Promptly examining the structure of a woman’s reproductive organs, as well as assessing their size and diagnosing developmental anomalies - all this is possible thanks to ultrasound of the uterus. The procedure is prescribed to confirm the diagnosis of gynecological diseases, monitor the treatment received and as a screening examination. There are several variations of ultrasound examination:
- transabdominal,
- transrectal,
- transvaginal.
Indications for uterine ultrasound
Gynecologists recommend that women who exhibit symptoms of reproductive system diseases undergo ultrasound diagnostics. These include nagging abdominal pain, cycle failure, painful and prolonged menstruation, uterine bleeding, vaginal discharge, etc. Diseases that require monitoring by ultrasound:
- Infertility.
- Uterine fibroids.
- Endometriosis.
- Polyps.
- Ectopic pregnancy.
- Ovarian cysts and others.
If there is a predisposition to the development of gynecological diseases (frequent inflammation, thrush), then doctors advise patients to periodically undergo ultrasound diagnostics for preventive purposes. In addition, ultrasound is indicated for pregnant women as a screening observation. After a caesarean section, it is mandatory to diagnose a scar on the uterus.
What is examined during an ultrasound of the uterus
During the examination, all parameters of the uterus are assessed: tissue structure, organ size, wall thickness and the presence of abnormalities. The cervix is also examined. There are standard indicators with which the obtained ultrasound results are compared. Be sure to take into account the patient’s age, possible hormonal changes in the body, number of births, and so on. Normal sizes of the uterus of a non-pregnant woman:
- The width of the organ is about 60 mm.
- The length of the uterus is approximately 70 mm.
- Front-rear size – 42 mm.
During the scan, the doctor evaluates the thickness of the inner layer of the reproductive organ and the correspondence of endometrial indicators to the day of the cycle. Deviations indicate the presence of pathologies, but not always. The doctor can make a diagnosis only after a detailed examination of the results of ultrasound and tests. If there are neoplasms in the structure of the uterus, the doctor should check their nature. A polyp on ultrasound looks like an overly thickened endometrium. The presence of a node and an increase in the size of the organ may indicate the development of fibroids. If tumors are found in the structure, a biopsy should be performed to rule out the possibility of cancer. The symptoms of many gynecological diseases are similar, so a routine examination by a doctor is sometimes not enough. Ultrasound diagnostics allows you to make an accurate diagnosis and select therapy that is gentle on the body.
How to properly prepare for an ultrasound of the uterus
If the diagnosis of the uterus is carried out through the anterior abdominal wall (transabdominal), then an hour before the procedure you need to fill the bladder with liquid - drink 1 liter of still water. In addition, three days before the ultrasound, you need to go on a diet to cleanse the intestines and eliminate increased gas formation. Such a scan is carried out no later than the 10th day of the start of the menstrual cycle. There is no need to prepare in advance for a transvaginal examination. It is advisable to empty your bladder before the procedure. Ultrasound is not performed on menstruation days. A transrectal examination of the uterus can be performed on any day of the cycle. Before diagnosis, you need to prepare the intestines - do a classic enema.
How is an ultrasound of the uterus performed?
During a transabdominal ultrasound, the patient needs to expose her stomach and lie on her back. The doctor will apply an ultrasound gel to the surface to be examined and begin the examination with the sensor. During transrectal diagnosis, the woman should take a lateral decubitus position. The doctor will use a special thin sensor (inserted into the rectum). During a vaginal examination (a sensor is inserted into the vagina), you need to remove your underwear and lie on your back with your knees bent. For hygienic purposes, a sterile condom is placed on the sensor during transvaginal and transrectal diagnostics.
Ultrasound of the uterus and appendages shows the condition of these organs, their structure, anatomical features and sizes. At certain stages of pregnancy, using an ultrasound of the cervix, you can even find out what the corpus luteum looks like.
Ultrasound of the uterus is also performed during pregnancy and after childbirth, although in these cases there are certain restrictions. Preparing for an ultrasound of the uterus and appendages is quite difficult, given the number of possible methods for performing this diagnosis.
In this article we will talk about how to prepare for an ultrasound of the uterus, how to properly perform an ultrasound of the uterus and appendages, and what this procedure shows. We will also take a detailed look at the description of the pathologies that this study shows.
