic value of blood
flow measurements on Spiral artery by Trans Vaginal Color Doppler
Ultrasonography in differentiation of the different endometrial
pathologies in patients with Dysfunctional Uterine bleeding.
This study was conducted on (50) patients aged 20-39 years
presented with Dysfunctional Uterine Bleeding (DUB) preferred for
dilatation and curettage (D&C) in department of Obstetrics &
Gynecology Tanta University Hospital.
The studied cases were subjected to history taking, complete
general and local examination, needed investigations, TVS measuring
endometrial thickness with color Doppler examination of the endometrial
spiral arteries (Doppler Indices RI &PI) and endometrial biopsy (D&CBiopsy). Finally, the sonographically measured endometrial thickness,
Doppler indices and histopathological results were correlated with each
other and statistically analysed. The aim was to assess the ability of these
screening methods to diagnose the patients with pathological
endometrium who would need further investigations and endometrial
biopsy.
The study showed that the results were significant according to
relation between histopathological results & endometrial thickness (p
value 0.001), endometrial spiral arteries resistance index (RI) &
histopathological results (p value 0.003), endometrial spiral arteries
pulsatility index (PI) & histopathological results (p value 0.001).