Sonohysterography findings in abnormal uterine bleeding in Kenyatta National Hospital

Abstract

Introduction: Abnormal uterine bleeding (AUB) is one of the most common gynecological problems faced by women especially in the reproductive age as well as post menopausal women. Several imaging modalities have been used to investigate this problem. Sonography is most easily accessible and easy to use modality for the initial management of AUB. Both transvaginal sonography (TVS) and transabdominal sonography are being used in many departments as the initial investigation modality. Though proven useful in the investigation of AUB, a normal finding in these modalities doesn't always rule out endometrial causes of AUB. Sonohysterography (SHG) is a sonographic investigation which involves infusion of normal saline into the uterine cavity and imaging with TVS. It enables better visualization of the endometrium and the endometrial cavity and therefore characterization of endometrial abnormalities. Objective: To determine the sonohysterographic findings in patients presenting with AUB in Kenyatta national hospital. Materials and Methods: A total of 87 women with abnormal uterine bleeding who satisfied the inclusion criteria were enrolled in this study. A prior transabdominal and transvaginal sonography followed by a sonohysterography was performed in all cases. The presence of focal endometrial and subendometrial lesions and the descriptions of lesions were done. Results: The age of women presenting with AUB was between 20 years and 45 years with the mean age of 31.57±6.06 years. The most common presenting symptom was menorrhagia (25%) and the least was oligomenorrhea. Out of the 87 subjects, uterine fibroids were seen in 6 of the patients with menometrorrhagia, and 1 of the patient with metrorrhagia. TVS done prior to the SHG showed abnormalities within the endometrium in 8/87(9%). These included endometrial hyperplasia, fibroids, and floating clot within the uterine cavity. TVS provided false normal findings in 6(7%) cases out of the normal 79 cases. All the cases of partial endometrial synechiae were seen in patients presenting with oligomenorrhea. Out of the 13 abnormalities seen on SHG, 3(23%) were accurately detected on TVS. All the 3 were endometrial hyperplasia. Out of the 8/87 abnormalities provided by TVS, 3(37%) were accurate while 5(62%) were inconclusive. Conclusion Although TVS is a simple, minimally invasiveIow cost technique initially used in evaluating AUB, however a normal TVS study doesn't exclude endometrial pathology as has been shown in previous and this study. SHG can detect abnormalities in an otherwise normal TVS. In addition, SHG is useful to further evaluate a positive finding on TVS. For this reason, SHG is recommended to be used in combination with TVS as an initial investigation of choice in patient with AUB. Further study is needed to correlate SHG findings with hysteroscopy and pathology findings to help with definite diagnosis of the endometrial masses seen on SHG in our study.