Ultrasound of the cervix and ovaries done in four different ways:
- (through the vagina);
- abdominally (or) - through the surface of the abdomen (ultrasound of the pelvis as a whole is also done);
- transrectally (through the rectum, only in virgins);
- using a sterile probe inserted directly into the pelvic cavity (such a study is performed very rarely, usually with fibroids).
In more detail, research using the transvaginal method is carried out using a thin sensor that is inserted into the patient’s vagina. Through the vagina, the ultrasound device has the shortest path to the organs being studied. That is why this transvaginal examination is used for fibroids and suspected cancer.
Transabdominal ultrasound examinations are performed through the lower surface of the abdomen. The sensor always remains outside, so transabdominal examination is indicated for suspicious patients.
However, for this reason, transabdominal ultrasound examination also has disadvantages. Due to the non-penetrating imaging method, the data obtained is much less informative than when using other methods of uterine ultrasound.
The transrectal method is chosen either for diagnosing the pelvis in virgins, or if the patient is menstruating during the procedure. The sensor is pre-isolated with a disposable condom, so there is no need to worry about the sterility of the device.
Internal examination with a sterile probe is carried out only when indicated. These include fibroids, cancer, inflammation of the uterus after childbirth, and ovarian cysts. In this study, the probe is inserted directly into the pelvic cavity.
Indications for the procedure
Ultrasound of the uterus is done for numerous symptoms and diseases.
The most notable ones can be noted indications requiring urgent diagnosis:
- Suspicion of inflammation in the vagina or pelvic area.
- Pain in the pelvic area.
- Pain during menstruation.
- Pain in the uterus after childbirth.
- Impaired uterine tone and ovarian tone. However, sometimes such a violation is noticeable even in cases where there are no pathologies. This is called an "ultrasound artifact."
- Lack of blood during menstruation without developing pregnancy.
- Heavy bleeding outside of menstruation or pathologically heavy discharge during menstruation.
- Pus or mucus that is not normally present and visible in the vagina.
- Pain during intercourse (especially if women experience this after childbirth).
- If you suspect ovarian cancer, cancer of the uterus or other pelvic organs.
- If you have fibroids and monitor their treatment.
- In terms of routine and preventive diagnostics after childbirth.
Also, a routine ultrasound of the cervix is done if you want to get pregnant. That is, simply put, an ultrasound of the cervix is done as part of the IVF program. Ultrasound of the cervix is also performed as a screening or urgent study during pregnancy.
Preparing for the examination
Preparing for a transabdominal ultrasound of the uterus is the easiest way. The first step is to stick to a diet, excluding legumes, carbonated drinks, bread and cabbage from the diet (but preferably all vegetables). You need to prepare in terms of dietary restrictions three days before the ultrasound of the uterus.
You should also fill your bladder immediately before the procedure. It is enough to drink about a liter of plain water an hour before the ultrasound of the uterus.
No other preparation is required. The procedure itself carried out on any day of the cycle, even during menstruation.
But you need to prepare differently for transvaginal surgery in general, and the uterus in particular. In this case, you need to empty your bladder immediately before the test.
It can be done on any day of the cycle, but not during menstruation. No drug preparation is required, but it is better to take Espumisan the day before the procedure in order to clear the intestines of gases.
There is no need to prepare for intrauterine diagnostics with a sterile sensor. However, it is better to empty your bladder immediately before the procedure. You can undergo this procedure on any day of the cycle except menstruation.
When preparing for a transrectal examination, you should cleanse your intestines the day before the procedure. For this purpose, both classic enemas and medicinal microenemas such as Microlax are used. The procedure can be performed on any day of the cycle, including during menstruation.
Carrying out diagnostics
When a transabdominal ultrasound examination is performed, the patient is asked to undress to the waist or simply expose the abdomen for diagnosis. The woman is then placed on her back. Conductive ultrasound gel is applied to the abdomen and the procedure begins.
In the case when a transvaginal diagnosis is performed, the patient is asked to remove her underwear and lie down on the couch. Next, the patient needs to bend her knees, after which an ultrasound sensor, pre-packaged in a disposable condom, is inserted into the vagina.
