Vaginal Bleeding Clinical Trial
Official title:
Assessment of Uterine Cavity and Endometrial Steroid Receptors in Women With Peri- and Post Menopausal Bleeding
100 women with abnormal uterine bleeding (peri and postmenopausal) were subjected to transvaginal ultrasound , saline sonohysterography , Diagnostic hysteroscopy and fractional curettage followed by histopathological examination and immunohistochemical analysis for estrogen and progesterone receptors.
Conventional TVUS will be done to all participants to measure the uterine size & endometrial
thickness and other pathology. TVUS will be done with an empty bladder in the lithotomy
position using an endovaginal curved linear probe (EV 4-9/10 ED) with frequency 4-9 MHz.
SIS will be performed for all patients at the same setting of TVUS. With the patient in the
lithotomy position, . A 6 or 8 French Foley's catheter will be inserted through the external
cervical os into the cervical canal. Its balloon tip will be inflated with 2-3 mL of saline,
depending on patient comfort, to help hold it in place. The speculum was then removed.
The vaginal probe was then reinserted and a 5-10 mL syringe filled with sterile saline was
attached to the catheter. Fluid will be instilled while the transducer moved from side to
side (cornua to cornua) in a long-axis projection then the transducer was rotated 90° into
an axial plane. More fluid was instilled while fanning down toward the endocervical canal
and up toward the uterine fundus to obtain a detailed survey of the endometrium. Every
portion of the uterine cavity should be imaged, to exclude any focal abnormality as polyps,
myomas, hyperplasia, and carcinoma. Any detected intrauterine pathology is described;
including its shape, size and site.
The hysteroscope used in this study is a rigid continuous flow panoramic hysteroscope, 25 cm
in length, 4 mm in diameter with an outer sheath 5 mm diameter and 30° fibro-optic lens.
The technique used to provide constant uterine distention will be by attaching plastic bags
of saline. Infusion pressure was elevated by pneumatic cuff under manometric control at a
pressure of 100-120 mmHg.
Detailed hysteroscopic examination will be performed under general anesthesia with the
patient in the lithotomy position, The thickness, colour, aspect and vasculature of the
mucous membrane lining the uterine cavity will be observed and recorded.
Endometrial curettage will be done to all patients, and specimens were fixed in Formalin 10%
solution for histopathological examination. Patients in whom endometrial polyps were found
by hysteroscopy, had polypectomy performed before curettage. The first sample will be taken
from the endocervical canal before hysteroscopy or cervical dilatation. Following diagnostic
hysteroscopy, cervical dilatation u. A sharp curette will be introduced into the uterine
cavity, and curettage will be done starting with the fundus then posterior, anterior, right
and left lateral walls consecutively.
Histopathological examination. All curettage & polypectomy specimens were embedded in
paraffin wax, then slides will be prepared to be stained by the conventional Haematoxylin
and Eosin (H & E) stain.
Detection of estrogen & progesterone receptors in the specimens (formalin-fixed, paraffin
wax-embedded) using immunohistochemical staining which will be carried out by using the Dako
ER/PR pharmDx™ Kit which specifically detects the ERα protein as well as the PR-A protein
located in the cell nuclei of ER and PR expressing cells, respectively.
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