Shehnaz Hansoti, Faryal A Khan and Dania Al Jaroudi
King Fahad Medical City, Riyadh, Saudi Arabia
Scientific Tracks Abstracts: Gynecol Obstet
Objectives: The purpose of this study is to determine the prevalence of uterine abnormalities in sub fertile women compared with fertile women with abnormal uterine bleeding (AUB) as determined by 3 dimensional trans-vaginal scan (3D TVS) and saline contrast sonohysterography (3D SCSH) in Saudi women. Design: Prospective cohort study. Setting: The ultrasound department, the Reproductive Endocrinology and Infertility in Medicine Department (REIMD) and AUB clinic of Women's Specialized Hospital (WSH), King Fahad Medical City (KFMC), Riyadh, Kingdom of Saudi Arabia. Population or Sample: Total of 2,224 women were included in the study from June 2013 to June 2015, of which 1,477 (66.41%) were recruited from REIMD clinic and 747 (33.59%) from AUB clinic. Out of 1,477 sub fertile women, 159 (10.76%) required 3D SCSH. Whereas out of 747 women from fertile AUB group 110 (14.72%) required 3D SCSH. Total of 256 patients successfully underwent 3D SCSH from both groups. No complication or difficulty was encountered. Methods: An initial clinical assessment was made and 3D-TVS was performed in the ultrasound unit of WSH. All those women who were found to have uterine abnormalities, either endometrial pathology or congenital Mullerian anomaly were further referred for 3D SCSH. Results: The difference of prevalence of uterine abnormalities diagnosed by trans-vaginal scan in both groups, sub fertility (n=1477) and fertility with AUB (n=745) were found to be highly Significant (P <000). Similarly the difference of prevalence of uterine abnormality diagnosed by 3D SCSH in both groups sub fertility (n=149) and fertility with AUB (n=107) was found to be highly significant (P <000). Among the women in the sub fertility group, 28.17% (n=42) were found to have intracavitary abnormalities, including polyps 15.43% (n=23), submucous fibroids 6.04% (n=9). Significantly, more fertile women with AUB group 57.94% (n=62) revealed intracavitary abnormalities, including polyps 32.71% (n=35), submucous fibroids 19.63% (n=21). In comparison the sub fertile women had higher percentage of adhesions (3.6%) than AUB (2.8%). Adenomyosis was less in sub fertile women (1.34%); compared to fertile women with AUB (2.8%).The difference of endometrial pathologies between the two groups were found to be highly significant (P<000). In contrast, significantly more uterine anomalies were found in the sub fertility group 16.11% (n=24) compared with the fertile AUB group 2.8% (n= 3). Arcuate uterus was the most common finding 6.04% (n=9) vs. 0.93% (n=1) of women, respectively. The difference of uterine anomalies between the two groups were found to be highly significant (P<000). Conclusion: Our study concluded that intracavitary abnormalities are of more common occurrence in fertile women with AUB than in women with sub fertility in Saudi women. It was also noted that polyp was the most common finding of all the intra-cavitary lesions not only in fertile women with AUB (56.4%, n=62) but also in sub-fertile women (54.7%, n=42). Whereas Mullerian anomalies are far more common in sub-fertile (16.1%, n=24) compared with fertile (2.8%, n=3) Saudi women, arcuate uterus being most common.
Faryal A. Khan, working at Ultrasound Unit, Obstetrics and Gynecology, Women Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
Email: fkhan@kfmc.med.sa