When performing a transrectal method of diagnosing the uterus, doctors use a thinner ultrasound sensor than for the transvaginal method. The patient is asked to remove her underwear and lie on the couch on her left side. A disposable condom is put on the sensor, lubricated with wire gel and the procedure begins.
Intrauterine diagnostics are carried out in exactly the same way as transvaginal diagnostics. However, in this case, the ultrasound sensor is inserted deeper, which, however, does not cause any pain.
Normal results
Ultrasound examination of the uterus. Normal results:
- sizes for women 15-40 years old: from 4.5 to 6.7 cm in length, from 4.6 to 6.4 cm in width and from 3 to 4 cm in thickness;
- dimensions 20 years after the onset of menopause: 4.2 cm length, 4.4 cm width and 3 cm thickness;
- echogenicity of the walls: homogeneous;
- cervical canal size: 2-3 mm;
- there is mucus in the cervical canal;
- tone: normal;
- the results of the M-ECHO study (size of the mucosa) are assessed based on the day of the cycle when the diagnosis was made.
Ultrasound examination of the ovaries. Normal results:
- the sizes of the right and left ovaries are normally equal;
- the exact dimensions of the ovaries are normal: length from 3 to 4.1 cm; width from 2 to 3.1 cm; thickness from 14 to 22 mm;
- ovarian volume: from 2 to 8 cm 3 for each;
- echostructure of the ovaries: homogeneous;
- organ density is not increased;
- tone: normal;
- on the average day of the cycle, a follicle should appear in one of the ovaries, the size of which is from 18 to 23 mm (dominant) and several small follicles up to 6 mm.
Ultrasound of the uterus and appendages (video)
Pathological results
A bicornuate uterus is a pathology that requires decoding. This pathology has many different types of manifestations, among which the two most dangerous should be highlighted:
- Incomplete duplication of the uterus.
- Complete doubling (usually happens after childbirth).
Incomplete duplication of the uterus on ultrasound looks like a single organ, but with a greatly increased width. The uterus is enlarged, the tone is low, there are signs indicating inflammation. Its child “copy” is usually filled with blood and inoperative (although there are exceptions).
With complete doubling, both the true and the daughter uterus are enlarged. There is inflammation, tone is reduced. Both organs are approximately the same in size. The uteruses themselves, which can be observed on an ultrasound monitor, diverge from each other at an angle.
Uterine cancer: transcript. Each uterine cancer can be detected on absolutely any day of the cycle. Cancer has a similar clinical picture as fibroids (which is also a neoplasm).
It is confirmed using an ultrasound machine with the following findings:
- the uterus is enlarged;
- increased density;
- there is moderate inflammation;
- decreased tone;
- hyperechoic formation;
- its contours are uneven;
- the neoplasm itself grows into nearby organs.
Uterine fibroids can be diagnosed on any day of the cycle. Typically, fibroids appear after childbirth (in 60% of cases) in women over 25. On an ultrasound monitor, fibroids look like this:
- the uterus itself is significantly enlarged, and its density is also increased;
- her tone is reduced (as after childbirth);
- the formation itself is hypoechoic (like cancer);
- the far contour is usually not detected;
- hyper- and hypoechoic stripes are present;
- cysts and calcifications are often present in myomatous nodes.
Ultrasound examination is popular due to its informativeness, reliability of results and painlessness. When choosing between other non-invasive procedures, ultrasound wins due to its minimal health risks. To date, any immediate and long-term consequences are unknown to medical science. This is a very important point when conducting research on a woman’s reproductive organs.
Ultrasound of the uterus and appendages has virtually no contraindications and can be performed at any period of a woman’s life, including during pregnancy. The procedure requires little preparation.
Indications
The indications for this procedure are numerous. But they can be divided into three main groups:
- Diagnosis of diseases.
- Diagnosis of pregnancy.
- Management of pregnancy and childbirth.
The first group includes ultrasound examination of the uterus and appendages, associated with the appearance of discomfort and pain in the pelvic area:
- Cycle failures.
- Bloody discharge during menstruation.
- Copious mucous or purulent discharge.
- Nagging pain in the lower abdomen.
- Pain, cutting, burning when urinating.
- Discomfort during intercourse.
The doctor prescribes an ultrasound if there is a suspicion of inflammatory processes affecting a woman’s reproductive organs or if there is a suspicion of the growth of tumors of varying degrees of malignancy. This test can help identify abnormal implantation of the embryo (ectopic pregnancy).
