Pelvic Ultrasound and Transvaginal Ultrasound

 

Alternative  Names:Endovaginal ultrasound; Ultrasound – transvaginal; Sonohysterography; Hysterosonography; Saline infusion sonography; SIS
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Definition:
Ultrasound uses sound waves instead of radiation to generate snapshots or moving pictures of structures inside the body. This imaging technique works in a manner similar to radar and sonar, developed in World War II to detect airplanes, missiles, and submarines that were otherwise invisible. After coating your skin with a lubricant to reduce friction, a radiologist or ultrasound technician places an ultrasound transducer, which looks like a microphone, on your skin and may rub it back and forth to get the right view. The transducer sends sound waves into your body and picks up the echoes of the sound waves as they bounce off internal organs and tissue. A computer transforms these echoes into an image that is displayed on a monitor.

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Pelvic organ ultrasound is used to monitor pregnancy, find cysts on your ovaries, examine the lining of your uterus, look for causes of infertility, and find cancers or benign tumors in the pelvic region. Depending on the view needed, the ultrasound sensor is placed either on your abdomen (pelvic ultrasound) or in your vagina (transvaginal ultrasound).

Pelvic ultrasound, primarily performed on females is most frequently used for evaluation of pelvic pain, abnormal vaginal bleeding, inflammatory disease, or detection of a mass. Pelvic ultrasound may help explain findings from a manual examination and provide additional information. Pelvic ultrasound examination will generally result in good depiction of the bladder, uterus, and ovaries.

In some patients, transvaginal ultrasound, which involves the insertion of a small transducer (probe) into the vagina, may be necessary to provide a complete analysis of the ovaries and uterine endometrial lining. Early pregnancy or body habitus (obesity) can obscure adequate evaluation of some structures. The decision to use transvaginal ultrasound is determined by the radiologist following pelvic ultrasound.

Pelvic ultrasound generally requires a full bladder and is performed with the patient lying flat on a padded table. Transvaginal ultrasound testing requires the patient to empty their bladder in the restroom and return to the scanning room for a transvaginal examination. Patients are asked disrobe from the waist down with hips elevated by folded towels or a foam pad. Patients usually insert the probe themselves, but can be assisted.

How to prepare for the test.
You will be asked to undress, usually from the waist down.
Your doctor might ask you to drink a few glasses of water before the test because a full bladder lifts your intestines out of the way and provides a clearer view of your pelvic organs. If you’re having a transvaginal ultrasound and have a tampon in place, you’ll need to remove it before the test.

A full bladder is essential for adequate visualization of the pelvic region.

* Finish drinking 4 glasses (32 ounces total) of water one hour prior to your appointment. It is important to drink water only. Do not substitute other beverages.

* Do not empty your bladder prior to the exam.

* Eat as you normally would before and after the examination and return to your usual or recommended activities after the exam.

To avoid delay or rescheduling of your pelvic / transvaginal ultrasound examination, follow preparation instructions carefully.

* Arrive 15 minutes prior to your scheduled appointment time to register for your test.

* The length of time needed to complete this examination will vary depending on the information needed. Plan for up to 45 minutes to complete your exam.

How the Test is Performed
You will lie down on a table with your knees bent and feet in holders called stirrups. The health care provider will place a probe, called a transducer, into the vagina. The probe is covered with a condom and a gel. The probe sends out sound waves, which reflect off body structures. A computer receives these waves and uses them to create a picture. The doctor can immediately see the picture on a nearby TV monitor.

The health care provider will move the probe within the area to see the pelvic organs. This test can be used during pregnancy.

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In some cases, a special transvaginal ultrasound method called saline infusion sonography (SIS), also called sonohysterography or hysterosonography, may be needed to more clearly view the uterus.

This test requires saline (sterile salt water) to be placed into the uterus before the ultrasound. The saline helps outline any abnormal masses, so the doctor can get a better idea of their size.

SIS is not done on pregnant women.

What happens when the test is performed.

You lie on your back on a table for the test. For a pelvic ultrasound, after squirting some clear jelly onto your lower abdomen to help the ultrasound sensor slide around easily, a doctor or technician places the sensor against your skin. For a transvaginal ultrasound, the doctor or technician covers a sensor with a condom and some jelly before inserting it into your vagina.When the sensor is in place, a picture will appear on a video screen. The technician or doctor moves the sensor on your abdomen or in your vagina to see the uterus and ovaries from many different views.

How the Test Will Feel
The test is usually painless, although some women may have mild discomfort from the pressure of the probe. Only a small part of the probe is placed into the vagina.

Risk Factors:
There are no known harmful effects of transvaginal ultrasound on humans.

Unlike traditional x-rays, there is no radiation exposure with this test.

How long is it before the result of the test is known.

If a doctor does the test, you might be able to get preliminary results immediately; this will not be possible if a technician performs the test.Whether a doctor or technician performs the test, he or she records it on a videotape so that it can be formally reviewed by a radiologist. Your doctor should receive the radiologist’s report in a day or two.

Results:
Normal Results

The pelvic structures or fetus are normal.

What Abnormal Results Mean

An abnormal result may be due to many conditions. Some problems that may be seen include:

* Cancers of the uterus, ovaries, vagina, and other pelvic structures
* Non-cancerous growths of the uterus and ovaries (such as cysts or fibroids)
* Twisting of the ovaries
* Infection, including pelvic inflammatory disease
* Birth defects

Some problems that may be found specifically in pregnant women include:

* Ectopic pregnancy
* More than one fetus (twins, triplets, etc.)
* Miscarriage
* Placenta previa
* Placental abruption
* Tumors of pregnancy including gestational trophoblastic disease

Resources:
https://www.health.harvard.edu/fhg/diagnostics/pelvic-ultrasound-and-transvaginal-ultrasound.shtml
http://www.tacomarad.com/exams/ultrasound/pelvic.html
http://www.nlm.nih.gov/medlineplus/ency/article/003779.htm

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