an introduction to gynaecological ultrasound
TRANSCRIPT
Techniques and Equipment.
Gynaecological Anatomy
Early Pregnancy
Complications of Early Pregnancy
Gynaecological Abnormalities
Techniques II
Transabdominal
3.5-5 MHz
Lower resolution
Full abdominal
assessment
? Full Bladder
Choice for later
gestations
Transvaginal
5 + MHz
Higher resolution
Focused pelvic
assessment
Empty Bladder
Choice for gynae,
earlier gestations and
cervical assessments
TVS/TAS scanning to assess the pelvis
in longitudinal (LS) and transverse (TS)
planes
Uterus and Cervix
Ovaries
Adnexa and Recto-Uterine Pouch /
Pouch of Douglas (POD)
Technique
Uterus and Cervix
Appearance of the Uterus
Uterine cavity - Endometrial thickening
- Intrauterine gestation
sac(s) and location
- Evidence of bleeding
Cervix ? Closed
Early Pregnancy
Clinical presentation - Pain
- Bleeding
- Other
LMP
Menstrual patterns
Clinical history - Treatment
- Previous
miscarriage(s)
TVS v TAS in
Early Pregnancy US
The higher resolution with TVS means
that details of early pregnancies can be
seen on average one week before they
can be seen on TAS.
Ultrasound Appearances Gestational Age
(wks)
Serum ßhCG
Gestation sac (GS) 4.5 - 5 75 – 2,600
GS with Yolk sac (YS) 5 - 6 850 – 20,800
GS, YS and fetal pole
with heart pulsations
6 + 4,000 +
Later gestations
Biparietal Diameter
(BPD) / Head
Circumference (HC)
can be used to give
an idea of
gestational age.
Charts on the
Ultrasound machine
Abnormalities - Pregnancy
Early Pregnancy
– Bleeding
– Ectopic
– Miscarriage
– Molar Pregnancy
– Retained Products of Conception
Ectopic Pregnancy
Any pregnancy occurring outside of the uterine cavity
Risk factors previous PID; Assisted Conception; IUCD, Endometriosis; Pelvic surgery; Previous ectopic pregnancy.
Ectopic Pregnancy
Absence of an intrauterine
gestation sac (beware of
pseudo sac)
Bleeding within the pelvis
or tube
Painful examination
Adnexal mass
Miscarriage
Clinical history
An intrauterine pregnancy that is not
consistent with LMP / Clinical dates /
pregnancy test.
Bleeding
Inactive or poorly active Corpus luteum
Miscarriage
Inevitable :Intrauterine pregnancy, not
consistent with dates, absent fetal heart
pulsations.
Missed : A pregnancy that is earlier in
appearance than clinical dates.
Complete : All productions of conception
have been expelled.
Incomplete
Ovarian Cysts
Simple / Functional
Haemorrhagic
Endometriotic
Complex
- Benign
- Malignant
Rupture
Torsion
Haemorrhage
Compression