title: Acceptability and accuracy of saline infusion sonohysterography in women with postmenopausal bleeding.
abstract: OBJECTIVE
  To validate the diagnostic efficacy of saline infusion sonohysterography (SIS) in the evaluation of uterine cavity,in women with postmenopausal bleeding and endometrial thickness (3) 5 mm.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Military Hospital, Rawalpindi, from March 2005 to July 2008 and Combined Military Hospital, Multan, from September 2008 to June 2009.
  
  
  METHODS
  Seventy seven eligible participants included women complaining of postmenopausal bleeding were included; out of whom 69 completed the procedure satisfactorily. Pain scores during procedure were assessed to determine patient acceptability. Following saline infusion sonohysterography all patients also underwent an out door pipelle endometrial biopsy in a one-stop postmenopausal bleed clinic. Findings of sonohysterography were compared with hysteroscopy/hysterectomy specimen.
  
  
  RESULTS
  Majority of the patients 34 (49.2%) experienced no pain during the procedure, 51 (74%) women had a positive SIS and the findings were negative in 18 (26%) patients. The commonest abnormal finding on SIS was focal thickening in 23 (32%) and endometrial polyp in 12 (17%) cases. Saline infusion hysterosonography picked up 3 cases of false positive polyps (5.8%) and missed a case of submucous fibroid near cervix (1.8%). Upon comparison of findings of hysteroscopy and hysterectomy in 53 cases, there was complete agreement in a total of 43 (88%) cases. The sensitivity of sonohysterography was 92% and specificity was 78%. All the ladies with abnormal SIS had diagnostic or therapeutic procedures and finally only 24 (35%) were managed on conservative follow-up. Normal SIS led to conservative management in 16 (88%).
  
  
  CONCLUSIONS
  Sonohysterography in combination with endometrial biopsy is a useful technique useful for the evaluation of postmenopausal bleeding. Patient acceptability and diagnostic capability is high and it reduces demand for hysteroscopy.
authors.affiliation: Department of Gynaecology, Combined Military Hospital, Multan. abeera_choudry@yahoo.com
authors.forename: Abeera
authors.initials: A
authors.lastname: Choudry
authors.forename: Irfan
authors.initials: I
authors.lastname: Shukr
authors.forename: Sumaira
authors.initials: S
authors.lastname: Khan
authors.forename: Humaira
authors.initials: H
authors.lastname: Hafeez
authors.forename: Shahid
authors.initials: S
authors.lastname: Jamal
authors.forename: Ambreen
authors.initials: A
authors.lastname: Anwer
mesh_terms: D000368:Aged; D004717:Endometrium / Q000000981:diagnostic imaging; D019160:Endosonography; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D012965:Sodium Chloride / Q000008:administration & dosage*; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging*
chemical_list: D012965:Sodium Chloride