OFFICE HYSTEROSCOPY IN OUTPATIENT PRACTICE OF AN OBSTETRICIAN-GYNECOLOGIST
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Abstract
Objective – to study the advantages of office hysteroscopy in comparison with manual vacuum aspiration of the endometrium in the early diagnosis of intrauterine pathology.
Materialsandmethods. The study included 166 women who were seen at the Clinical Polyclinic N 20: 83 patients who received office hysteroscopybefore taking the material for histological examination by manual vacuum aspiration and 83 patients who underwent only manual vacuum aspiration. All women were examined by clinical, laboratory, ultrasound, instrumental, statistical methods.
Results. When performing office hysteroscopy in combination with manual vacuum aspiration, intrauterine pathology was detected in 85.5 % women. Endometrial polyps were detected in 24 cases (33.8 %), endometrial hyperplasia – in 20 (28.2 %), submucousmyoma – in 8 (11.3 %), adenomyosis – in 3 (4.2 %), intrauterine synechiae – in 16 (22.5 %). Visual diagnosis based on the results of office hysteroscopy coincided with the results of histological examination in 63 cases among 71 (88.7 %). When performing manual vacuum aspiration of the endometrium, intrauterine pathology was detected in 43.4 % women. According to the results of histological examination, endometrial polyps were detected in 19 cases (52.8 %), endometrial hyperplasia – in 17 (47.2 %). To obtain additional data on intrauterine pathology (submucousmyoma, adenomyosis, uterinesynechiae) without visualization was not possible.
The sensitivity of office hysteroscopy was 86.2 %, specificity – 84.4 %,while the sensitivity and specificity of manual vacuum aspiration were 71.2 % and 62.1 % respectively.
Conclusion. Office hysteroscopy is a minimally invasive, low-traumatic modern method of the diagnosis of intrauterine pathology. Office hysteroscopy allows reducing the scopeand period of pre-hospital examination, as well as unreasonable referral to the hospital in case of false positive endometrial pathology according to ultrasound investigation findings. Currently, office hysteroscopy is a small part of outpatient care, but the data obtained in the conditions of the antenatal clinic give grounds for a large-scale routine introduction of office hysteroscopy into outpatient practice.
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