Overview of Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
Younger girls and teenagers can have various issues with their reproductive system that may be due to birth defects, infections, growths, or connected to other health conditions. Medical imaging, like ultrasounds, can be used to help diagnose these problems. Some of the most common reasons girls might need an ultrasound of their reproductive organs include pain in the lower abdomen, a growth in the lower abdomen, unclear physical characteristics of their sex organs, not starting their period when expected, or starting puberty at an unusually young age.
Ultrasound scans are often the first and easiest type of imaging done. These scans create a picture of the inside of the body using sound waves. It’s important for radiologists, especially those who specialize in children’s health, to understand what healthy and various unhealthy conditions look like in these scans. This article will discuss the technique for performing an ultrasound, what normal results look like, and how to interpret results of different conditions, including in emergency situations, for girls’ reproductive organs.
Anatomy and Physiology of Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
The uterus, or womb, sits in the area of a woman’s body called the pelvic region, nestled right between the bladder and the rectum. You’ll also find the ovaries, which are two small organs, one on each side of the uterus. Both the uterus and ovaries can vary in size depending on a woman’s age. For example, in newborn babies, the uterus is typically larger due to hormones from the mother’s body. It then becomes smaller as the baby grows older and remains that way until around 7 or 8 years old.
In newborns, the uterus is usually about 3.5 cm long and 1.4 cm wide. At this age, the cervix part of the uterus is thicker than the top part, or fundus. Before puberty, the uterus continues to be a tube-like shape and can be between 2.5 to 4 cm in length with a thickness of less than 1 cm. During puberty, the uterus starts to take on a larger, more adult shape. The top part of the uterus gets bigger, and the uterus as a whole can vary between 5 to 8 cm in length and 1.5 cm in width. The thickness of the endometrium layer inside the uterus can also change depending on a woman’s menstrual cycle stage.
Similar to the uterus, the ovaries also change in shape and volume as a girl gets older. During infancy, the ovaries are about 1 cm in volume. By the time a girl is 2 years old, the volume of the ovaries will decrease slightly to around 0.67 cm. However, this volume will slightly increase again and remain less than 1 cm until the age of 6. Then, from around 6 to 10 years old, the volume slowly starts to increase until it’s about 1.2 to 2.3 cm at the prepubertal stage. As a girl enters the premenarchal stage, right before the first menstrual period, the ovary size increases further to measure between 2 to 4 cm. During the first growth spurt, which is also around the time of the first menstrual period, the ovary volume can go up to 8 cm. After the first menstrual period, the ovary volume can range between 2.5 to 20 cm long. These changes in the size of the ovaries are directly influenced by maternal hormones during infancy and follicle-stimulating hormone (FSH) during puberty.
Why do People Need Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
A pelvic ultrasound is a safe test that doctors use to take images of the inside of the lower part of the belly. It’s used in children for many reasons, including:
- Unclear physical characteristics: Doctors might recommend a pelvic ultrasound if they can’t confirm the sex of the child by looking at their physical characteristics.
- Checking for birth defects: If doctors suspect that a child may have been born with an issue or deformity in the pelvis, they might use an ultrasound to get a better view.
- Pelvic pain: If a child is suffering from pain in their lower belly, doctors might use an ultrasound to find the source of the problem.
- No menstruation: For girls who have not started having periods when they should have, an ultrasound can help find out why.
- Pelvic swelling or mass: If a child has unexplained swelling or a lump in their lower belly, an ultrasound can help identify what’s causing it.
- Bleeding before puberty: If a child who hasn’t started puberty yet is experiencing vaginal bleeding, doctors might use an ultrasound to investigate.
- Early puberty: If a child starts showing signs of puberty earlier than is usual, an ultrasound can help doctors figure out the reason.
- Irregular periods: If a girl’s menstrual periods are not regular, doctors might suggest a pelvic ultrasound to find out why.
- Pelvic inflammation in teenagers: If an adolescent has an infection in their pelvis, doctors might use an ultrasound to see how severe it is.
- Unexpected pregnancy in teens: If a teenage girl could be pregnant with the baby growing outside of the womb (a condition called an ectopic pregnancy), doctors might use an ultrasound to check for it.
When a Person Should Avoid Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
Sonography, which is a type of medical imaging test, is safe and can be performed on anyone with no specific reasons for not being able to have it.
Equipment used for Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
To conduct an ultrasound examination, a special machine and a handheld tool called a transducer are essential. An ultrasound gel facilitates the journey of ultrasound beams from the device onto the skin and back, as it helps reduce the gap between the skin and the transducer.
Different types of transducers can be used, depending on the patient. In adolescents, a curved or convex array transducer (it beams out ultrasound waves in a particular pattern) of 3 to 5 MHz is used for an abdominal ultrasound. For small children or infants, a linear or straight patterning 5 to 9 MHz abdominal transducer is ideal.
The linear transducer is particularly useful for an ultrasound of the area around the anus in infants or newborns. A higher frequency 12 MHz linear transducer is beneficial in distinguishing and assessing the bowel, fat, muscles, and lymph nodes near the pelvic organs.
Transvaginal sonography, which is a specific type of ultrasound that provides pictures of a woman’s reproductive organs, is not performed in children. In sexually active adolescents, it can be used along with abdominal ultrasound. A long transducer with a high frequency, similar to a wand, is inserted into the vagina for a closer examination of the pelvic anatomy, particularly the endometrium, or lining of the uterus.
