o_1977r8vv9vk1ts2ms0kd8pksa.pdf

574 I. Zalud
Table 39.2. Data on women having endometrial biopsies
Histology
Age
(years)
No.
Thickness
(cm)
Adenocarcinoma 65±73 3 0.83±1.10
Adenomatous hyperplasia 51±60 5 0.68±1.10
Polyps 56±69 7 0.89±3.73
Disordered endometrium 54±56 2 0.60±1.08
Atrophic 59±62 3 0.67±1.14
No biopsy 53±79 4 0.60±1.34
Lost to follow-up 49±68 6 0.69±1.12
Fig. 39.8. Transvaginal sonography from a case of septic
abortion. The patient had undergone elective termination
of pregnancy at 16 weeks' gestation. Ten days later she
presented with pelvic pain, fever, and bleeding. Transvaginal
sonography of the uterus showed ªtissueº in the uterine
cavity. Close examination of the ultrasound image
shows intraabdominal contents entering the left fundus
Fig. 39.7. Myometrial invasion in the case of an advanced
stage of endometrial cancer seen by transvaginal ultrasonography
of the endometrium, five hyperplasias (one with atypia),
and seven polyps (one with hyperplasia). There
was no cutoff value, however, whereby benign versus
malignant conditions could be discriminated. In one
of the adenocarcinoma cases abnormal blood flow
was observed in the uterine artery and the myometrial
vessels by waveform analysis. Attention should be given
to the endometrial-myometrial interface, as myometrial
invasion can be visualized (Fig. 39.7). Others have
also evaluated the use of color Doppler analysis for assessing
endometrial cancer [8±11].
When hormone replacement therapy is used, a
cutoff value of 6 mm cannot be used as an accurate
criterion for suspicion. In the case of breakthrough
bleeding on hormone therapy, these authors utilize
transvaginal sonography and color Doppler analysis
to assess the endometrium [12, 13]. If a thin echo is
seen at 2±3 mm and color Doppler velocimetry is
normal, the patient may be able to avoid repeated
endometrial biopsies. In the case of an endometrial
thickness of more than 6 mm, sampling for breakthrough
bleeding (i.e., endometrial sampling) is suggested
and supported.
Retained Products of Conception
Transvaginal sonography can be valuable when evaluating
a postabortal patient. After a spontaneous abortion
the uterine cavity may be inspected for retained
products of conception, determining if surgical completion
is required. In the case of elective termination
of pregnancy (TOP) or postsurgically completed
abortion, postoperative bleeding can be assessed for
retained tissue. The application of color Doppler analysis
is new and uncertain in this setting.
Transvaginal sonography proved vital in a case of
septic abortion presenting to the emergency room at
our hospital. The patient had undergone an elective
TOP at 16 weeks' gestation at another institution. Ten
days later she presented with pelvic pain, fever, and
bleeding. Transvaginal sonography of the uterus revealed
ªtissueº in the uterine cavity. Close examination
of the ultrasound image showed intraabdominal
contents entering at the left fundus (Fig. 39.8). A color
flow analysis may have been interesting in this
case, looking for bowel motility within the cavity.
More than likely, however, any bowel would have
ªileusº, or diminished motility. Laparotomy confirmed
a left fundal perforation, with omentum and
transverse colon within the defect. Reinstrumentation
of this patient would have been harmful and potentially
fatal. Ultrasound findings in this case were
paramount to the management.
The other uterine condition connected to pregnancy
is gestational trophoblastic disease (GTD). This
term describes a group of tumors that share several
characteristics: (1) they arise in fetal chorion; (2)
they produce human chorionic gonadotropin (hCG);
and (3) they respond well to chemotherapy. The inci-