the pelvic scan early pregnancy problems gynaecological abnormalities l.
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The Pelvic Scan: Early pregnancy problems Gynaecological abnormalities - PowerPoint PPT Presentation


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The Pelvic Scan: Early pregnancy problems Gynaecological abnormalities. Normal pelvic anatomy. Anatomy of uterus and ovaries Arterial blood supply Venous blood supply Neural supply. Gynaecological scan indications. Pelvic pain Pelvic mass Irregular/ heavy vaginal bleeding

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Presentation Transcript
normal pelvic anatomy
Normal pelvic anatomy
  • Anatomy of uterus and ovaries
  • Arterial blood supply
  • Venous blood supply
  • Neural supply
gynaecological scan indications
Gynaecological scan indications
  • Pelvic pain
  • Pelvic mass
  • Irregular/ heavy vaginal bleeding
  • Post menopausal vaginal bleeding
  • Infertility
  • Endocrine symptoms/ signs
  • Recurrent miscarriage
routine
Routine
  • Sagittal image uterus and bladder
    • Length of endometrium and cervix
    • Measure length uterus +/- ET in AP
    • Check for fluid in POD
  • Transverse image bladder and cervix
  • Transverse image bladder and uterus at widest part
    • Image whole uterus as move cephalad
    • Measure ET in AP
    • Measure uterus width and AP
  • Transverse to top of uterus
routine5
Routine
  • Transverse image broad ligament
  • Move to Right/Left
    • Check no tubal dilatation
    • Visualise ovary
    • Move caudally if unable to see
  • Split screen and measure ovarian volume
  • Cyst?
    • Measure volume
    • Septations, papillary lesions, solid areas, low level internal echoes
    • Check mobility with valsalva or hand on abdomen
    • Check for ascites
    • Torsion?
early pregnancy scan indications
Early pregnancy scan indications
  • Dating
  • Bleeding
  • Pain
  • Previous ectopic/ miscarriage/ molar pregnancy
complete miscarriage
Complete miscarriage

Bleeding and cramps which are usually settling

missed miscarriage
Missed miscarriage

Spotting only usually. Expected to be 6-12 weeks by LMP.

Fetal pole seen

other miscarriages
Other miscarriages
  • Anembryonic pregnancy
    • Spotting or nil
    • Gestational sac, MSD >2cm
    • No fetal pole
  • Incomplete miscarriage
    • Bleeding and cramps
    • RPOC
    • Doppler to diagnose
  • Threatened miscarriage
    • Bleeding +/- pain
    • Viable pregnancy
ectopic pregnancy
Ectopic pregnancy
  • Pregnancy outside the uterine corpus
    • Ampulla
    • Cornu
    • Ovary
    • Abdominal
  • Life- threatening intra-abdominal bleeding
  • Symptoms and signs
    • Spotting, pain- usually one side, fainting, shouler-tip pain
  • URGENT referral on USS diagnosis
  • High index of suspicion if
    • previous ectopic
    • IUD
    • infertility
uss findings
USS findings
  • Empty uterus
  • Adnexal mass
    • +/- FHR
    • Ring of blood flow on doppler
    • Tenderness on probe pressure over mass
  • Free fluid especially POD
  • TV scan ideally if available
hydatidiform molar pregnancy
Hydatidiform molar pregnancy
  • Abnormal placental development
  • Usually no recognisable fetus
  • ‘Snowstorm’ appearance on USS
  • Exaggerated symptoms of pregnancy
    • Hyperemesis
    • Thyroid hormone abnormality
    • Large theca-lutein cysts
  • Rx is ERPOC and CXR
  • Can recur and rarely in malignant form