Module 2 : Sonography Of The Female Pelvis

Question 1

Reasons for pelvic ultrasound

Answer 1

Pelvic pain
Dysfunctional bleeding
IUCD placement 
Mass felt on bimanual pelvic exam 
? Pregnancy

Question 2

Exam prep

Answer 2

1 liter of water one hour before exam starts

Question 3

Reasons for full bladder

Answer 3

Pushes uterus from anteflexed position to a more horizontal plane for better visualization

Displaced intestine

Great window for pelvic anatomy

Landmark

Indicates mobility of female pelvic pathology

Comparison for cystic legions

Question 4

Questions to ask for exam

Answer 4

Age
Gravidity - have you been pregnant 
Parity - how many children 
LMP (Normal?)
Symptoms (cyclical?)
Results of clinical pelvic exM 
Previous pelvic surgery
Results of a pregnancy test

Question 5

Gravity (G)

Answer 5

Number of times a women has been pregnant

Including if currently pregnant

Question 6

Parity

Answer 6

Number of term pregnancies or live births

Question 7

Abortion (A)

Answer 7

SA - spontaneous

TA - therapeutic

Question 8

Nulliparous

Answer 8

Never been pregnant

Question 9

Parous

Answer 9

Currently pregnant

Question 10

Prima gravida

Answer 10

First time pregnant

Question 11

Scanning basic protocol

Answer 11

1. Explain what going to do
2. Use protective drapes as per protocol
3. Apply warm gel just above the symphysis pubis
   * SWITCH TO HRES
4. Start in sagittal ALWAYS
   - assess if bladder is full enough
   - scan it to side wall of pelvis in all direction
   - SWEEPING = to the vessels
5. Turn transverse and look from inferior to superior aspect of pelvis ( ALL THE WAY TO UMBILICUS)
6. Take required images

Question 12

Bladder filling

Answer 12

Just full enough to cover fundus but not too much that it will squish it!

Question 13

Scanning ovaries

Answer 13

Best view to use is contralateral

USE BLADDER AS WINDOW

Question 14

Obese patients

Answer 14

Move them to trendelenberg
Ask for assistance
Use EV

Ask patient to lift panniculus

Question 15

Endovaginal advantages

Answer 15

Higher frequencies
Better resolution
Empty bladder
Larger image

Question 16

Endovaginal limitations

Answer 16

Pathology may be outside field of view
- fibroid or ovary

If patient can’t fully empty bladder

Question 17

Endovaginal basics

Answer 17

Always cover probe with condom or non latex transducer cover

Explaining

• “ an internal camera to get better images”
• “ similar to inserting a tampon”

Question 18

Endovaginal orientation

Answer 18

Right on top of the organ

Sagittal exam

• cervix is on the right hand side
• fundus on left hand side
• bladder in left hand corner

Question 19

EV vs TRANS ABD or VESICLE

Answer 19

EV
 - ectopic pregnancies 
 - early pregnancies 
 - ovarian detail 
 - better endometrium 
TRANS
 - mandatory for assessing free fluid with ectopic pregnancies, ovaries high in the pelvis, large masses, relational anatomy 

• complimentary

Question 20

Contraindications to EV

Answer 20

Effaced or dilated cervix

Young girl (virgin)

Infection (herpes) painful

Atrophic Anatomy (elderly )

Question 21

Measuring the uterus

Answer 21

AP measurement done in long axis

Length includes cervix

Along endometrial canal

Question 22

Measuring endometrium

Answer 22

Outerwall to outer wall

• do not include hypoechoic halo

Question 23

female pelvis detailed routine

Answer 23

1. Sag Ute Cvx Vag (length and AP)
2. Sag endometrial canal (AP)
3. Trans Vag
4. Trans Cvx
5. Trans Ute(width)

• document abnormal

6. Sag right ovary (length and AP)
7. Trans right ovary (width)
8. Sag left ovary (length and AP)
9. Trans left ovary (width)

• also document and measure abnormalities

Question 24

Kidney portion

Answer 24

1. Sag right kid (measured)
2. Trans right kid (measure at mid)
3. Sag left kid (measured)
4. Trans left kid (measured at mid)