An Introduction to Gynaecological Ultrasound

An Introduction to

Gynaecological Ultrasound

Leisha de Cruz

Barts and the London NHS

Trust

Techniques and Equipment.

Gynaecological Anatomy

Early Pregnancy

Complications of Early Pregnancy

Gynaecological Abnormalities

Techniques

Transabdominal (TAS)

Transvaginal (TVS)

Transrectal (TRS)

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

Transabdominal Longitudinal

Section (LS)

Transabdominal Transverse

Section (TS)

Uterus and Cervix

Appearance of the Uterus

Uterine cavity - Endometrial thickening

- Intrauterine gestation

sac(s) and location

- Evidence of bleeding

Cervix ? Closed

Uterus and Cervix

Uterus

Ovaries

Follicles

Corpus Luteum / Corpora lutea

Other cysts / follicles

Ovaries

Ovaries

Adnexa and POD

Free fluid

Masses / Cysts

Haemorrhage

Fallopian tubes

Adnexa and POD

Early Pregnancy

Clinical presentation - Pain

- Bleeding

- Other

LMP

Menstrual patterns

Clinical history - Treatment

- Previous

miscarriage(s)

Investigations

Urinary Test

Pelvic Examination

Serum ßhCG

Bedside Ultrasound

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 +

Early Pregnancy

Dating performed from Crown Rump

Length (CRL) measurement up to 14

weeks gestation.

4 Weeks Gestation

5 Weeks Gestation

6 Weeks Gestation

7 Weeks Gestation

8 Weeks Gestation

9 Weeks Gestation

TransabdominalTransvaginal

10 Weeks Gestation

11 Weeks Gestation

Later gestations

Biparietal Diameter

(BPD) / Head

Circumference (HC)

can be used to give

an idea of

gestational age.

Charts on the

Ultrasound machine

Multiple pregnancies

Abnormalities - Pregnancy

Early Pregnancy

– Bleeding

– Ectopic

– Miscarriage

– Molar Pregnancy

– Retained Products of Conception

Bleeding in Early Pregnancy

Where is the bleeding?

Is it fresh or clot?

Is the cervix open?

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

Ectopic Pregnancy II

Miscarrying Ectopic

Pregnancy

Heterotopic pregnancy

Occurrence of an ectopic with a

simultaneous intrauterine pregnancy.

Miscarriage

Clinical history

An intrauterine pregnancy that is not

consistent with LMP / Clinical dates /

pregnancy test.

Bleeding

Inactive or poorly active Corpus luteum

Miscarriage

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

Molar pregnancy

Retained Products of Conception

Abnormalities -

Gynaecological

Fibroids

Polyps

Ovarian Cysts

Hydrosalpinx

Pelvic Free fluid

Fibroids

Polyps

Ovarian Cysts

Simple / Functional

Haemorrhagic

Endometriotic

Complex

- Benign

- Malignant

Ovarian Cysts

Simple / Functional

Haemorrhagic

Endometriotic

Complex

- Benign

- Malignant

Rupture

Torsion

Haemorrhage

Compression

Simple Cysts

Haemorrhagic cysts

Endometriotic Cysts

Complex Cysts

Hydrosalpinx

Intrauterine Contraceptive Devices

(IUCD) / Intrauterine Systems (IUS)

Communicating findings

Description

Measurements

Diagrams

Summary

Clinical history

Understanding what is seen

Remember the importance of the

unseen

Sharing information.