Pelvic ultrasound (transvaginal)

Background

• Also known as endovaginal ultrasound
• Used to evaluate female reproductive organs including uterus, ovaries, fallopian tubes, cervix, and vagina

Indications

• Abnormal uterine bleeding
• Abnormal abdominal or pelvic exam
• Pelvic pain
• Confirm intrauterine pregnancy
• Gestational dating during pregnancy
• Fetal monitoring and surveillance
• Evaluation of placenta
• Evaluate for spontaneous abortion
• Evaluate for ectopic pregnancy
• Uterine fibroids
• IUD placement confirmation
• Ovarian torsion
• Ovarian cysts

Technique

• Probe and transducer
  • Endocavitary probe (high frequency, low penetration)
  • Probe "dot" stays on left side of ultrasound screen
    • Corresponds with anterior structures (if probe marker held at 12:00) and right-sided structures (if probe marker held at 9:00)

• Patient positioning
  • Lithotomy position
  • Gently advance probe into vaginal canal
  • May be more comfortable for patient to insert probe into vagina herself

Findings

• Endometrial stripe: Measured from thickest echogenic area (from one basal endometrial interface to the other, including canal)
  • Pre-menopausal:
    • During menstruation: 2-4mm
    • Early proliferative phase: 5-7mm
    • Late proliferative phase: 11mm
    • Secretory phase: 7-16mm
    • After D&C or SAB: >5mm
      • Consider retained POC if thicker
  • Post-menopausal:
    • With vaginal bleeding: <5mm
    • Without vaginal bleeding: <11mm

• Adnexa:
  • Simple ovarian cyst: <2.5-3cm

Writing that you want on the bottom of the photo

Images

Normal

Normal thickened endometrial stripe during secretory phase

Normal thin endometrial stripe during menses

Abnormal

Ectopic pregnancy at the cervix

Free fluid in cul-de-sac, no gestational sac visualized in uterus