In case of infertility, ultrasound can help identify an organ abnormality that interferes with conception or a violation of the patency of the fallopian tubes. Ultrasound allows you to confirm or refute the doctor’s assumption in doubtful situations. The same study is used to monitor the results of surgical interventions or monitor the effectiveness of drug therapy.
An ultrasound examination of the uterus is prescribed by an obstetrician-gynecologist to confirm the fact of pregnancy, along with a blood test for hCG. If a woman’s previous birth resulted in a caesarean section, then the scar needs to be examined. Scar tissue is assessed for its consistency in the third trimester of gestation. This allows you to take timely action if the fabric begins to “diverge.”
Ultrasound diagnostics are allowed at any stage of pregnancy. The number of procedures is limited only by necessity.
During pregnancy, this study is carried out at least 3 times to confirm the normal development of the fetus and the optimal state of the uterus-placenta-fetus system. After pregnancy, an ultrasound is performed to assess the condition of the uterus and its contractility. The procedure allows you to assess the contents of the uterus (number of clots) and its condition (signs of inflammation, if any).
If the pregnancy is resolved promptly, an ultrasound examination allows you to assess the quality of healing of the postoperative scar and detect complications in time, for example, the formation of abscesses or fistulas.
Kinds
Types of examination of a woman’s reproductive organs are divided according to the method of conducting them:
- Transabdominal.
- Transvaginal.
- Transrectal.
- Intrauterine.
A transabdominal examination (TAU) is performed through the abdominal wall. It is less informative than other methods. Especially if the patient is obese. The voluminous abdominal wall impairs the visualization of the genital organs. An unprepared intestine filled with gases can also affect the effectiveness of the procedure.
The advantage of the procedure is the possibility of carrying it out:
- For virgins.
- Women at any stage of pregnancy.
- In case of obstruction of the cervical canal or its injuries.
- Severe pain during the transvaginal procedure.
Transvaginal ultrasound (TVU) is done using a special vaginal transducer (sensor). It is inserted into the vagina, and due to the proximity of the sensor to the organs being examined, the doctor can see the picture more clearly. This procedure is considered more reliable than the previous one, but is not performed on either virgins or pregnant women from the end of the first trimester.
Transrectal examination (TRS) is performed quite rarely to examine a woman’s reproductive organs. For these purposes, a special rectal sensor is used, which is inserted into the rectum. This option makes it possible to conduct a study in cases where TAU was not sufficiently informative, and TVU cannot be performed for some reason (virginity, pregnancy, stenosis or fusion of the walls of the cervical canal, etc.).
Intrauterine examination is prescribed in exceptional cases, for example, to verify a diagnosis suggesting the development of intrauterine tumors. In this case, the sensor is immersed directly into the uterine cavity. The procedure is very informative, because there are no obstacles between the organ being examined and the sensor. In addition, it allows you to assess the patency of the fallopian tubes.
Carrying out
Women who are prescribed this type of diagnosis are interested in how an ultrasound of the uterus is done. The procedure is quite simple for any type of study, it takes no more than half an hour, on average 20 minutes.
The most comfortable procedure is a transabdominal ultrasound. In this case, the woman lies on her back, exposing her stomach. The doctor lubricates the skin with a special gel for better contact of the area being examined with the sensor. And then moves the sensor across the study area. This is the whole procedure.
Ultrasound of the uterus and appendages performed using the transvaginal method is a less comfortable procedure. To perform it, a woman will have to expose her lower body. She will also lie on her back, but the specialist will insert a special vaginal sensor into the vagina. A condom is placed over the sensor. This provides the woman with confidence that foreign microflora will not enter her vagina.
For an ultrasound of the uterus and ovaries, which is performed through the rectum, the woman will have to lie on her side. It exposes the lower part of the body in the same way as for TVU. A condom is also placed on the sensor. It is lubricated with gel, which facilitates the sliding of the device and reduces discomfort. The sensor used for these purposes is smaller in size (narrower) than the device for TVU.
Ultrasound of the uterus and appendages, performed intrauterine, is somewhat different from other procedures, and somewhat more difficult to perform:
- The patient undresses, as if for a gynecological examination, and lies on her back.
