الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Abnormal uterine bleeding (AUB) is a symptom and not a disease. It can be defined as any bleeding whose duration, frequency, and amount are excessive for a certain patient occurring in pre- and postmenopausal women due to several causes such as organic (polyps, myomas, hyperplasia, atrophy, endometrial cancer) or not organic ”dysfunctional uterine bleeding”. It is a common reason for gynecological consultation in pre- and postmenopausal women as it makes the patient uncomfortable due to the limitations that it poses, such as the increased need to use tampons and the concern about the cause of bleeding and the possibility of a malignant disease. In addition to the disturbance caused to women, AUB is viewed as a sign for possible uterine diseases, some of which are pre-malignant or malignant.
Many of these patients will undergo office hysteroscopy as part of their diagnostic flowchart to evaluate the uterine cavity, as it has a very high accuracy. Because it is introduced under direct vision, complications are extremely rare. It has a much larger role beyond diagnosis, however, enabling the physician to remove polyps and submucous myomas, and perform targeted biopsies, where patients are comfortable and relaxed. In addition, patients undergoing examinations as outpatients have significantly less time off work and have a faster recovery with consequent savings to patients and their physicians.
This study was conducted aiming to evaluate the role of office hysteroscopy as an outpatient procedure in the evaluation of endometrial & intracavitary lesions in patients with abnormal uterine bleeding.
The study was conducted on 100 women who had been selected from the outpatient clinic of El Shatby Maternity University Hospital. Diagnostic office hysteroscopy using vaginoscopic approach was performed to all patients without anesthesia or analgesia. Hysteroscopy was performed after clinical examination and exclusion of any case with pelvic infection, Pregnancy Postpartum and Postabortion, to decrease complications during the procedure, and the results showed that:
• The comparison between results of diagnostic office hysteroscopy and transvaginal sonography was:
Normal Findings 20 % & 15 %
Endometrial polyp 29 % & 32 %
Submucous fibroid 13 % & 17 %
Endometrial hyperplasia 18 % & 2 4%
Atrophic endometrium 11 % & 11 %
Endometial carcinoma 0 % & 1 %
Missed IUDs (lippes loop) 2 % & 1 %
Failure 6 % & 0 %
For office hysteroscopy and transvaginal sonography (TVS) respectively.
• The study showed a significant statistical difference between TVS and office hysteroscopy in the detection of different endometrial lesions in patients with abnormal uterine bleeding. So diagnosis of endometrial polyp, submucous fibroid and endometrial hyperplasia is preferred to office hysteroscopy.
• Most of the patients (44%) had symptoms for less than 6 months and most common presenting symptom was Postmenopausal bleeding (30%) and Menorrhagia (26%).
• Endometrial polyp (39.2%) was the most common abnormality, followed by endometrial hyperplasia (24.3%).
• Combined hysteroscopy and targeted biopsy leads to almost 100% accuracy in the diagnosis of endometrial neoplasia and its precursors.
• The results showed that pain during diagnostic office hysteroscopy was 11.70% no pain during procedure, mild pain in 44.60%, moderate pain in 30.85% and sever pain was found in 12.76%. Pain intensity is higher in postmenopausal than in premenopausal women especially in severe pain, so menopause is a factor related to pain occurrence and intensity. There was no procedure related complications in our study.
Our results concluded that:
1) Office hysteroscopy using vaginoscopic approach is an easy, simple and rapid technique that is not associated with complications for diagnosing uterine cavity abnormalities in patients with abnormal uterine bleeding.
2) Office hysteroscopy showed superior accuracy compared to ultrasound in the diagnosis of endometrial diseases in patients with abnormal uterine bleeding.
3) Office hysteroscopy allows the patient and the gynecologist to view the abnormality simultaneously through a video monitor. This allows better counseling of the patient about her condition.
4) Office procedure using versascope which has made the possibility of one step ”see & treat” like resection of polyp and submucous fibroid and extraction of missed IUDs at the same session of the diagnosis.
5) Anesthesia or analgesia free office hysteroscopy is often associated with pain, and it has been determined that menopause is a factor associated with pain.
from these results, diagnostic office hysteroscopy (versascope) using vaginoscopic approach without anesthesia or analgesia should be used as a tool for diagnosing the intrauterine pathology in patients with abnormal uterine bleeding .