FMGC offers gynaecology scan for the detailed evaluation of the female pelvis. Using the trans-vaginal (internal) probe, the pelvic organs can be examined with improved clarity and where indicated, 3D scan can also be done to add to the evaluation of pelvic disorders. Newer technology such as Doppler study and power Doppler 3D are used to evaluate pelvic masses to exclude malignancy (cancer).
Ever since its introduction in obstetrics in the 1960's, ultrasound has been used in many other clinical situations to confirm diagnoses and to help in interventional procedures. Almost all areas of medicine have used the ultrasound scan as an integral part of managing various conditions, ranging from echocardiography (assessment of the heart) to the evaluation of the skin in dermatology. Transducers or probes of different shapes and sizes of varying frequencies have been developed to suit its clinical purpose. The practice of gynaecology has evolved over the decades and the use of ultrasound has given doctors the opportunity to evaluate the female pelvic organs. Hitherto, it is commonplace for the gynaecological patient to be further evaluated with the ultrasound scan.
There are many uses for the ultrasound scan in gynaecology. With the advent of trans-vaginal ultrasonography, pelvic structures can be seen with improved clarity as a result of the higher resolution vaginal transducer. However, the trans-abdominal probe is also used in gynaecological practice.
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| Indications of ultrasound in gynaecology: |
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- Evaluation of early pregnancy problems.
- Assessment of pelvic masses.
- Location of IUCD.
- Evaluation of ovarian follicular growth (follicular tracking).
- Assessment of congenital abnormalities of the uterus.
- Interventional ultrasonography in gynaecology e.g. oocyte (egg) retrieval.
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| The different ultrasound probes used in gynaecoloy, a) 2D trans-abdominal probe, b) 3D trans-abdominal probe, and c) trans-vaginal probe |
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| Preparing for a gynaecology scan |
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For a trans-abdominal scan (TAS), the bladder must be full. This provides an "acoustic" window which is created by having a full bladder. His will allow the doctor to improve visualization of the pelvic structures. In contrast, a full bladder may hinder the imaging when a trans-vaginal scan (TVS) is used. Therefore, a full bladder is unnecessary in this situation.
Privacy will be maintained especially when a trans-vaginal scan in performed. A chaperone / nurse will be present. Your husband/partner or friend can be with you when the doctor performs the scan.
When a trans-abdominal probe is used, the woman is scanned while lying on her back. For a trans-vaginal scan, she is placed in a lithotomy position (with the legs up). This is best facilitated by the use of a gynaecological couch.
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| The gynaecological couch facilitates trans-vaginal scanning |
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| A trans-abdominal ultrasound scan in progress |
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| A longitudinal view(a) and a transverse view(b) of the womb showing the bladder (B), endometrial lining (E), cervix (C) and vagina (V) |
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| Assessment of pelvic masses |
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The ultrasound scan enables doctors to evaluate pelvic masses. If a pelvic mass is suspected, the following information may be obtained with an ultrasound scan:
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- Confirm the presence of a mass.
- Measurement of the mass(es) and evaluate its extent.
- Determine its origin (from the womb, ovary or other structures in the pelvis.
- Assess the architecture (simple or complex).
- Evaluate its vascularity; this may differentiate the benign from the cancerous mass.
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| 3D ultrasound will allow an improved assessment of the complexity of the masses and more accurately assess its size (volume) and extent. A newer technology that is available at FMGC called 3D colour power angio will allow the doctor to assess with almost 100% certainty if the mass is cancerous. This measures the amount of vascularity in the tumour (mass) as cancerous tumours tend to be very vascular. Appropriate advice can then be given prior to the operation. |
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2D and 3D images of an ovarian cyst.
The nature of the cyst is enhanced with 3D reconstruction. |
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3D ultrasound is an excellent technique
to assess for surface irregularities of a pelvic mass;
in this case, an ovarian cyst. |
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These are 2D and 3D images of a fibroid uterus. The 3D image demonstrates clearly the fibroid indenting the endometrial lining. 3D ultrasound allows the ability to accurately assess fibroids in terms of size and locality. |
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A pelvic mass is further evaluated
with Doppler studies, measuring the blood flow.
3D Power Doppler (Angio) assesses the vasculature
of the tumour and characterizes the tumour vessels.
These techniques help to differentiate
between benign and malignant lesions.
In this case, pelvic TB was diagnosed on pathology report. |
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| Congenital uterine abnormalities |
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The trans-vaginal ultrasound scan is an excellent tool for the diagnosis of most pelvic conditions. In order to confirm or classify congenital uterine abnormalities, on the other hand, requires the womb to be visualized in the "coronal" plane. This view is extremely difficult to obtain with the traditional 2D scan. However, 3D ultrasound is able to obtain this difficult plane simultaneously. This will allow an accurate diagnosis of congenital abnormalities of the womb.
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3D reconstruction of a congenital uterine anomaly - bicornuate uterus
The nature of the cyst is enhanced with 3D reconstruction. |
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| Location of IUCD |
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| Ultrasound scan can identify the locality of an intra-uterine contraceptive device (IUCD). The three-dimensional ultrasound is superior to 2D ultrasound in correctly classifying IUCD's by enabling easy identification in the uterine cavity. The exact position of the IUCD within the uterus can be determined. |
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Three-dimensional ultrasound enables the identification of the type of IUCD and the exact location within the uterine cavity. |
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| Assessment of sub-fertility |
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| The role of ultrasound in the assessment of sub-fertility includes: |
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- Monitoring of ovulation and assessment of follicle size and numbers
- Assessment of tubal patency
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Follicular tracking is common place in the management of ovulation
problems. After giving fertility drugs, the follicles (eggs) are tracked with ultrasound scan until they reach an optimum size (at least 18mm diameter), when an injection is given to induce ovulation (release of the egg). |
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Using the multiplanar mode to measure the size of a follicle. |
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| Hysterosonosalpingography has recently been introduced to assess tubal patency in the investigation of sub-fertility. Compared with the other procedures such as laparoscopy and hysterosalpingography, hysterosonosalpingography does not involve X-Ray, general anaesthesia and does not cause an allergic reaction. It is a reproducible and reliable method of assessing tubal patency. |
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| Other applications of ultrasonography in gynaecology |
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| Polycystic ovarian syndrome is a common cause of menstrual problems, and sub-fertility. Its diagnosis can be made with ultrasound scan and confirmed with blood tests. |
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3D ultrasound accurately diagnoses polycystic ovaries. The syndrome is confirmed by blood tests. |
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| Ultrasound scan may have a role in the aspiration of follicles, cyst and other pelvic masses. It can assist in the correct placement of needles. Indeed, puncture procedures, such as oocyte collection, can be performed very precisely. |
