Role of Uterine Artery Doppler Indices in Patients with Perimenopausal Bleeding for Diagnosis of Endometrial Pathologies: A Prospective Study

Abstract

Background: Abnormal uterine bleeding is nearly a daily challenge in gynecological practice. In addition, it responsible for a respected percentage of hysterectomies. Early diagnosis is crucial, especially if noninvasive, readily available method is used. Aim of the work: To investigate the usefulness of Doppler transvaginal ultrasound in diagnosis of uterine pathology responsible for abnormal uterine bleeding in the perimenopausal women. Patients and Methods: The study included 156 patients [106 with AUB and 50 healthy controls]. The study was carried out during the duration between February to September 2020. For all females, full history taking, clinical and laboratory investigations were carried out. In addition, transvaginal ultrasonic uterine artery Doppler was done and its indices [Pulsatility index [PI] and resistance index [RI]] were documented. After histopathological results from endometrial biopsy, females were subdivided into two groups [A and B]: Group A included 52 patients with non-significant [dysfunctional] causes of AUB. Group B included 54 patients with significant [pathological] causes of AUB as endometrial hyperplasia and carcinoma. Results: Both groups of AUB were comparable regarding patient age, BMI, pattern of bleeding, number of used vulval pads, and preoperative hemoglobin concentration. However, pathological ABU was associated with high parity, long duration of bleeding, increased number of bleeding days/last month, and significantly lower values of uterine artery PI and RI. Endometrial thickness was significantly increased in ABU when compared to control group. Finally, RI was sensitive than PI in diagnosis of pathological AUB. [area under the curve was 0.998 and 0.834 respectively]. PI had a sensitivity of 70.8%, specificity of 92. % at a cut-off value of 1.82; while RI had sensitivity of 96.2% and specificity of 100.0% at a cutoff value of 0.575.Conclusion: Transvaginal Doppler ultrasound seems to sensitive and specific modality for diagnosis of endometrial abnormalities in females with perimenopausal AUB

Keywords

• transvaginal ultrasound
• abnormal uterine bleeding
• pulsatility index
• resistance index
• perimenopausal