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Abstract Summary Abnormal Uterine Bleeding (AUB) is a common problem in gynecological practice, accounting for 15% of office visits &25% of gynecological operation. Dysfunctional Uterine Bleeding (DUB) is diagnosed after the exclusion of pregnancy or pregnancy-related disorders, medications, iatrogenic causes, obvious genital tract pathology, and systemic conditions. DUB occurs mostly after puberty and before menopause .However, DUB can also occur during reproductive years due to many causes. FIGO adopted in 2011new classification for causes of AUB during reproductive years known by the acronym “PALMCOEIN”. The components of the “PALM” group are discrete structural entities while the “COEIN” group comprises entities that are not defined by imaging or histopathology – they are “nonstructural”. DUB is diagnosed by exclusion after full history taking, clinical examination, laboratory investigations and exclusion of any structural causes of AUB. Medical treatment is the first-line therapy once malignancy and significant pelvic pathology have been ruled out including hormonal therapy regimes such as oral contraceptive pills (OCP), progestin given during luteal phase or in an extended regimen, Levonorgestrel intrauterine device (L-IUD), and Gn-RH agonist. There are also nonhormonal medical therapies: NSAIDs and tranexamic acid.Endometrial ablation and hysterectomy are the two surgical options for DUB and performed when medical therapy fails or there is an associated symptom such as pain. Also, some of the patients prefer surgery instead of long-term use of medications. Endometrial sampling is the gold stander of differentiating endometrial pathologies. TVS is a method which has proven its value in the diagnosis of endometrial pathologies. Many authors have studied the significance of measurement of endometrial thickness by TVS in the diagnosis of abnormal uterine bleeding. The various studies performed in this aspect have proven that, measurement of endometrial thickness is significant in differentiating normal and abnormal endometrium. Other studies focused on the value of color Doppler ultrasound in the assessment of endometrial pathology. The aim of this study is to evaluate the diagnostic value of blood flow measurements on Spiral artery by Trans Vaginal Color Doppler Ultrasonography in differentiation of the different endometrial pathologies in patients with Dysfunctional Uterine bleeding. This study was conducted on (50) patients aged 20-39 years presented with Dysfunctional Uterine Bleeding (DUB) preferred for dilatation and curettage (D&C) in department of Obstetrics & Gynecology Tanta University Hospital. The studied cases were subjected to history taking, complete general and local examination, needed investigations, TVS measuring endometrial thickness with color Doppler examination of the endometrial spiral arteries (Doppler Indices RI &PI) and endometrial biopsy (D&CBiopsy). Finally, the sonographically measured endometrial thickness, Doppler indices and histopathological results were correlated with each other and statistically analysed. The aim was to assess the ability of these screening methods to diagnose the patients with pathological endometrium who would need further investigations and endometrial biopsy. The study showed that the results were significant according to relation between histopathological results & endometrial thickness (p value 0.001), endometrial spiral arteries resistance index (RI) & histopathological results (p value 0.003), endometrial spiral arteries pulsatility index (PI) & histopathological results (p value 0.001). |