An audit on outpatient hysteroscopy (OPH) in the evaluation of abnormal uterine bleeding

Abstract

We report a series of OPH for evaluation of abnormal uterine bleeding. Pelvic ultrasound has a better positive predictive value in postmenopausal compared to premenopausal bleeding to detect endometrial pathology. Introduction: OPH has gained popularity in evaluation of abnormal uterine bleeding. It is used in premenopausal as well as postmenopausal age groups and is considered complementary to imaging such as ultrasonography. We report a series of 250 patients who underwent outpatient hysteroscopy in the evaluation of abnormal uterine bleeding and analyse the positive and the negative predictive value of pelvic ultrasound in the diagnosis of uterine polyps in the pre and post menopausal age groups. Material andMethods The study sample included 152 pre-menopausal and 98 postmenopausal women who underwent OPH between 2009- 2011. The indication for hysteroscopy was according to the department clinical protocols of evaluation of uterine bleeding and postmenopausal bleeding. Most patients had an ultrasound evaluation prior to the procedure. See and treat approach was taken in the presence of a polyp and endometrial biopsy was undertaken in others. Results: Pelvic ultrasound for polyps had a Positive predictive value (PPV) of 43.9% and Negative predictive value (NPV) of 81.3% in premenopausal women. In postmenopausal women the PPV was 62.5% and NPV was 37.7%. Endometrial malignancies were detected in 4 premenopausal patients and were found in the polyps that were removed. Discussion: The procedure had to be abandoned due to discomfort only in a minority (6/250). This analysis demonstrates that ultrasonography has a limited place in evaluation of endometrial pathology, especially in the premenopausal women. Such assessment should be complemented by OPH when clinically indicated.