II. Indications

  1. Fetal Ultrasound or Ectopic Pregnancy evaluation
    1. Early first trimester (before day 42, HCG <6000)
  2. Postmenopausal uterine bleeding
  3. Pelvic mass
  4. Dysmenorrhea
  5. Infertility evaluation

III. Technique

  1. Uterus
    1. Check Cervix with the probe pulled slightly back
    2. Measure Uterine Size in sagittal and coronal views
    3. Identify posterior masses and cul-de-sac fluid
  2. Ovaries
    1. Ovaries are adjacent to the femoral vessels
    2. Identify free fluid near Adnexa
    3. Completely scan ovaries in two planes
    4. Normal ovarian volume: 6-14 cubic cm
  3. Endometrium
    1. Follicular Phase: Endometrium begins to thicken
    2. Ovulation: Triple line seen
    3. Secretory phase: Endometrium echogenic and 8-12 mm
    4. Postmenopausal: Thickness <6-8 mm

IV. Efficacy

  1. Postmenopausal Bleeding: Endometrial stripe evaluation
    1. Endometrial Stripe >5 mm considered abnormal
      1. Consider Endometrial Biopsy
    2. Scandinavian Study (n=1168 all with uterine bleeding)
      1. 114 women with Endometrial Cancer by biopsy
      2. No cancer cases in endometrial thickness <4mm
      3. Reference
        1. Karlsson (1995) Am J Obstet Gynecol 172:1488-94 [PubMed]
    3. Japanese study (n=150, 47 with uterine bleeding)
      1. Six patients had Endometrial Cancer
      2. Three cancer patients had 2-4 cm thick endometrium
      3. Reference
        1. Tsuda (1995) Am J Obstet Gynecol 172:1494-5 [PubMed]

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