Ultrasound examination of the pelvic organs is a popular diagnostic method in gynecological practice, characterized by accessibility, safety and information content. The results of ultrasound scanning allow the doctor to assess the condition of the pelvic organs and diagnose pathological changes with high accuracy.
There are two methods of ultrasound diagnostics that are used to examine the pelvic organs - transabdominal and transvaginal. In the first case, the ultrasonic sensor is placed on the anterior abdominal wall, in the second, a special sensor is inserted into the vagina. Transvaginal ultrasound allows you to examine the structure of organs in more detail, determine the size, shape and structural features of pathological formations.
- How it works?
- What can be seen with an ultrasound examination of the uterus and appendages?
- Indications for appointment
- Study preparation
- Features of the procedure
- Restrictions and contraindications
With a transvaginal ultrasound, a special probe is inserted into the woman's vagina. The sensor is a plastic rod with a handle, about 10-12 centimeters long and up to 3 centimeters in diameter. A special groove can be built into it, designed to accommodate a needle for taking tissue samples for a biopsy. Before the procedure, a personal protective equipment is put on the sensor, which ensures complete sterility and safety of the method; a medical gel is applied on top to improve the propagation of the ultrasonic wave.
This type of examination takes about 10-15 minutes. It is safe, painless and provides the specialist with the most complete picture of the state of the pelvic organs, even in the case when the transabdominal diagnostic method turns out to be completely non-informative.
Transvaginal diagnostic method has a number of advantages over transabdominal ultrasound:
- high information content - ultrasound does not pass through the subcutaneous fat of the anterior abdominal wall, the bladder, since the sensor is located near the uterus and appendages;
- no special preparation for the examination (pre-filling of the bladder) is required.
Ultrasound examination with a transvaginal sensor allows you to determine the presence of pathologies, neoplasms or diseases in the female genital organs:
- uterus and retrouterine space;
- fallopian tubes;
- vessels of the pelvic organs.
Transvaginal ultrasound is recognized worldwide as the most effective method for examining the female genital area, as it allows you to identify various problems in the early stages, including before clinical manifestations.
Transvaginal ultrasound allows a complete examination of the pelvic organs. During the examination, the position, shape, main dimensions of the uterus and the structure of its walls are determined, the uterine cavity and its inner layer (endometrium) are examined separately. The size of the ovaries and the condition of the follicular apparatus are assessed. The presence of neoplasms in the pelvic cavity is also determined. Ultrasound of the pelvic organs in women can detect developmental anomalies, inflammatory gynecological diseases, benign and malignant neoplasms of the uterus and ovaries, and detect the causes of menstrual irregularities. Pelvic ultrasound is widely used to monitor the functioning of the ovarian follicular apparatus in the treatment of infertility and pregnancy planning.
Parameters that an ultrasound specialist evaluates during the procedure:
- size and position of internal organs;
- structural anomalies;
- the thickness of the endometrial layer, its structure;
- the presence of pregnancy, its localization;
- the presence of neoplasms, cysts, adenomas, polyps;
- parameters of the cervix;
- the number of follicles.
Very often, transvaginal ultrasound is recommended for women in early pregnancy. Scanning allows you to confirm or refute the fact of pregnancy and establish the localization (uterine or ectopic) of the fetal egg. With transvaginal ultrasound, it is possible to fix the fetal heartbeat for a period of 5 weeks. In later pregnancy, an ultrasound scan is performed with an abdominal probe through the anterior abdominal wall.
Transvaginal ultrasound can be combined with color Doppler imaging (CDM) of the pelvic vessels. Color mapping significantly complements the clinical picture and makes it possible to judge the nature of blood flow in the organs and tissues of the small pelvis.
Transvaginal ultrasound facilitates diagnosis and reveals pathologies and lesions of the pelvic organs. A referral for research can be issued by a gynecologist, reproductologist or surgeon.
The main indications for transvaginal ultrasound of the pelvic organs are:
- pain in the lower abdomen (any in duration, frequency and nature);
- suspicion of gynecological pathology;
- abnormal uterine bleeding and painful menstruation;
- disruptions in the menstrual cycle, a pathological change in the duration of menstruation;
- fertility assessment and infertility therapy;
- preparation for pregnancy and IVF procedure;
- diagnosis of early pregnancy;
- planning gynecological operations;
- control of the state of the pelvic organs after gynecological manipulations (including after termination of pregnancy);
- tracking the dynamics during the treatment of gynecological diseases;
- suspicion of the development of neoplasms in the pelvic area;
- the presence of inflammatory and purulent-inflammatory processes;
- to choose a contraceptive, in some cases - its installation and control;
- premenopausal and menopause;
- periodic preventive examination.
Additionally, experts advise every woman to undergo a transvaginal examination at least once a year. This will allow to identify diseases at an early stage of development and prevent the development of complications.
Special preparation for the procedure is not required. If necessary, ultrasound is performed on the day of appointment. The study takes place with an empty bladder - before diagnosis, a woman needs to visit the toilet, and an hour before the appointed time, refuse to eat and drink.
Patients with diseases of the gastrointestinal tract, accompanied by increased gas formation, are recommended to take medications that prevent this phenomenon.
Cycle day selection
In case of an emergency, the examination is carried out immediately, regardless of the day of the menstrual cycle. However, during a routine examination, an ultrasound examination of the female genital organs is recommended in the first half of the menstrual cycle (usually on the 5-7th day), since the endometrium is in the secretory phase in the second half of the cycle. This may complicate the interpretation of the results.
To assess folliculogenesis (the formation and development of ovarian follicles), the study must be carried out on the 5-9th, 11-14th and 15th days of the menstrual cycle. If endometriosis is suspected, transvaginal ultrasound is recommended to be performed closer to the middle of the cycle or in the second phase of the cycle, when ovulation has already passed and foci of pathological changes become most noticeable.
Ultrasound in early pregnancy
An informative ultrasound examination can be performed as early as the third week of pregnancy. With the help of transvaginal ultrasound in the early stages, it is possible to accurately establish the fact of pregnancy, the localization of the fetal egg (uterine or ectopic), the number of embryos in the uterine cavity and clarify the timing of conception by the size of the embryo. At a period of 5-6 weeks, an ultrasound doctor can already determine the fetal heartbeat. At a period of 7-8 weeks, a specialist can detect the appearance of organ buds and diagnose an undeveloped pregnancy.
With a transvaginal ultrasound, you need to undress, as at a gynecologist's appointment, lie on your back on the couch. The doctor then prepares the probe and inserts it into the vagina. The procedure is performed with an empty bladder.
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The ultrasound transducer is inserted into the vagina. Before starting the procedure, a condom must be put on it, which is additionally lubricated with a special gel. The function of lubrication is to reduce discomfort for the woman and improve contact between the probe and the vaginal walls.
The specialist performing the examination gently inserts the probe into the vagina so that the patient does not experience pain or discomfort. The duration of the scan is about 10-15 minutes.
The attending physician is responsible for deciphering the results of the study.
There are practically no contraindications to transvaginal scanning. The limitation is the 2nd and 3rd trimester of pregnancy - at this time, inserting the sensor into the vagina can provoke an increase in the tone of the uterus. Before the onset of sexual activity, ultrasound of the pelvic organs is done by the transabdominal method for patients.
Ultrasound diagnosis is necessary for the initial diagnosis. If various disorders are detected, the gynecologist may prescribe additional laboratory or instrumental studies. For preventive purposes, it is recommended to perform an ultrasound of the pelvic organs once a year.