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An Introduction to
Gynaecological Ultrasound
Leisha de Cruz
Barts and the London NHS
Trust
Techniques and Equipment.
Gynaecological Anatomy
Early Pregnancy
Complications of Early Pregnancy
Gynaecological Abnormalities
Techniques
Transabdominal (TAS)
Transvaginal (TVS)
Transrectal (TRS)
Techniques II
Transabdominal
3.5-5 MHz
Lower resolution
Full abdominal
assessment
? Full Bladder
Choice for later
gestations
Transvaginal
5 + MHz
Higher resolution
Focused pelvic
assessment
Empty Bladder
Choice for gynae,
earlier gestations and
cervical assessments
TVS/TAS scanning to assess the pelvis
in longitudinal (LS) and transverse (TS)
planes
Uterus and Cervix
Ovaries
Adnexa and Recto-Uterine Pouch /
Pouch of Douglas (POD)
Technique
Transabdominal Longitudinal
Section (LS)
Transabdominal Transverse
Section (TS)
Uterus and Cervix
Appearance of the Uterus
Uterine cavity - Endometrial thickening
- Intrauterine gestation
sac(s) and location
- Evidence of bleeding
Cervix ? Closed
Uterus and Cervix
Uterus
Ovaries
Follicles
Corpus Luteum / Corpora lutea
Other cysts / follicles
Ovaries
Ovaries
Adnexa and POD
Free fluid
Masses / Cysts
Haemorrhage
Fallopian tubes
Adnexa and POD
Early Pregnancy
Clinical presentation - Pain
- Bleeding
- Other
LMP
Menstrual patterns
Clinical history - Treatment
- Previous
miscarriage(s)
Investigations
Urinary Test
Pelvic Examination
Serum ßhCG
Bedside Ultrasound
TVS v TAS in
Early Pregnancy US
The higher resolution with TVS means
that details of early pregnancies can be
seen on average one week before they
can be seen on TAS.
Ultrasound Appearances Gestational Age
(wks)
Serum ßhCG
Gestation sac (GS) 4.5 - 5 75 – 2,600
GS with Yolk sac (YS) 5 - 6 850 – 20,800
GS, YS and fetal pole
with heart pulsations
6 + 4,000 +
Early Pregnancy
Dating performed from Crown Rump
Length (CRL) measurement up to 14
weeks gestation.
4 Weeks Gestation
5 Weeks Gestation
6 Weeks Gestation
7 Weeks Gestation
8 Weeks Gestation
9 Weeks Gestation
TransabdominalTransvaginal
10 Weeks Gestation
11 Weeks Gestation
Later gestations
Biparietal Diameter
(BPD) / Head
Circumference (HC)
can be used to give
an idea of
gestational age.
Charts on the
Ultrasound machine
Multiple pregnancies
Abnormalities - Pregnancy
Early Pregnancy
– Bleeding
– Ectopic
– Miscarriage
– Molar Pregnancy
– Retained Products of Conception
Bleeding in Early Pregnancy
Where is the bleeding?
Is it fresh or clot?
Is the cervix open?
Ectopic Pregnancy
Any pregnancy occurring outside of the uterine cavity
Risk factors previous PID; Assisted Conception; IUCD, Endometriosis; Pelvic surgery; Previous ectopic pregnancy.
Ectopic Pregnancy
Absence of an intrauterine
gestation sac (beware of
pseudo sac)
Bleeding within the pelvis
or tube
Painful examination
Adnexal mass
Ectopic Pregnancy II
Miscarrying Ectopic
Pregnancy
Heterotopic pregnancy
Occurrence of an ectopic with a
simultaneous intrauterine pregnancy.
Miscarriage
Clinical history
An intrauterine pregnancy that is not
consistent with LMP / Clinical dates /
pregnancy test.
Bleeding
Inactive or poorly active Corpus luteum
Miscarriage
Miscarriage
Inevitable :Intrauterine pregnancy, not
consistent with dates, absent fetal heart
pulsations.
Missed : A pregnancy that is earlier in
appearance than clinical dates.
Complete : All productions of conception
have been expelled.
Incomplete
Molar pregnancy
Retained Products of Conception
Abnormalities -
Gynaecological
Fibroids
Polyps
Ovarian Cysts
Hydrosalpinx
Pelvic Free fluid
Fibroids
Polyps
Ovarian Cysts
Simple / Functional
Haemorrhagic
Endometriotic
Complex
- Benign
- Malignant
Ovarian Cysts
Simple / Functional
Haemorrhagic
Endometriotic
Complex
- Benign
- Malignant
Rupture
Torsion
Haemorrhage
Compression
Simple Cysts
Haemorrhagic cysts
Endometriotic Cysts
Complex Cysts
Hydrosalpinx
Intrauterine Contraceptive Devices
(IUCD) / Intrauterine Systems (IUS)
Communicating findings
Description
Measurements
Diagrams
Summary
Clinical history
Understanding what is seen
Remember the importance of the
unseen
Sharing information.
