Transvaginal USTransvaginal USTransvaginal USTransvaginal US

TVSTVS

Gynaecologic US

Earlt first trimester obstetric US

Obstetric complications later in pregnancy

E.g. Placenta previa

Fetal spine in breech

Evaluation of fetal intra..... in cephalic fetuses

Evaluation of nuchal region before 14w

TVSTVS

Suspected ectopic pregnancy

Follicle monitoring

Monitoring of assisted reproductive technology (ART)

Generally :

TAS with full bladder

then empty the bladder

Followed by TVS

Not to be done in virginal pt, no consent to vaginal examination

Orientation of TV probe Orientation of TV probe (manoeuvres)(manoeuvres)

Rotation 0 to 90 degrees about its longitudinal axis from capital to coronal

Angled or pointed in any direction for plane of section

Advance or withdraw

As a marker note the position of the urinary bladder- angle of the bladder is consistent .... the variable positions of the uterus and ovaries

1st manouvre

Sagittal plane

Then rotation in coronal plane from cervix to uterine fundus

Sweep

Sagittal plane:

Cervix, endocervical canal

Post cul de sac

Uterus and endometrium

Right ovary and adnexa

Left ovary and adnexa

Coronal plane:

Vagina

Cervix and post cul de sac

Uterine corpus and endometrium

Uterine fundus and endometrium

R ovary and L ovary and adnexa

Applying pressure on ant abd wall for high ovary

The UterusThe Uterus

Before menarche- ratio of uterus to cervix is half

Nulliparous women- corpus and cervix equal length

Multip- corpus is double the size

Size of uterus is variable in adults:

6-8.5cm in length in multips

Width - 3 -5 cm in nulliparous, 4-6cm in multips

AP diameter- 2-4cm in nulliparous, 3-6cm in multips

After menopause- atrophy

>5 years menopause:

3.5-7cm length

2-4 cm width

1.7- 3.3cm AP

Prepubertal uterus 2-4.4cm

Position is highly variable and changes with varying degree of bladder and rectal distension

Muscular layers- 3 distinct layers

The endometrium: thickness

4-8mm proliferative phase

6-10mm periovulatory

7-14mm secretory phase

Post menopausal < 8mm

If the endometrium > 5mm in PMB--> investigate

The OvariesThe Ovaries

Ellipsoid

Location is variable

Recruitment of follicles:

TVS can pick up when follicle is 2mm

Day 5-7

Day 8-12 one or more dominant follicles are seen

Rate of growth of dominant follicles:

2-3mm per day

To reach max mean diameter of approx. 20mm (range 16-28mm)

24 hrs before ovulation:

The granulosa layer separates from the theca layer resulting in a hypoechoic ring