ABSTRACT

Background and aim: This study aimed to determine the compatibility of ultrasound and hysteroscopy findings and histopathological results in women with abnormal uterine bleeding. Due to the high prevalence of cesarean section in our country and since less attention has been paid to cesarean section defects (isthmocele) as a cause of abnormal uterine bleeding, even in cases where hysteroscopy findings and ultrasound are not fully matched, in the present study, the presence of isthmocele during hysteroscopy and its compliance with the ultrasound reports is examined.

Material and method: In this cross-sectional study, 913 women with abnormal uterine bleeding who met the inclusion criteria, were studied. After obtaining written consent from the patients, hysteroscopy was performed under local or general anesthesia, and ultrasonography was also performed. If polyps or myoma were observed, the resection was performed using scissors or a resect scope. The site of cesarean section defects was also examined by hysteroscopy. In the absence of focal lesions, endometrial curettage was performed, and all samples were sent for pathological examination. Data were entered into SPSS software, version 23, and analyzed.

Results: The study included 913 patients with abnormal uterine bleeding (AUB) with an average age of 41.13± 9.22. The mean duration of AUB in patients was 10.97±14.61 months. The most common form of bleeding was intermenstrual spotting, which was seen in 27.7% of patients, followed by menorrhagia in 26.4% and menometrorrhagia in 21.1%. In ultrasonography findings, the most common findings were polyp and then myoma in 38.1% and 20.0% of patients, respectively. In hysteroscopy, the most common findings were polyp, myoma, and normal evaluation, respectively. A positive and significant correlation was found between the presence of isthmocele in ultrasonography and the number of cesarean sections (CC=0.189, p-value=0.0001) and the duration of bleeding (CC =0.086, p-value=0.009), and there was also a positive and significant correlation between isthmocele finding in hysteroscopy with the number of cesarean sections (CC=0.566, p-value=0.0001) and parity (CC=0.200, p-value=0.0001). An inverse and significant correlation was also observed between the age of patients and abnormal pathological findings in ultrasonography and hysteroscopy. Based on the kappa coefficient (19.2%), hysteroscopy was a more appropriate method in diagnosing patients with AUB.

Conclusion: The ultrasound and hysteroscopy diagnostic methods demonstrated appropriate sensitivity in investigating cases of abnormal uterine bleeding. However, the hysteroscopy was actually useful in diagnostic experiments of AUB.

Keywords: ultrasound, hysteroscopy, histopathology, abnormal uterine bleeding, isthmocele