الفهرس 
Introduction & Aim of workOnly 14 pages are availabe for public view
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Abstract
Evaluation of abnormal uterine bleeding is estimated to represent approximately 10% of gynecologic office visits and generates a diagnostic dilemma for the gynecologist. The evaluation of the uterine cavity is considered a cornerstone in investigating abnormal uterine bleeding. This work conducted to assess the role of sonohysterography (SHG) and transvaginal color Doppler (TVCD) in the diagnosis of gynecologic causes of premenopausal uterine bleeding. Our study included 41 female patients presented by premenopausal bleeding (PMB), their age ranged from 25 to 49 years. They were subjected to general, gynecological examinations, TVS, TVCD, and SHG examinations, except 3 cases failed to perform the later one. Our results were compared to the histopathological (all patients) and hysteroscopic results which were done only for 6 patients. According to pathological diagnosis, our 41 patients were classified into three groups according to the site of the lesion. Endometrial lesion were seen in (n = 17) including endometrial hyperplasia (n = 5), endometrial polyps (n = 8) and endometrial carcinoma (n = 4), mural lesions (n = 14) (Submucous fibroid 6 cases and mural fibroid 8 cases) and normal uterus 10 cases. Endometrial hyperplasia were diagnosed when endometrial thickness was more then 12mm but less than 20mm and appeared homogenous with intact endometrial-myometrial interface. SHG correctly diagnosed endometrial hyperplasia in 3 out of 5 cases. If there was a well defined localized endometrial thickening endometrial polyp was diagnosed. SHG correctly diagnosed endometrial polyp in 7 cases out of 8 cases. The presence of thickened irregular non-homogenous endometrial diagnosed endometrial carcinoma. SHG correctly diagnosed endometrial carcinoma in 2 out of 3 cases. Submucous fibroid appeared hypoechioc well defined mass protruding into the uterine cavity, SHG correctly diagnosed submucous fibroid in 5 out of 6 cases. SHG detected mural fibroid (in 6 out of 7 cases) when the lesion is located within the myometrium A sensitivity and specificity of SHG were 60% and 87.8% in cases of hyperplasia, 87.5% and 96.6% in cases of polyps, 92.3% and 96% in cases of fibroids as well as, 66.6% and 94.2% in cases of carcinoma, respectively. In this work the use of TVCD to differentiate benign from malignant pelvic tumours is based on the fact that new, low impedance vascular channels are found within neoplasm. TVCD detected abnormal blood flow in 3 out of 4 of endometrial carcinoma. It had 89.1% sensitivity in diagnosis of benign lesions and 75% sensitivity in detecting of malignancy denoting its low diagnostic values. On conclusion * Transvaginal sonography ( TVS ) is an excellent initial screening examination for patients with abnormal uterine bleeding because the improved resolution afforded by the higher frequency vaginal probes, used in close proximity to the pelvic organs. * Sonohysterography (SHG) is a simple, easy, less painful, and an excellent technique for diagnosis of intrauterine abnormality. It have to be done for all cases of abnormal uterine bleading having abnormal endometrial changes on initial TVS. Also it is an important step prior to hysteroscopy for proper planning of future management. * Sonohysterography is a valuable technique for depicting intraluminal , endometrial or submucosal lesions. An anechoic interface provided by the saline allowed an improved determination of the cause, site and nature of the abnormality seen on TVS. * Sonohysterography is more accurate than TVS in detecting multiple lesions when diffuse endometrial process is present, a cost effective aspiration endometrial biopsy (without visual guidance) should be adequate for diagnosis. However, a focal lesion seen at sonohysterography should be further evaluated with visually directed biopsy because of the high percentage of false-negative results at blind biopsy.