- She must place her feet in special stirrups.
- The cervix is dilated using a speculum, then a catheter is inserted, the speculum is removed and the transducer is inserted into the uterine cavity. A catheter is needed so that saline solution can be injected into the uterus. This helps to straighten the folds of the endometrium and better examine the organ.
- To assess the patency of the fallopian tubes, saline solution is injected with air. It is easy for a doctor to determine their patency by the movement of bubbles through the pipes.
- The study will be done on average within half an hour.
Time spending
Unlike ultrasound examination of any other organs, the information content of ultrasound of the uterus and other reproductive organs directly depends on the day of the cycle, and on how correctly the woman named it. It is recommended to conduct research:
- With the development of acute pathology - on the day the first symptoms are felt (pain, appearance of purulent discharge, etc.).
- Routine diagnostics are carried out on days 3–10 of the menstrual cycle.
It is better to conduct the study at the very beginning of the cycle on days 3–5.
During this period, the mucous uterine layer (endometrium) has not yet had time to grow, and it is easier for the doctor to see the polyp or tumor. In this case, differential diagnosis of cystic formations is more successful.
Preparation
The scope of preparatory measures depends on the type of procedure. A minimum of preparation is required for diagnostics using the intrauterine method - it is enough to come to the examination with an empty bladder.
Preparation for an ultrasound of the uterus, which is performed through the abdominal wall, requires dietary restrictions. 24 hours before the test, it is recommended to exclude all gas-forming foods from your menu, from carbonated drinks to legumes and black bread. If a woman suffers from flatulence, carminatives (Semiticon, Espumisan) are recommended.
You need to go to the test with a full bladder. To do this you should:
- Drink 1 liter of clean water without gas and refrain from visiting the toilet.
- Or does not urinate for 3 hours before the procedure.
It is recommended to carry out the procedure on an empty stomach. Diet restrictions will also be necessary for other types of ultrasound diagnostics. They are needed to prevent gas bubbles from accumulating in the intestines. Air (gas) may interfere with imaging.
When conducting a TVU study, if a woman suffers from flatulence, she should also take carminatives. Before the examination, the bladder must be emptied.
When learning how to prepare for an ultrasound of the uterus during TRU, a woman needs to take into account that the sensor will be inserted into the rectum. That is, the intestinal ampoule should be as clean as possible. To do this, 8 hours before the procedure you need to take a microenema (Norgalax) or drink a laxative (Sanade).
Decoding
The description of the results and their interpretation is the prerogative of the doctor. Ultrasound examination allows you to evaluate the anatomical features of the reproductive organs. Interpretation of the results includes a description of the size of the genital organs, their condition, the presence of pathological structures or signs of inflammation.
The cervical canal should normally have a diameter of about 3 mm. And signs of mucus should be visualized in it. The size of the uterus depends on the age of the woman. After menopause, the organ becomes slightly smaller:
- Length 4.5–6.7 cm.
- Width 4.6–6.4 cm.
- Thickness 3–4 cm.
If the uterus is smaller than the specified dimensions, this indicates its underdevelopment (infancy); if the dimensions exceed the specified size, the woman is either pregnant or has fibroids growing in her uterus.
Ultrasound diagnostics makes it possible to determine the thickness of the endometrium. Indicators are variable and depend on the day of the cycle. In the first days, the thickness barely reaches a millimeter, in the middle of the cycle the endometrium should be about 8–15 mm, and by the end of the cycle the mucous membrane grows to 17 mm.
Interpretation of the ultrasound examination also involves a description of the ovaries. The volume of these organs ranges from 2 to 8 cm3. According to the echo structure, healthy ovaries should give a homogeneous signal. Their dimensions are also quite definite:
- Thickness 0.14–0.22 cm.
- Length – 3–4.1 cm.
- Width – 2–3.1 cm.
Changes in the size of the organ, the quality of the echo signal, and contours are all visual signs of various pathologies.
Thanks to ultrasound, it is possible to diagnose polycystic ovary syndrome and inflammatory processes in these organs (salpingitis). Cancerous changes in the tissues of the cervix, ectopic pregnancy and other pathologies are also visible.
