Intro to Female Pelvis

Question 1

Name some advantages of TV ultrasound

Answer 1

○ no need for a full bladder
○ Fewer artifacts due to avoidance of attenuation of the beam through the anterior abdomen
○ Closer to pelvic organs means higher frequency transducer can be used therefore better resolution of anatomy and pathology of pelvic organs
○ Allows a dynamic assessment of uterus and ovaries
Especially good in obese patients or a retroflexed uterus

Question 2

Name some disadvantages of TV ultrasound

Answer 2

○ Depth is limited due to higher frequency
○ Large masses may decrease view, as they can fill or extend outside of the field of view - makes orientation difficult
○ Involves only the depiction of specific organs rather than the global view that the TA offers
○ Movement is limited due to the vaginal canal
○ Distended or partially filled bladder can displace organs or masses outside of the FOV of transducer
○ Fundal masses can be difficult to evaluate or missed in TV
Invasive and can be a emotionally sensitive procedure to many women

Question 3

Name some points of patient consideration

Answer 3

• Motivation for consent primarily must be to assist the patient in deciding for herself whether the procedure is one that she wants to have done.
  
  • Patient care:
    ○ Patients may have concern for potential pain and modesty
    ○ May have concerns about the necessity of the procedure
    Reassure the patient about the exam and that the camera only inserts a short distance

Question 4

What is a part of the comprehensive history?

Answer 4

Comprehensive history must be taken, with these obvious questions answered:
○ Stage of menstrual cycle
○ Previous pregnancies/children
○ Pain
○ Abnormal menstrual cycle
○ Hormonal contraception or hormonal replacement therapy
Previous surgeries

Question 5

Why is the TA portion of the scan important?

Answer 5

• Transabdominal component is a general survey studying the major structures for gross pathology
  ○ Uterine measurement can be performed during TA or tV scan
  ○ Both adnexae are carefully reviewed
  Check for non-gynaecological causes of pain such as bowel or appendiceal pathology
  Kidneys may be assessed