This is a generalised overview to identify the cervix, uterus and ovaries.
- Check for the orientation the uterus (anteverted V’s retroverted)
- Assess the myometrium
- Assess the endometrial status and measure the thickness: <10mm pre menopausal; <4mm post menopause or ,<6mm if post menopausal on HRT
- Look for free fluid in the pouch of douglas
- Check the ovaries and adnexae
- Assess bladder
Scan sagittally in the midline immediately above the pubis. In this plane you should be able to assess the uterus, vagina and cervix. Zoom the image to assess and measure the endometrial thickness. Rotate into transverse and angle slightly cranially to be perpendicular to the uterus. Whilst in transverse and slightly right of midline, angle left laterally to identify the left ovary using the full bladder as an acoustic window. Examine this ovary in two planes. Now repeat this for the right ovary.
TRANS-VAGINAL (TV) APPROACH
INSERTING THE TV PROBE
- Before letting the patient empty their bladder, show them the TV probe and explain the procedure. Indicate the length that is inserted which is approximately the length of a standard tampon. Explain there is no speculum used. Explain the importance of a TV scan because it is the gold standard in gynaecological ultrasound because of its superior accuracy and improved diagnostic resolution.
- Cover the probe with a latex free Transvaginal sheath and lubricate with sterile gel on the outside.
- Elevate the patients bottom on a thick sponge/pillow to assist the scan. A gynaecological ultrasound couch which drops down is ideal so that a better angulation is achieved for an anteverted uterus.
- Ensure the patient is ready and get permission before inserting the probe.
- If there is some resistance as the probe is being inserted, offer for the patient to help guide the probe in far enough to see the end of the fundus.
- Keep asking the patient if they are okay.
- When manouvering the probe to visualise the adnexae, withdraw slightly then angle the probe towards the fornix. This avoids unnecessary patient discomfort against the cervix.