The more than 50-year history of ultrasound diagnostics has gone through different stages of its development: a period of complete denial, distrust, and reluctance of specialists to use the method, which was replaced by total enthusiasm and its revaluation. This stage is characterized by an adequate assessment of the capabilities and reliability of the results of ultrasound examination (US).
Ultrasound has become especially popular among patients and doctors in gynecology and obstetrics. It allows you to diagnose inflammatory diseases and developmental anomalies with high reliability, identify pelvic tumors, including during screening examinations, etc.
Advantages of the method and reasons for its popularity
The method became possible thanks to such basic properties of ultrasound as focusing, the ability to propagate in biological tissues and various reflections from dense environments of the body, including from the boundaries between them. Ultrasound examination is based on the principle of echolocation, which is the perception of reflected waves.
A special sensor device is connected to the device that generates ultrasonic waves. As one of the main elements, it includes a converter of the received information. Using the sensor, directional radiation occurs, the reflected signals are perceived and converted. As a result, a certain “picture” is displayed on the device’s display screen.
When passing through dissimilar tissues and cavities, varying degrees of attenuation and absorption of the wave, its partial reflection and refraction occur. When encountering homogeneous structures that have the same temperature and tissue density in all areas, ultrasound will be uniformly partially absorbed and equally uniformly reflected, creating an image of an organ with its more or less clear boundaries. If there is tissue in this environment with different characteristics, for example, a myomatous node in the muscular layer of the uterus (myometrium), the different intensity of the reflected signals forms a corresponding pathological formation with its boundaries on the display screen.
The ultrasound method has taken a strong position among other types of radiation diagnostics. Its popularity is explained by:
- the reliability and information content of the results obtained, which in most diseases coincide with the results of pathological studies (85-100%);
- accessibility of the procedure, its relative simplicity and non-invasiveness;
- the ability to obtain information in real time;
- the ability to carry out diagnostic and some therapeutic manipulations under visual control;
- absence of negative effects on tissues and the body as a whole during short-term research;
- low cost compared to other radiation diagnostic methods.
Principles of Ultrasound
Ultrasound diagnostics comes down to determining indications and goals, choosing the type and mode of examination, and preparing the patient.
Indications for use
In gynecology, ultrasound examination is recommended:
- In case of menstrual irregularities and changes in their nature (heavy or, conversely, scanty, premature or delayed, etc.), which may be a sign of ovarian dysfunction, fibroids or other neoplasms, endometrial or cervical polyps, etc.
- If menstrual pain is a symptom of endometriosis or inflammatory processes, or if there is a suspicion of inflammatory diseases of the uterus, fallopian tubes, ovaries or pelvic cavity.
- When discharge and/or pain appears in the lower abdomen; they can occur with the development of tubal pregnancy, torsion of the fallopian tube, adhesions and inflammatory processes in the pelvis, tumors, and ovarian cysts.
- For the purpose of diagnosing congenital anomalies of the uterus and appendages, pregnancy and dynamic monitoring of fetal development.
- For a comprehensive diagnosis of the causes of infertility.
- When taking oral contraceptives or if there are doubts about the correct installation of the intrauterine device in order to timely identify complications.
- For urinary disorders, including urinary incontinence.
- Before and after diagnostic curettage, medical or instrumental termination of pregnancy.
- As a routine preventive examination for the purpose of early detection of benign and malignant tumors that are asymptomatic.
Types and modes
Various types of ultrasound in gynecology are performed using sensors of different shapes. Depending on the purposes and conditions of acoustic access, three types of studies are distinguished:
- Vaginal ultrasound (through the vagina), which uses a standard probe. Visualization of the pelvic organs with this method is the clearest. It is performed with an empty bladder by inserting a sensor into the vagina. Transvaginal examination is used in most cases.
- Transperitoneal or transabdominal ultrasound - the sensor is manipulated along the surface of the lower parts of the anterior abdominal wall with a full bladder. The technique is used mainly when there are formations of significant size in the pelvis.
- Transrectal ultrasound - through the rectum. This type of diagnosis in gynecology is used only when examining virgins.
The choice of method and, accordingly, the type of sensor depends on the functional, anatomical and topographical features of the area under study or the targeted study of a specific organ or pelvic area.