Additional features of the ultrasound machine like the Color Doppler mode provide more data about the blood flow in the ovaries, uterus, and any visible abnormal area. Spectral Doppler is used to capture the blood flow patterns in a vascular abnormality, which can help detect certain diseases like ovarian torsion or twisting of the ovary.
Who is needed to perform Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation?
An ultrasound is a medical test that uses sound waves to create pictures of the inside of your body. This test is performed by a specially trained technician known as an ultrasound technologist. The technologist carefully captures different images, both still and moving, of the area being examined. These images are then analyzed by another specialist called a radiologist.
Radiologists are doctors who are experts at reading medical images like ultrasounds. They look at the images to understand what’s happening inside your body, which helps in diagnosing health conditions. Sometimes, the radiologist might perform the ultrasound themselves, especially when they need to get a clearer understanding of a specific situation.
Preparing for Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
When getting an ultrasound that scans the abdomen, it is recommended for patients to have a full bladder. This is because the water in the bladder pushes the gas-filled colon out of the way, which creates a clear pathway or ‘window’ for sound waves to pass through. This makes it easier to see the pelvic organs during the ultrasound. That’s why patients are often asked to drink water and avoid going to the bathroom before they have this type of ultrasound scan. In cases where children don’t have bladder control, a bladder catheter (a thin tube) can be used to fill the bladder up with water in a process called ‘retrograde filling’.
During the ultrasound, patients lie flat on their back on the bed with the pelvis area (the lower part of the belly) open to be scanned while the rest of the belly is covered with a drape. For a different type of ultrasound called a transvaginal ultrasound (TVS), patients are asked to empty their bladder before the scan. For this test, the patient is positioned in what’s known as a ‘lithotomy position’, which is a common position for medical procedures where you are lying on your back with your legs up and spread apart.
How is Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation performed
For newborns and small children, doctors typically use an imaging technique called a transabdominal ultrasound to view pelvic structures from the surface of the skin on the belly. If there’s something abnormal like a mass or a structural malformation, a different technique, a transperineal or translabial ultrasound, might be performed instead. This involves placing an imaging device directly on the vaginal opening. This creates images of the vagina, womb and ovaries.
If a transabdominal ultrasound is used, the patient will lie on their back. The doctor will place a device called a transducer on the patient’s lower belly. In older, sexually active teenagers, an internal ultrasound – known as transvaginal sonography or TVS – might be done. In this procedure, a high-frequency probe is inserted into the vagina. This provides very clear images and can help diagnose early pregnancy or identify masses near the ovaries.
In pre-pubescent children, the uterus can be seen behind the bladder – it’s tube-like shape remains until just a few years before puberty. The lining of the womb might appear bright on the ultrasound image and there might be some fluid in the womb cavity related to hormones inherited from the mother. Pre-pubescent ovaries show up as oval shapes with tiny cysts. The vaginal canal will be visible near the cervix and toward the front of the rectum.
In teenagers who have started having periods, the womb appears larger at the fundal part (top) than the cervix, giving it a pear-shaped appearance. The thickness of the womb lining will vary depending on the menstrual cycle. The ovaries also enlarge as the reproductive system becomes more active with maturity.
There are certain cases where abnormal findings might show up in an ultrasound:
For congenital (present at birth) abnormalities, issues might arise from either underdevelopment, misalignment or defects in absorption. The reproductive tract of females can sometimes be affected by these abnormalities, such as in Mayer-Rokitansky-Küster-Hauser syndrome where the vagina and/or womb might be underdeveloped or absent. Other abnormalities might obstruct the reproductive tract, such as a vaginal septum, imperforate hymen or cervical dysgenesis.
Non-congenital diseases can also be detected in ultrasound. For example, in pelvic inflammatory disease (PID), an infection of the female reproductive organs, the ultrasound can show inflammation and fluid in the pelvic region. Other conditions such as ectopic pregnancy and torsion, or twisting of the ovary, can also be identified with the aid of ultrasound.
Early detection of these reproductive system anomalies and diseases can help in managing these conditions to prevent further complications.
Possible Complications of Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
There aren’t any known problems or risks associated with having an ultrasound scan.
What Else Should I Know About Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation?
Ultrasound is a safe, simple, and readily accessible imaging technique. This type of scan can be done right at the patient’s bedside, making it convenient. The main advantages of ultrasound are that it doesn’t involve any radiation, it’s always available in most clinics or hospitals, and it’s easily portable.
This imaging method is particularly beneficial in the initial check-up of children and women’s specific conditions. In many situations, an ultrasound scan can provide a definite diagnosis, and it helps doctors determine if more in-depth examinations, such as an MRI or CT scan, are needed.
Pediatric radiologists, who are doctors that diagnose and treat diseases in children using medical imaging, need to be familiar with how normal female pelvic organs appear under ultrasound from infancy to adolescence. The understanding of different illnesses that can affect children’s pelvic region and their appearance on an ultrasound is significant in making an accurate diagnosis. For instance, it’s crucial to know what ovarian torsion, a painful condition involving the twisting of an ovary, looks like on an ultrasound to save the affected ovaries if possible.
In conclusion, ultrasound is a very reliable, primary method used to look into conditions concerning children and gynecological issues.
