الفهرس 
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Abstract
Aim of the work: To evaluate the value of transvaginal sonography
without, and with, saline infusion (ultrahysterosonography)
compared with hysteroscopy in the diagnosis of abnormal
uterine bleeding.
Patients: This included 30 patients with abnormal uterine bleeding; 23
premenopausal and 7 postmenopausal, 39-60 years old, with uterine size not more than 12 weeks of pregnancy size, with no
hormonal intake for at least 6 weeks and no history of systemic bleeding disorders.
Methods:The patients were subjected to complete history taking,
complete general and pelvic examination and complete blood count, complete urine analysis and x-ray chest and ECG if
needed. This was followed by conventional vaginal ultrasonographic and sonohysterographic examination using
saline. One week later, they were examined by diagnostic
hysteroscopy under general anesthesia with endometrial curettage for histopathological examination.
Results: By trans vaginal ultrosonography (TVS) 6 cases were diagnosed as endometrial hyperplasia, but only 5 proved true on TVHS
and histopathology. Sensitivity was 100%, specificity was 96%, accuracy 97%, +ve 86% and -ve predictive value 100%. That of
TVHS were (100%), while that of hysteroscopy the sensitivity was 40%, specificity 100%, accuracy 90%, positive predictive value 100% and negative predictive value 100%. As, hysteroscopy confirmed the diagnosis in 2 cases only of the 5 cases of endometrial hyperplasia.
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All endometrial polypi were diagnosed only after saline instillation.
Sensitivity of TVS was 100%, specificity 89%, accuracy 42%, ve predictive value 0% and -ye predictive value 44% with the lowest ve positive predictive value of TVS. While, That of TVHS and 1-1scope were 100%.
TVS diagnosed 8 of submucous myomas, out of 9 and one case was misdagnoscd as being endometrial polyp. All 9 myomas were diagnosed by TVHS and hysteroscopy with sensitivity, specificity. accuracy,+ve and-ve predictive value or TVS of 100%. While that of TVS sensitivity 100%, specificity 90%, -ve predictive value 86%, -Nic predictive value 100% and accuracy 97%. TVHS was in complete agreement with hysteroscope, it gave more accurate data about the size. location, intramural extension and the number of myomas.
TVHS is recommended as a first-line of investigating the uterine cavity and walls in cases of abnormal uterine bleeding as it proved to he the least invasive and the most accurate method of diagnosis.