Vaginal ultrasound
Transabdominal ultrasound
To conduct an ultrasound of the pelvic organs, equipment with various modes is used, which have different capabilities and have the corresponding purpose:
2D mode, or two-dimensional
It is characterized by the formation of a planar image of a gray-white color with many shades, that is, the organs are depicted in one plane (tomogram). In practical work, the method is used most often and is basic for any ultrasound examination.
This mode allows you to determine the shape and size of the uterus and its cavity, the cervical canal, the condition of their internal membrane, position in relation to other pelvic organs, the structure, shape and size of the uterus and ovaries, the presence of myomatous nodes, the condition of the ovaries, the size of the follicles and the corpus luteum , the presence of tumors in the pelvis and their size, the presence of fluid, as well as some pathological changes in the bladder when it is sufficiently full.
3D, or three-dimensional, but static mode
It is a synthesized volumetric image in several planes (two or more). This mode provides conditions for layer-by-layer study of the pelvic organs at different depths, as well as through “slices” in different planes and different thicknesses - from several centimeters to less than 1 millimeter.
If you do a gynecological ultrasound in 3D, this will make it possible to determine the sex of the child, congenital anomalies of the uterus (one-horned, two-horned, saddle-shaped), more accurate shapes and sizes of a benign or malignant tumor, endometrioid ovarian cysts, the degree of spread of endometriosis, the size of cervical tumors. You can also diagnose the presence of polyps and determine their size, the presence of intrauterine septa and synechiae (adhesions), the position of the intrauterine device, the ingrowth of its elements into the mucous membrane of the walls or prolapse from the uterine cavity.
4D mode
This is a three-dimensional image, but in dynamics. It allows you to see the movements of the fetus and the dynamics of its development, detail the vascular network of the pelvic organs by blood flow for differential diagnosis of inflammatory processes with tumors, determine their volume, exact size and even the nature and condition of the tumor, insufficiency of blood flow during necrosis of the myomatous node. You can also see the state of blood supply and varicose veins of the cavity and pelvic organs, and diagnose vein thrombosis.
In most devices, 3D and 4D modes are combined with the CID mode, which allows you to obtain a color image. In some cases, it becomes necessary to combine examination modes and ultrasound sensors, for example, transabdominal and transvaginal.
Patient preparation and optimal diagnostic timing
The doctor recommends to each patient individually when it is best to do a gynecological ultrasound. In standard cases, it is recommended in the first phase of the menstrual cycle, that is, 5-7 days after the start of menstruation. Optimally, this is the 3-5th day after its end, but not later than 7-10 days of the cycle. To assess ovarian function (formation of the corpus luteum, development of follicles), ultrasound is performed on days 8-10, 14-16 and 22-24 of the menstrual cycle.
The first diagnosis of pregnancy is possible from 3-4 weeks. When using a transvaginal sensor, it is possible at earlier stages. In order to identify asymptomatic pathological processes, especially tumors, all women are recommended to undergo preventive ultrasound of the pelvic organs annually or once every 2 years, and after 40 years - annually.
The study is carried out on an empty stomach after defecation and urination. The last meal should be no later than 8-12 hours before the procedure. If there are certain indications, the study is carried out regardless of the timing of the menstrual cycle:
- severe pain;
- intense bleeding;
- suspicion of ectopic pregnancy - tubal, ovarian, cervical;
- removal of the intrauterine device;
- presence of a foreign body, etc.
Recommended preparation for ultrasound in gynecology is aimed at maximally freeing the intestines from feces and gases. This is necessary to ensure optimal conditions for the passage of ultrasonic waves and their visualization on the screen. Therefore, appropriate preparations should begin 3-4 days before the upcoming study.
During these days, it is recommended to exclude from the diet indigestible and fatty foods and foods that contribute to gas formation in the intestines. The latter include legumes, fresh vegetables and fruits rich in fiber, brown bread, whole milk, carbonated drinks, coffee, high-calorie confectionery products (cakes, pastries)
To improve the digestion of food, you can take enzyme preparations - Festal, Creon, Panzinorm, Enzistal, and for better removal of gases - Espumisan, Carbolen, infusions of fennel or chamomile flowers. If you are prone to constipation, it is recommended to take laxatives. You should not use cleansing enemas, as this contributes to the retention of gases and air trapped with water in the lower intestines.
