Transvaginal ultrasound

1. Transvaginal ultrasound Dr Samina Khalid Sindh Institute of Reproductive Medicine ( SIRM)

2. INTRODUCTION • A Transvaginal ultrasound, or Endovaginal ultrasound, is a noninvasive procedure used to assess organs and structures within the female pelvis. • An ultrasound utilizes high-recurrence sound waves to create point by point pictures of inside organs. Not at all like X-beams, ultrasound checking strategies don't utilize radiation, which implies that they have no unsafe symptoms and are protected. • It allows quick visualization of the female pelvic organs and structures including the uterus, cervix, vagina, fallopian tubes, and ovaries. • Doppler ultrasound may also show blood flow in certain pelvic organs.

3. EQUIPMENT

4. PROCEDURE • There are no known risk factors associated with Transvaginalultrasound. • Performing Transvaginal ultrasounds on pregnant women is also safe, for both mother and fetus. This is because no radiation is used in this imaging technique. • When the transducer is inserted into your vagina, you'll feel pressure and in some cases discomfort. The discomfort should be minimal and should go away once the procedure is complete. • If something is extremely uncomfortable during the exam, be sure to let the doctor or technician know. • The transvaginal ultrasound probe is placed in the anterior or the posterior fornix. This allows the probe to be pushed up against the cervix

5. PROCEDURE • The saggital view can be obtained as well as the transverse view • It is not possible to obtain a coronal view of the uterus, hence it is derived by 3D imaging techniques. • TVS frequency is 5-8 MHz

6. PROCEDURE • Patient should empty her bladder • Patient lay in lithotomy position • Gel placed on ultrasound probe • Sterile probe cover placed on probe • Gel placed on probe cover • sonographer inserts probe • Images obtained

7. 1) Buttocks at edge of the table or elevated on a firm foam cushion. • 2) Ultrasound system at the patient's buttocks. Keyboard reached easily. • 3) insert probe-watch ultrasound monitor-looking for cervix to see if the probe is inserted far enough. • 4) At midline tip anteriorly and posteriorly. Right— anteriorly and posteriorly. Left-anteriorly and posteriorly. • 5) Flip the probe with the sagittal marker downward for the retroverted uterus—repeat midline-anterior and posterior. Right-anterior and posterior. Left-anterior and posterior. • 6) After locating the uterus, adjust the scale and elongate the endometrial lining with "screwdriver mini-turns."

8. FEATURES OF TRANSVAGINAL ULTRASOUND • An abnormal pelvic or abdominal exam • Unexplained vaginal bleeding • Pelvic pain • An ectopic pregnancy • Infertility • A check for cysts or uterine fibroids • Verification that an IUD is placed properly • Early pregnancy\dating scan

9. ADVANTAGES • Malignant growth of the regenerative organs. • Routine pregnancy. • Fibroids • Pelvic disease • Ectopic pregnancy • It is difficult to see the pelvic organs from a trans-abdominal perspective as the pubic bone creates shadows • There is a long distance between probe and organs in transabdominal ultrasound

10. TVS ASSESSMENT • Size, shape, and position of the uterus and ovaries • Thickness, echogenicity and presence of fluids or masses in the endometrium, myometrium, fallopian tubes, or in or near the bladder • Length and thickness of the cervix • Blood flow through pelvic organs

11. INDICATIONS • Abnormalities in the anatomic structure of the uterus • Fibroid tumors (benign growths), masses, cysts within the pelvis • Intrauterine contraceptive device (IUCD) • Pelvic inflammatory disease (PID) • Postmenopausal bleeding • Monitoring of ovarian follicle size for infertility evaluation • Aspiration of follicle fluid and eggs from ovaries for in vitro fertilization • Ectopic pregnancy (pregnancy occurring outside of the uterus, usually in the fallopian tube) • Monitoring fetal development during early pregnancy

12. CONTRAINDICATIONS ABSOLUTE: • Paedriatic age group • PROM • Bleeding associated with placenta previa RELATIVE: • Refusal of patient

17. COLOR DOPPLER • Doppler color flow mapping uses different colors to depict the direction of flow on a real-time color image • Useful to determine: • Presence of flow to rule out ovarian torsion • Vascularity of a mass • Characterize the mass • Vascularity of the endometrium/myometrium to distinguish benign versus malignant conditions

19. DATING SCAN

20. Early vibility scan

21. NUCHAL TRANSLUCENCY • NUCHAL TRANSLUCENCY is an ultrasound that measures the amount of fluid behind the neck of fetus , • IDEAL TIME between 11th and 13.6 weeks • At 11 week_1.8, • At 12 week_2.0 • At 13.6 week_2.8mm • CVS 10-13 WKS, • AMNIOCENTESIS 16-20 WKS

22. NUCHAL TRANSLUCEY

25. RETAINED PRODUCT OF CONCEPTION(Rpocs)

26. MOLAR PREGNANCY

27. PARTIAL MOLE

28. COMPLETE MOLE

30. INVASIVE MOLE

31. INVASIVE MOLE

32. choriocarcinoma

33. SALINE INFUSION SONOGRAPHY (SIS)

37. ROLE OF TVS IN GYNECOLOGY

38. CYST

39. OVARIAN CARCINOMA

40. How to measure cervical incompetence

42. Haemetometra/haemetocolpos

43. STRUCTURAL ABNORMALITIES

45. FIBROIDS • Well circumscribed lesions • Foci of calcification with acoustic shadowing • Blood vessels going around the lesion

46. FIBROIDS

48. ADENOMYOSIS • Endometrial tissue that grows into the muscular wall of the uterus • Heterogenous looking junctional zone myometrium • Myometrial asymmetry • Cystic areas within myometrium • Blood vessels passing through abnormal looing area

49. ADENOMYOSIS