Transvaginale contrastechoscopie van de uterus in de diagnostiek van abnormaal uterien bloedverlies: minder hysteroscopieën nodig

To determine the value of transvaginal saline-infusion sonography of the uterus in patients with abnormal uterine blood loss in terms of avoiding hysteroscopy.

Design

Prospective.

Method

According to the protocol, transvaginal saline-infusion sonography was carried out on all consecutive patients with abnormal uterine blood loss (post-menopausal patients with an endometrial thickness of ≥ 5 mm and all pre-menopausal patients with menorrhagia or metrorrhagia) in the St. Joseph hospital in Veldhoven, the Netherlands, during the period 1999-2001. If sonography did not provide an image suitable for assessment, or if intracavitary (pedunculated) lesions such as polyps or myomas were suspected, a planned therapeutic hysteroscopy was carried out. Patients indicated their perception of pain on a visual analogue scale.

Results

Saline-infusion sonography of the uterus was performed in 457 patients (age: 40-69 years). In 32 patients (7) it did not result in a representative image. In 138 (32) of the remaining 425 patients, a pedunculated lesion was suspected. In 262 (59) of the 457 patients, diagnostic efforts were restricted to ultrasonic examination. This was combined with endometrial aspiration in 161 (61) of these patients. In total, hysteroscopy was carried out in 195 of the 457 patients (43). There were no complications. Pain was scored as ‘none-little’ by 292 patients (64), ‘moderate’ by 76 (17) and ‘a great deal’ by 48 (10) patients.

Conclusion

Saline-infusion sonography of the uterus is a safe diagnostic method in patients with abnormal uterine blood loss, which, in more than half the cases, can replace less well-tolerated diagnostic procedures.