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بسم الله الرحمن الرحيم Sudan University of Science And بسم الله الرحمن الرحيم Sudan University of Science and Technology Collage of Graduate Studies Role of ultrasonography in diagnosis causes of uterine bleeding دور الوجات فوق الصوتيه في تشخيص اسباب النفيف الرحمي A thesis Submitted for Partial Fulfillment for the Requirements of M.Sc Degree in Medical Diagnostic Ultrasound Prepared by Mr. Moawia Abelrhman Abdallah Frag Supervisor Dr. Mona Ahmed Mohammed 2016 1 الةية : قال تعالى ) ) َو َل َت ْع َم ُلدو َن ِم ْن َع َم ٍل ِإّل ُك ّنا َعلَ ْي ُك ْم ُش ُهدو ًدا صدق الله العظيم (سدورة ةيدونس (الةية: 61 Dedication For my father- smile of my life For my mother – the first teacher for me For all who give me a hand in this research 2 ACKNOWLAGEMENT I thank .Dr. Mona Ahmed Mohammed for her close contact supervision and guidance throughout this work Abstract This is practical study which was done during September -2015 to July 2016 and was carried out in Sudan- Khartoum state scanned in many hospitals include, ( Aldayat, Alsaudi hospitals ).The objective of this study was to assess the role of ultrasonography in diagnosis 3 causes of uterine bleeding in non pregnant patient .transabdominal ultrasound scan using ‘Honda’ Aloka and General Electric scanners with 3,5MHz probe was done for 60 patient of non pregnant women with abnormal uterine bleeding from different area, their ages between (20 -78) year, which data on configuration of easy question and ultrasound finding ,were collected .we found that, abnormal uterine bleeding, was most common in ages between (35 - 44 ) years. usually associated with varying symptoms, Menorrhagia was the most common symptom . and uterine fibroid was most common causes, (30)patient 50% followed by ovarian cyst (16)patient26.7% ,Endometrium hyperplasia(5) patient8.3% , uterine carcinoma ( 7)patient 11.7%.and lastly by poly cystic (2) patient 3.3%..Finally the researcher recommended the uses of ultrasound scanning as first line in diagnosing of abnormal uterine bleeding ,because it was fast exam ,non invasive ,low cost and is a good tool for diagnosis the causes of abnormal uterine bleeding, The menopausal women should be educated about post menopausal uterine bleeding for early complain to health centers for early diagnoses and treatment. Further studies should be carried out in this field on many aspects such as increasing the number of patients to show the relation between the uterine bleeding and other clinical symptoms, ultrasound finding ,and Doppler scan role in diagnosis causes of abnormal uterine bleeding.the government should update the ultrasound machines and increase the training institutes of ultrasound for increasing the sonologists skills and experiences. ملخص الدراسة هسسذه الدراسسسة عمليسسة ,أجرةيسست خلل سسسبتمب 2015م إلسسي ةيدوليسسدو 2016م طبقسست بجمهدورةيسسة السسسدودان ولةيسسة الخرطسسدوم (مستشسسفيات السسسسعدودي و السسسداةيات ام درمسسسان). ناقشسسست الدراسسسسة تقييسسسم السسسسح بالدوجات فدوق الصدوتية في تشخيص النةيسسف الرحمسسي السسذي ةيظهسسر 4 عنسسسد النسسسساء غيسسس الحمسسسل , هنالسسسك (60) مرةيضسسسه تسسسم اختيسسسارهن عشدوائيا و جميعهن لدةيهن نزةيف رحمي كل الرةيضات فحصن بالدوجسات فسدوق الصسدوتية باسسستخدام ماسسحات .هدوندا, الدوكا وجنال اليكتةيك بطاقة مقدارها 3.5 ميقا هرتز هذه الدراسة وجدت أن النةيف الرحمي هدو اكث السباب شيدوعا للدخدول للمستشفيات وان معظم هدولء الرض تتاوح اعمارهم بي 35- 44 سنه 31مرةيض (51.7%) , وانهم ةيعاندوا من اعراض متباةينة غزاره الطمث 28 مرةيض (%46.6) و عس الطمث 20 مرةيض 40% وندرة الطمث 6مرةيض 12% والم البطن 44 . %مرةيض 88% وسخانه البدول 19مرةيض 38 كما وجدت الدراسه ان اكث اسباب النةيف الرحمي عندهم لحميه الرحم 30مرةيض 50% وكيس البيض 16مرةيض 26% وسماكه بطانه الرحم 5مرةيض 8% و تكيس الباةيض 2مرةيض %3 .%وسطان الرحم 7مرةيض 11 كما وجدت الدراسه ان 40مرةيض 66% من الحالت لم تصل سن الياس بينما 20مرةيض 44% قد وصلت سن الياس .ووجدت اةيضا ان 44مرةيض(73% ) ل ةيعاندوا من امراض سابقه بينما 3مرةيض 5% بالسكري و 3 مرض 5% من قصدور درقي و 10 مرض %16 . من فقر الدم هذه الدراسة أوصت باستخدام الدوجات فدوق الصدوتيه كدوسيله اوليه في تشخيص اسباب النةيف الرحمي و بضورة التثقيف 5 الصحي للنساء خصدوصا فدوق سن 40 بأسباب حدوث النةيف الهبلي بعد انقطاع الدورة وسعة الذهاب لقرب مستشفى لسعة التشخيص و العل ج , كما تمت التدوصية بتحسي الخدمات في أقسام أمراض النساء بالستشفيات و تحدةيث الجهزة و تدرةيب الكدوادر للمساعدة في دقه التشخيص لهذا الرض كما أوصت بزةيادة عدد أخصائيي أمراض النساء في الستشفيات التعليمية و ذلك لزةيادة عدد حالت أمراض النساء وخاصة حالت النةيف ما بعد انقطاع الدورة الشهرةية في هذه الفتة. وعمل دراسات اخري لنفس الدوضدوع في مجالت مختلفه مثل زةيادة عدد الرض واةيضا .