Is dilatation and curettage obsolete for diagnosing intrauterine disorders in premenopausal patients with persistent abnormal uterine bleeding?

Background. To determine the predictive value of dilatation and curettage (D and C) for diagnosing intrauterine disorders in patients with persistent abnormal uterine bleeding. Methods. An observational descriptive study was performed in a large university-affiliated teaching hospital. The suspicion of intrauterine disorders described in theater-reports involving D and C was compared with the hysteroscopical findings in 131 premenopausal patients with persistent complaints of abnormal uterine bleeding who were referred by other gynecologists within six months after D and C. Pre-test probability (prevalence), post-test probabilities (predictive values) and likelihood-ratio's were calculated. Results. The pre-test probability for all intrauterine disorders was 0.49. The post-test probabilities for a 'suspect' and a 'not suspect' D and C were 0.61 and 0.46 respectively with an overlap of confidence-intervals The corresponding likelihood-ratio's were 1.69 and 0.87 respectively. Conclusions. D and C findings were of no value in the prediction of the presence or absence of intrauterine disorders in this population with persistent complaints.