Norm of Gynecologic Ultrasonography
Normal size, shape, and position of pelvic structures (uterus, ovaries, fallopian tubes); negative for cyst, foreign body, stones, or tumor.
Usage of Gynecologic Ultrasonography
Evaluation of the size, shape, and position of bladder, ovaries, vagina, and uterus; detection of pelvic cyst, ectopic pregnancy, endometrial abnormalities, foreign body (such as intrauterine device), hydatidiform mole, stones, or masses; differentiation of solid from liquid masses; infertility work-up (monitoring the ovarian follicle or screening for uterine cavity abnormalities); monitoring of pelvic tumor response to therapy; and transvaginal sonography have an added advantage of providing information regarding the cervical and uterine vascular supplies.
Description of Gynecologic Ultrasonography (Gynecologic Echogram, Gynecologic Sonogram, Pelvic Sonogram, Pelvic Ultrasound)
Gynecologic ultrasonography (ultrasound) is the evaluation of the pelvic structures by the creation of an oscilloscopic picture from the echoes of high-frequency sound waves passing over the pelvic area (acoustic imaging). The time required for the ultrasonic beam to be reflected back to the transducer from differing densities of tissue is converted by a computer to an electrical impulse displayed on an oscilloscopic screen to create a three-dimensional picture of the pelvic contents. Both transabdominal and transvaginal methods may be used. Traditional transabdominal methods are more helpful for the evaluation of large cysts and fibroids, whereas the newer, transvaginal method is more specific for ruling out ectopic pregnancy or evaluating endometrial abnormalities. Transvaginal methods have also been shown to provide better depictions of the fine structures and individual organs of the pelvic cavity and are better tolerated by the subject because a full bladder is not required. Gynecologic ultrasonography may be used as an adjunct to the pelvic bimanual examination in women who are at risk for ovarian cancer.
Professional Considerations of Gynecologic Ultrasonography (Gynecologic Echogram, Gynecologic Sonogram, Pelvic Sonogram, Pelvic Ultrasound)
Consent form NOT required.
- This test should be performed before intestinal barium tests or after the barium is cleared from the system.
- The client should disrobe below the waist or wear a gown.
- Obtain ultrasonic gel.
- See Client and Family Teaching.
- Transabdominal method
- a. The client is positioned supine in bed or on a procedure table.
- b. The pelvic area is covered with ultrasonic gel, and a lubricated transducer is passed slowly and firmly over the lower abdomen at a variety of angles and at 1- to 2-cm intervals.
- c. The client may be repositioned to a right or slight left decubitus position so that better pictures of the ovaries or the adnexal area may be obtained.
- d. A water enema may be administered if more specific evaluation of the adnexal area is required.
- e. Photographs are taken of the oscilloscopic pictures.
- f. The procedure takes less than 30 minutes.
- Transvaginal method
- a. The client is positioned in the dorsal lithotomy position or on a conventional examination table, with a pillow supporting the hips.
- b. A sterile, nonreservoir condom containing ultrasonic gel is placed over the transducer, and air bubbles are worked out of it. The condom is then coated with a sterile lubricant.
- c. The client or the examiner may insert the transducer into the vagina until it touches the posterior or anterior walls.
- d. The transducer is rotated 90 degrees against the vaginal vault to obtain sagittal and coronal scans of the uterus. The probe is pulled back 2–3 cm to examine the cervix. Using identified landmarks, the ovaries and fallopian tubes are pictured. All possible angles are scanned. The client may be repositioned slightly to facilitate imaging.
- Remove the lubricant from the skin.
- Allow the client to void.
- Disinfect the transducer probe by soaking in glutaraldehyde solution for 10 minutes.
Client and Family Teaching
- The procedure is painless and carries no risks.
- If transabdominal ultrasonography is to be performed, drink 1 quart of water during the hour before the test, and refrain from voiding during this time. The full bladder provides an acoustic window for imaging.
- If transvaginal ultrasonography is to be performed, fast from fluids for 4 hours before the procedure, and void just before the procedure.
Factors That Affect Results
- Dehydration interferes with adequate contrast between organs and body fluids.
- Intestinal barium or gas obscures results by preventing proper transmission and deflection of the high-frequency sound waves. This problem is particularly pronounced with pelvic ultrasonography as the result of the proximity of the large bowel.
- The more abdominal fat present, the greater is the attenuation (reduction in sound wave amplitude and intensity), which interferes with the clarity of the transabdominal picture.
- Transvaginal techniques are not adequate for very large masses.
- Further studies may include tomography or other radiographic imaging.