Sonographic findings in symptomatic patient with adenomyosis uteri

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We found non-statistically significant differences between sonographic findings and symptoms among the studied population.

______________________________________________________________________________ 1. Introduction:
Adenomyosis is a common disorder defined as the presence of endometrial glands and stroma within the uterine myometrium [1].It is associated with heavy menstrual bleeding, pain, and infertility [2].
It occurs when the normal boundary between the endometrial basal layer and the myometrium is disrupted.The cause of this disruption is not fully understood but may be due to uterine trauma, pregnancy, postpartum endometritis, or cesarean delivery.As a result of this disruption, the endometrial glands invade the myometrium, resulting in ectopic intramyometrial glands, which are associated with adjacent myometrial hypertrophy [3].
The clinical presentation of adenomyosis is the parous, perimenopausal patient with dysmenorrhea and menorrhagia.Physical examination may reveal an enlarged, tender uterus, but the diagnosis has been difficult to obtain without histologic confirmation [4].

The preoperative diagnosis of adenomyosis
remains elusive, although the use of sonography and MR imaging improves the diagnosis, with high sensitivities reported for MR imaging in high-prevalence populations.However, as transvaginal imaging techniques have improved, the diagnostic accuracy of US has become comparable to that of MRI [5].
A study by Reinhold et al., [6]

2.2.Methods:
1 Severe symptoms were considered if VAS score was equal or more than 5.
3) The presence of abnormal uterine bleeding (AUB) was investigated, the amount of menstrual loss was assessed using the pictorial blood loss analysis chart (PBAC), that provides a score depends on the number of tampons or sanitary towels used during the menstrual cycle and also on the degree to which each item is soiled.PBAC score has been shown to have a high specificity and sensitivity when used as a diagnostic test for objective menstrual bleeding [10] and the PBAC score more than 100 is consistent with menorrhagia.

Results:
The current study included 100 women aged from 25 to 35 years old with an average age of (29.25 ±2.9), BMI was ranged from 24 to 35 kg/m 2 with an average BMI of (29.36 ±3.3), parity was ranged from nulliparous to 4 times with an average parity of (1.7 ±1.6).
All women in the current study underwent complete blood count, the average Hb level was (9.4

Discussion
Adenomyosis is a common benign disease of the uterus that has a reported incidence of

Conclusion and Recommendations
Transvaginal sonography is able to assess type and severity of adenomyosis.Our

2. 1 .
Study Design: This was a cross sectional study performed in department of obstetrics and gynecology at Beni-Suef university hospital within10 months from July (2020) to May (2021), the study was approved by the local research ethics committee.A total of 100 women, between 25 to 35 years old were included in the current study based on presence of symptoms and ultrasound criteria of adenomyosis according to previous studies.Patient with endometrial lesion, fibroids, adnexal lesion, coagulopathy, coagulation disorder, history suggested of PID, tube-ovarian abscess, IUD and lactating mothers were excluded from the current study.

4 ) 5 ) 2 . 3 .
Complete blood picture (CBC) for anemia, thrombocytopenia bleeding profile, kidney function tests and liver function tests done.All transvaginal ultrasound examinations were performed by two experienced sonographers and carried out using 2D Ultrasound (MindryDCN2 & XARIO 200), ultrasonography criteria to make a diagnosis of adenomyosis were described as follows: asymmetrical thickening of uterine walls, intramyometrial cysts or hyperechoic islands (or both), fan shaped shadowing of the myometrium, myometrial echogenic sub-endometrial lines and buds, translesional vascularity and irregular or interrupted JZ.Statistical Analysis: Statistical analysis was undertaken using the Statistical Package for the Social Sciences (SPSS, version 15.0, Chicago, IL, USA).All continuous variables were expressed in terms of mean ± SD, while categorical variables were expressed in terms of frequency and percentage.Comparison of numerical variables between the study groups will be analyzed with the independent-samples t-test, for categorical data as all complications e.g.bleeding, infertility dysmenorrhea etc. Chi square (x2) test was performed.Statistical significance https://ejmr.journals.ekb.eg/ was set at a probability value (P value ≤ 0 .05).
scheme may be helpful in selecting and evaluating the effectiveness of medical and surgical management, as well as the possible relationship between adenomyosis and infertility.