To fill the bladder, if an examination is to be performed through the anterior abdominal wall, it is recommended to drink 1-1.5 liters of liquid 1 hour before the procedure (depending on age and the presence of heart, vascular or kidney diseases).
Results of ultrasound examination in gynecology
When performing an ultrasound of the pelvic organs, a holistic picture of the organs being studied is created based on the comparison and interpretation of such characteristics as the localization and mobility of the organ or its parts, shape and size, structure, external and internal contours, location and anatomical relationship with neighboring structures or organs, indicators of functionality, the degree of conductivity of sound waves and the degree of their reflection (echogenicity), the absence or, conversely, the presence of effects characteristic or not characteristic of acoustic systems.
The examination report only describes the above indicators, but does not make a final diagnosis. Often, the conclusions of radiology specialists on the results of an ultrasound examination of the same patient, which were carried out in different diagnostic institutions, are different. This is due to the equipment used, the adequacy of the patient’s preparation for the procedure, the tasks set by the treating gynecologist, and the qualifications of the specialist.
As a rule, a diagnostician, describing the resulting “picture” of the pelvic cavity and its organs, can in his conclusion only make an assumption about certain deviations from the norm, but does not make a final diagnosis. Diagnostics is the prerogative of a gynecologist who formulates a diagnosis based on a comprehensive examination of the patient, including a general clinical examination, laboratory data, histological examination results, and additional consultations with the necessary specialists.
However, modern ultrasound technology, which makes it possible to obtain three-dimensional images of the pelvic organs at any depth and in various planes, especially in real time, makes it possible to solve complex problems in diagnosing the majority of gynecological diseases, and in most cases is a decisive factor in making a diagnosis .
Many women are concerned about the question of when is the best time to do a pelvic ultrasound. Doctors usually recommend performing a pelvic ultrasound on days 5-7 from the start of menstruation, that is, in the initial phase of the menstrual cycle. If at this time minor bleeding still persists, you can carry out the procedure immediately after the end of bleeding.
Using this method, you can diagnose inflammation, the presence of tumors, etc. In some cases, the doctor may prescribe other dates for the ultrasound.
Ultrasound of the pelvic organs allows you to assess the condition of the organs of the woman’s reproductive system. Most often, an ultrasound is performed on days 5-7 of the cycle. Can the study be carried out on a different day of the cycle?
Ultrasound in preparation for the IVF protocol
An ultrasound can also be performed on days 2-4 of menstruation if a woman is preparing for an IVF protocol. Ultrasound determines the number of follicles in the ovaries.
Folliculometry
Folliculometry is ultrasound monitoring of ovarian activity. The method allows you to determine the day of ovulation by observing the maturation of the follicle.
The procedure is carried out several times a day on different days of the cycle. The first procedure is prescribed on days 4-6 of menstruation or immediately after bleeding has stopped, no later than 10 days from the start of menstruation, in the first phase of the menstrual cycle. During this phase, the endometrium is thin, due to which all the features and pathologies of the organs of the woman’s reproductive system are visible on ultrasound. A second ultrasound is performed on days 12-14, a third - 3-5 days before the expected start date of menstruation.
Ultrasound for suspected diseases of the pelvic organs
Ultrasound is the most informative procedure for identifying pathologies of the pelvic organs. Depending on the suspicion, the study may be scheduled on different days of the cycle.
Days of pelvic ultrasound:
- to confirm or exclude the diagnosis of endometriosis, an ultrasound is performed in the second phase of the cycle, on days 16-20;
- for benign tumors (fibroids), ultrasound can be prescribed immediately after menstruation and again on days 16-20 of the cycle;
- if cysts or other formations are suspected, immediately after menstruation.
To monitor the dynamics after surgery, as well as if inflammatory processes in the appendages are suspected, an ultrasound can be performed on any day of the cycle. The date of the ultrasound must be agreed with the doctor. The doctor will be able to calculate the day when to do a pelvic ultrasound, taking into account the length of the patient’s cycle and the indications for the study.
Video: Ultrasound
Attention! This article is posted for informational purposes only and under no circumstances constitutes scientific material or medical advice and should not serve as a substitute for an in-person consultation with a professional physician. For diagnostics, diagnosis and treatment, contact qualified doctors!
