Module 2 Sonography of the female pelvis Flashcards
What kind of preparation is needed prior to a obstetrics and gyn protocols for the patient?
They need to consume 4x 250 ml of water 1 hour prior to the exam
Why do we need a full bladder for a Obstetrics or Gyn exam? 6
- Pushes uterus from anteflexed position to closer to a perpendicular plane for better visualization
- Displaces bowel
- Great window to view pelvic anatomy
- Landmark
- Indicates mobility of pelvic pathology
- Comparison for cystic lesions
What should you ask a general person coming in for a obstetrics and gyn scan? 8
- Age
- Gravidity
- Parity
- Last menstrual period (First day and what day it currently is)
- Symptoms
- Result of clinical (pelvic) exam
- Previous pelvic surgery
- Result of pregnancy test
What does gravidity mean?
- Number of times a women has been pregnant
- Including current pregnancy is she is pregnant
What does parity mean?
- Number of term pregnancies (over 36 weeks) or live births
What does and A mean in terms of parity?
Abortion.
SA- spontaneous
TA- Therapeutic
What does the T mean in terms of parity?
Live births
What does G1 P1 mean?
Pregnant once and delivered one child
What does G2 P1 SA1
- Pregnant twice
- Delivered one child
- One spontaneous abortion
What does G4 P2 SA1 TA1 mean?
- Pregnant four times
- Two children birthed
- One spontaneous abortion
- One therapeutic abortion
What does G1 P0 would mean?
Women is pregnant with her 1st pregnancy
What does G2 P1 mean?
- 2nd pregnancy
- delivered one baby
What does G2 P2 mean?
- 2nd pregnancy
- Previous pregnancy was twins
What does G4 P1 or G4 P1 A2 or G4 P1 SA1 TA1 mean?
- Fourth pregnancy
- One child birthed
- Two abortions (either spontaneous or therapeutic)
What does nulliparous mean?
Never given birth
What does parous mean?
Have given birth
What does prima gravid mean?
First pregnancy
What is the process for a OB and GYN scan? 6
- Explain what you are going to do
- Use protective drapes as per site protocol
- Apply some warm gel just above the symphysis pubis
- Start in the sagittal plane (check to make sure there is enough water in bladder)
- Turn transverse and look from inferior to superior aspect of pelvis (vagina all the way up to umbilicus)
- Take the required images (protocol
What can we do to assist in the scan of a obese patient? 4
- Put them in Trendelenburg
- Get Assistance
- EV
- Panniculus
What is the panniculus? What should we do in a situation with one?
- Fatty apron
- Ask patient to lift up the panniculus to access the symphysis with the transducer
What are the advantages of the endovaginal exams? 4
- Higher frequency
- Better resolution
- Empty bladder
- Larger image
What are the limitations of Endovaginal sonography? 2
- Pathology may be outside of the field of view
- Must have an empty bladder
What must we always do for a endovaginal exam?
Cover probe with a condom or non latex transducer cover. (Ask patient if they have a latex allergy)
What do we use Endovaginal exams for? 4
- Ectopic pregnancy
- Early pregnancy/ early failed pregnancy
- Ovarian detailed
- Endometrium
What is the transabdominal exam used for? 4
Mandatory for
1. Assessing free fluid with ectopic pregnancies
2. Ovaries located high in pelvis
3. Large masses
4. Relational anatomy
Rola
What are some contraindications for EV? 5
- effaced or dilated cervix in pregnancy
- Ruptured membranes in pregnancy
- Pediatric female
- Infections
- Atrophic anatomy (elderly female)
Pre. Ai
What are some techniques for measuring a retroflexed uterus?
- Select more tools
- Curved caliper
- Trace the length of the uterus from the fundus to the external OS of the cervix
- This measurement will go into the electronic reporting system. Use the arrow and click on uterus length
What can be said about measuring a retroflexed uterus?
Endometrium might be difficult to assess as the uterus will rotate as it flexes resulting in a wider than normal endometrial appearance
What can be said about a retroflexed uterus in transverse? 2
- With the retroflexion the transverse plane the endometrium will appear in a more coronal plane
- The measurement is still transverse
What does the female pelvic routine consist of?
- Sagittal uterus, cervix and vagina
- Sagittal endometrial canal
- Transverse vagina
- Transverse Cervix
- Transverse uterus at fundus
- Sagittal right ovary
- Transverse right ovary
- Sagittal Left Ovary
- Transverse left ovary
- Sagittal right kidney (measured)
- Transverse right kidney (mid at the renal pelvis)
- Sagittal left kidney (measured)
- Transverse left kidney (mid at the renal pelvis)
**also document images of pathology/ variants
What are some pathology/ variants that may present in a OBGYN exam? 4
- Fibroids
- IUCD
- Free fluid
- cysts or masses on the ovary
How do we document fibroids?
- Document in 2 planes, measure in 3 dimensions
- Colour doppler in 2 planes
How do we document ovarian cysts?
- Over 2 CMs
- Document in 2 planes, measure in 3 dimensions
- colour doppler in two planes
How do we document IUCDs?
- document in two planes
What can be said about documenting Nabothian cysts?
- document in two planes
- do not need to measure
- do not need to use colour doppler
- Annotate sag cervix, trans cervix
