basic gynaecolgoy ultrasound: basic knowledge

8/12/2019 Basic Gynaecolgoy Ultrasound: Basic knowledge

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Chok Chin Nam

Cathy Heng Siang Ting



Ultrasound

Base on sound wave reflection at the ultrasonicfrequency (2 to 18 megahertz).

Non ionizing, no radiationUltrasound wave produced from transducer reflectedupon hitting tissue echo vibrates the transducer software interpret the sound wave.

Often require bladder window for better accoustictransducibility if TAS is performed.



Potential uses for ultrasound in gynaecology 1:

Early Pregnancy Loss Assessment of adnexal pelvic masses

Compound B scan Doppler vessel studies

Diagnosis of polycystic ovaries

Investigation of postmenopausal bleeding Imaging and measure of endometrial thickness

Investigation of menorrhagia Fibroids and adenomyosis

Monitoring of follicle number and growth for IVF Egg recovery for IVF and ICSI Evaluation of pelvic pain

A limited role

Screening for ovarian cancer Too many false positives



Potential uses for ultrasound in gynaecology 2:

IUCD and Implanon location

Treatment of ovarian cysts (aspiration) and ectopicpregnancy (methotrexate)

Saline hysterography for delineation of the uterine cavity

Tubal patency studies in infertility

Evaluation of primary amenorrhoea



2 types of probe. Abdominal

Lower Frequency

3.5 MHz (2-5 MHz) Penetrate Deeper

Poor Distal Resolution

Large field

The full bladder servesas an acoustic windowand pushes the bowel

out of the sound path

Vaginal

Higher Frequency

7.5 MHz (5-8MHz) 6-8 cm Penetration

Excellent Resolution

Limited field



Transabdominal TECHNIQUES Supine position

A full bladder willprovide sonographic

window

3.5 MHz curvilineartransducer

Place transducer in the

sagittal plane just abovethe pubic bone

Locate the long-axis ofuterus and sweep fromside to side

Turn transducer 90degrees counter-clockwise

Locate the short-axis of

the uterus and anglecephalad and caudad

Goal is to see the entireuterus



TRANSVAGINAL TECHNIQUES Supine lithotomy

position

5.0-7.5 MHz

intravaginal transducer Need to apply gel to the

transducer andtransducer cover

Have assistant tochaperone

With locator anterior,scan the long-axis of theuterus

Transducer does notneed to be inserted allthe way to the cervix

Turn transducer 90degrees counter-

clockwise to scan theshort-axis of the uterus

Goal is to see the entireuterus



Indication Uterine pathology

Adnexal pathology

Bleeding in early pregnancy Ovary phase determination



Specific types of USG Hysterosonography.

USG Doppler.



UTERUS

Anteverted uterus: fundus towards same side as bladder

Retroverted uterus : fundus opposite side from bladder



Uterine pathology Fibroid

Endometrial Hyperplasia

Endometrial Ca Adenomyosis



Uterine leiomyoma

Transvaginal ultrasound is preferable, but large fibroidmight be better with TAS.

Fibroid is hypoechogenic compare to normalmyometrium.



Submucosal fibroid



Endometrial thickening

cyclical change during menstrual cycle

endometrial hyperplasia endometrial polyp

endometrial carcinoma

medications : HRT



Endometrial polyp

Visual can be enhanced via Doppler.



Endometrial thickeningIn the productive period, an endometrial

thickness of up to 14 mm may be considered normal andup to 5 mm post-menopausally

Sign of Endometrial Cancer (HPE exclusion) Higher possibility if ET > 10 mm compare to if < 5 mm



ENDOMETRIAL SCAN Double wall thickness

measurement (mm)

Immediate 1 - 4

Proliferative 7 - 10

Secretory 8 - 16



Endometrium Ashermann syndrome

Bands of calcification(hyperechogenic area)



Adenomyosis Enlarged Uterus

Thickened myometrium

Areas of decreased echogenicity(smooth musclehyperplasia)

Myometrial cystic space(haemorrhagic foci)



IUCD LOCALIZATION Proper Positioning

Loss IUCD

Perforation

Not > 20 mmIndicate Proper Positioning



Adnexal massNormal ovary size 2 × 2 × 3cm

Assessment includeds:

• Mobility

• Septation

• Wall structure• Pain

• Echogenicity

colour Doppler can beuse for :identification ofblood vessels within the

cyst wall and septa, within solid componentsand papillaryprojections.



Polycystic ovarian disease.



OVARIAN FOLLICLES (FUNCTIONAL)Phase Follicle Size

Follicular 2- 5 mm

DF (Day 10) 10 mm

Pre-ovulatory 20-24 mm

Corpus Luteum < 30 mm



Endometriotic cyst



Ovarian Tumour Characteristic of ultrasonic appearance suggestive of

malignancy:

Multilocular cyst

Solid areas Papillary projection

bilateral lesions

Ascites Intra-abdominal metastases

Large tumour >10cm

Thick, irregular wall



OVARIAN CYST Dysfunctional Cyst

HemorrhagicCyst/corpus luteum cyst

ConservativeManagement withFollow up 3/12



DERMOID CYST



Pelvic inflammatory disease



Ectopic pregnancy Abnormal implantation (extra uterine) of the

developing embryo 98% in the fallopian tube (ampullary)

Suspected when thickened endometrial lining (decidua)but without gestational sac (UPT +ve), with free fluid inPOD

Look for yolk sac

Fetal pole and HR outside uterine cavity-confirmthe diagnosis



A gestational sac outside the uterus with or without fetalheart beat

An adnexal mass which may be echo filled or hypoechoic with an adnexal ring.

A possible decidual cast in the uterus.(pseudosac)

Substantial fluid in the pouch of Douglas or paracolic

gutters or sub hepatic space, due to haemoperitoneuma serum β-hCG greater than 1,500 – 2,000 without

evidence of a gestational sac by transvaginalultrasound represents an ectopic pregnancy



Pesudosac vs gestational sac



Double decidual sign



Molar Pregnancy

Snow storm appearance due to vesicles Bilateral theca lutein cyst



Missed miscarriage Fetal pole > 6 mm with no fetal heart activity.

Gestation sac diameter 20 mm with no fetal poleoryolk sac

Abnormal hyperechoic material

Irregular gestational sac.



Complete miscarriage Endometrial thickness <15mm

No evidence of retained tissue



Incomplete miscarriage•

Heterogenous tissues sac distorting midlineendometrial echo• Any endometrial thickness



Threatened miscarriage

+ Fetal pole with heart echo

+ IUGS

+/-Subchorionic Haematoma



Subchorionic haematoma

http://www.ajronline.org/content/vol176/issue3/images/large/03_AA0513_03B.jpeg



Saline infusion Sonohysterography

(SIS) To detect abnormalities of the uterus and

endometrium

Abnormal uterine bleeding, infertility, recurrentspontaneous miscarriage, congenital abnormalities ofthe uterus, preoperative and postoperative evaluationof the uterine cavity, suspected intrauterine adhesions(synechiae or scar tissue)

Using Insemination catheter 5-15 ml saline into theUterine Cavity



Thank you!!!

basic gynaecolgoy ultrasound: basic knowledge

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