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Transvaginal Ultrasound
Aka: Transvaginal Ultrasound, Endovaginal ultrasonography
- Indications
- Fetal Ultrasound or Ectopic Pregnancy evaluation
- Early first trimester (before day 42, HCG <6000)
- Postmenopausal uterine bleeding
- Pelvic mass
- Dysmenorrhea
- Infertility evaluation
- Technique
- Uterus
- Check Cervix with the probe pulled slightly back
- Measure Uterine Size in sagittal and coronal views
- Identify posterior masses and cul-de-sac fluid
- Ovaries
- Ovaries are adjacent to the femoral vessels
- Identify free fluid near Adnexa
- Completely scan ovaries in two planes
- Normal ovarian volume: 6-14 cubic cm
- Endometrium
- Follicular Phase: Endometrium begins to thicken
- Ovulation: Triple line seen
- Secretory phase: Endometrium echogenic and 8-12 mm
- Postmenopausal: Thickness <6-8 mm
- Efficacy
- Postmenopausal Bleeding: Endometrial stripe evaluation
- Endometrial Stripe >5 mm considered abnormal
- Consider Endometrial Biopsy
- Scandinavian Study (n=1168 all with uterine bleeding)
- 114 women with Endometrial Cancer by biopsy
- No cancer cases in endometrial thickness <4mm
- Reference
- Karlsson (1995) Am J Obstet Gynecol 172:1488-94 [PubMed]
- Japanese study (n=150, 47 with uterine bleeding)
- Six patients had Endometrial Cancer
- Three cancer patients had 2-4 cm thick endometrium
- Reference
- Tsuda (1995) Am J Obstet Gynecol 172:1494-5 [PubMed]