استخدامات الدوبلر Table of contents Topics Page No Quran I Dedication II Acknowledgment iii 6 Abstract in English IV Abstract in Arabic VI List of figure VIII List of tables VIII CHAPTER ONE Introduction 1 the problem of the study 2 Objectives 2 General objective 2 Specific objectives 2 Overview of the study 2 CHAPTER TWO Anatomy 3-8 Physiology 9 Pathology 11 Physic &technique 18-21 Previous Studies 22 CHAPTER THREE Material & methods 23 CHAPTER FOUR Results 26 CHAPTER FIVE Discussion 30 Conclusion 32 Recommendation 33 Reference 34 Appendix 35-42 LIST OF FIGURE FIG 4-1 FIGURE show Age distribution of study population 26 FIG 4-2 FIGURE show Reason for admission in the study population27 FIG 4-3 FIGURE show Menopause status in the study population 28 FI G 4-4 FIGURE show correlation between the age group and29 different causes List of table page Table NO 26 show Age distribution of study Table: (4-1) 7 population 27 show Reason for admission in the Table: (4-2) study population 28 show Menopause status in the study Table: (4-3) population 29 show correlation between the age Table: (4-4) group and different causes CHAPTER ONE 8 CHAPTER ONE Introduction 1-1 Menstruation is considered normal when uterine bleeding occurs every 21 to 35 days and is not excessive. The normal duration of menstrual bleeding is between two and seven days. Abnormal uterine bleeding occurs when either the frequency or quantity of uterine bleeding differs from that mentioned above or the woman has spotting or bleeding between her menstrual periods. Abnormal uterine bleeding may be caused by a variety of factors. The two most common causes are structural abnormalities of the reproductive system and ovulation disorders.. Some of the more common structural causes of abnormal uterine bleeding include benign (non-cancerous) lesions of the uterus such as polyps, fibroids (myomas), and adenomyosis (uterine thickening caused by endometrial tissue moving into the outer walls of the uterus) , Ultrasound imaging of the pelvis uses sound waves to produce pictures of the structures and organs in the lower abdomen and pelvis. There are three types of pelvic ultrasound: abdominal, vaginal (for women), and rectal (for men). These exams are frequently used to evaluate the reproductive and urinary systems . (Ultrasound n Obstetrics and Gynecology first edition) 1.2 Statements of the problem:- Uttering bleeding disease becomes a significant challenge public health which may be due to benign or malignant pathology , 1-3 Objective of the study : Main objective 1-3-1 Role of ultrasonography in diagnosis causes of uterine bleeding in Gyne Specific objectives 1-3-2 o To identify the causes of abnormal uterine bleeding in Gyne. o To identify the most common causes of abnormal uterine bleeding in Gyne o To identify the most common age group in the study population o To identify the ultrasound findings of each cause. 9 o To evaluate the role of ultrasound in demonstrating of abnormal uterine bleeding causes in Gyne. 1-4 Overview of the study: This study consist of five chapters, chapter one contains introduction, hypothesis, objectives and overview of the study. chapter two deals with literature review which includes anatomy of the female pelvic organs ,physiology , pathology, imaging technique and previous study .chapter three contains methodology of the study, chapter four contains the results ,chapter five contain discussion , conclusion and recommendations, finally there are list of references and appendices which include ultrasound images . CHAPTER TWO 10 CHAPTER TWO 2-1Theoretical background 2-1-1 Anatomy:- 2-1-1-1 Mons pubis The mons pubis is the rounded portion of the vulva where sexual hair development occurs at the time of puberty. this area may be described as directly anterosuperior to the pubic symphysis. (Snell 2014). 2-1-1-2 Labia The labia majora are 2 large, longitudinal folds of adipose and fibrous tissue. They vary in size and distribution from female to female, The labia minora, also known as nymphae, are 2 small cutaneous folds that are found between the labia majora and the introitus or uterine vestibule. Anteriorly, the labia minora join to form the frenulum of the clitoris. (Snell 2014). 2-1-1-3 Hymen The hymen is a thin membrane found at the entrance to the uterine orifice. (Snell 2014). 2-1-1-4 Clitoris The clitoris is an erectile structure found beneath the anterior joining of the labia minora. (Snell 2014). 2-1-1-5 Vestibule and urethra Between the clitoris and the uterine introitus (opening) is a triangular area known as the vestibule, which extends to the posterior fourchette. the vestibule is where the urethral (urinary) meatus is found, the urethra is composed of membranous connective tissue and links the urinary bladder to the vestibule externally. a female urethra ranges in length from 3.5 to 5.0 cm. ( Snell 2014) 2-1-1-6 Skene and Bartholin glands The Skene glands secrete lubrication at the opening of the urethra. The greater vestibular (Bartholin) glands are also responsible for secreting lubrication to the vagina, with openings just outside the hymen, bilaterally, at the posterior aspect of the vagina. each gland is small, similar in shape to a kidney bean.
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