Overview of Sonography Transvaginal Assessment, Protocols, and Interpretation
Transvaginal ultrasound is a special kind of imaging test that can provide a detailed look at a woman’s reproductive organs. Unlike an ultrasound that is done from the outside of the belly, this one involves placing the ultrasound probe into the vagina to get a closer view. Unlike a CT scan, it doesn’t use any kind of harmful radiation.
This test can be used for many kinds of medical investigations. It can help see things like growths on the ovaries or womb, changes in the lining of the womb, fibroids (non-cancerous growths in the womb), pregnancies (including those which can be outside the womb, which can be dangerous), and developmental issues with the reproductive organs. An ultrasound technician will initially perform a scan from the outside of the belly, then follow up with a transvaginal ultrasound for a more thorough inspection.
The pictures captured in these tests are sent to a system known as a PACS system, which is a way to securely store, organize, and share medical images. A radiologist, a doctor who specializes in interpreting medical images, will then look at these pictures to help make a diagnosis or plan a treatment (as shown in the ‘Transvaginal Ultrasound’ image).
Anatomy and Physiology of Sonography Transvaginal Assessment, Protocols, and Interpretation
To take a detailed ultrasound look into a woman’s pelvis, the person performing the ultrasound needs to have a good understanding of anatomy. With an ultrasound probe, they mark out specific areas on the image, such as up (cephalad) on sagittal imaging and the right side on transverse imaging.
Starting from outside, the opening to the vagina (introitus) leads to the vaginal canal which ends at the cervix. The cervix has two parts: one that sticks out into the vagina (ectocervix), and another that joins the cervix to the uterus (supravaginal portion).
The endocervical canal serves as a connection between the vagina and the womb or uterus. Surrounding the cervix are the fornices, which are small spaces near the top of the vagina. Using a specific type of probe used for vaginal ultrasounds, scans can be taken from the front, back, or sides of the cervix by positioning the probe within the fornix. The fornix at the back is the lower boundary of the Pouch of Douglas, while the fornix at the front borders another pouch called the vesicouterine pouch from below.
The external os of the cervix leads to the endocervical canal and ends at the internal cervical os, marking the entrance to the uterus. The fallopian tubes are found on either side of the uterus and divide into three sections. The part closest to the uterus is the isthmus, followed by the ampullary segment and then the infundibulum. On the ends of the infundibulum, there are finger-shaped outgrowths known as fimbriae that move to guide an egg released during ovulation into the fallopian tubes. The spot where the uterus and fallopian tube connect is called the cornu.
The ovaries are held in place on the sides of the pelvis by the infundibulopelvic ligament. This ligament contains the blood vessels that supply the ovaries. The utero-ovarian ligament, which carries a blood supply from the uterine artery, stretches from the uterus to the ovaries.
Why do People Need Sonography Transvaginal Assessment, Protocols, and Interpretation
An ultrasound scan of the female pelvis can be recommended for numerous reasons, including:
* Checking on a pregnancy
* Observing the baby in the womb
* Detecting pregnancies that are outside the womb, known as ectopic pregnancies
* Investigating potential miscarriages
* Assessing infertility
* Finding out the reason for difficulty in getting pregnant
* Checking if treatments to aid pregnancy are effective
* Unusual bleeding from the uterus
* Absence of periods, termed amenorrhea
* Painful periods, known as dysmenorrhea
* Heavy periods, referred to as menorrhagia
* Irregular bleeding between periods, called metrorrhagia
* Urinary incontinence, or lack of bladder control
* Detecting a mass or lump in the pelvic area
* Checking for possible infection
* Assessing any unusual structural features of the pelvic organs
* Assisting in guiding other procedures conducted on these organs.
The ultrasound can also aid in evaluating other, non-gynecological organs and structures in the pelvic area:
* Bladder:
* Diagnosing tumors or growths
* Detecting bladder stones
* Identifying abnormal connections between organs, known as fistulas
* Diagnosing inflammation in the bladder, termed cystitis
* Urethra, or the tube that carries urine from the bladder out of the body
* The lower end of the intestine, or the small bowel and rectosigmoid colon
* The blood vessels in the pelvis
* Scarring or adhesions in the pelvic region.
When a Person Should Avoid Sonography Transvaginal Assessment, Protocols, and Interpretation
Certain situations can make it unsafe or unsuitable for a woman to have a transvaginal ultrasound, which is a type of scan used to examine the female reproductive organs. Such situations include:
1. If a pregnant woman has a rupture of membranes, which means that the water around the baby in the womb has broken. This can increase the risk of an infection in the uterus known as chorioamnionitis.
2. If a woman has an imperforated hymen. This means the thin tissue that guards the entrance to the vagina isn’t properly opened, which would make an ultrasound impossible.
3. If there’s an obstruction in the vagina that prevents the ultrasound tool from being inserted.
4. If a woman has had recent vaginal surgery, as this might make the ultrasound unsafe or uncomfortable.
5. If a woman does not, or is not able to, give her consent for the procedure.
In addition to these, pregnant women should be aware of two specific conditions that prevent the use of a transvaginal ultrasound: rupture of membranes, which was mentioned earlier, and bleeding from a condition called placenta previa. This happens when the placenta, which feeds the baby, is unusually low in the womb and near or covering the cervix. This condition can cause serious bleeding during pregnancy and delivery, making a transvaginal ultrasound unsafe.
Equipment used for Sonography Transvaginal Assessment, Protocols, and Interpretation
The equipment used during a transvaginal ultrasound, a type of internal ultrasound where a special device is inserted into the vagina to take pictures of the pelvic organs, includes the following:
* An ultrasound machine with a special wand-like device called a transvaginal ultrasound probe.
* Ultrasound gel, a type of lubricant that helps improve the quality of the ultrasound images.
* A protective cover for the probe.
* A special table where the patient lays down with her feet raised and placed in supports called stirrups, or the patient may lie on a flat table with a rolled towel or pillow under her pelvis. This helps the ultrasound technician to move the probe more easily.
Who is needed to perform Sonography Transvaginal Assessment, Protocols, and Interpretation?
An ultrasound technician, a medical professional trained to use special machines, will carry out two types of ultrasounds – one on your stomach area and another internally, through the vagina. The pictures from these tests are then sent to a special system, and an expert called a radiologist will look at them to try to figure out what’s happening in your body. How good the pictures are, and how much they can tell the radiologist, depends a lot on the skill of the ultrasound technician. They need to be able to spot problems and take pictures that help the radiologist understand what’s going on. To make you feel more comfortable and to avoid any misunderstandings, you might be offered someone else to be there with you during the tests.
Preparing for Sonography Transvaginal Assessment, Protocols, and Interpretation
Before beginning, the patient is asked to remove their clothes from the waist down and put on a hospital gown. Laying flat on their back, the first step involves performing a transabdominal ultrasound, which is a type of scan. Having a full bladder is helpful for this process because it moves any nearby loops of intestine out of the way. This ensures the scan pictures aren’t blurred or distorted and it helps to better visualize the organs behind it.
Once the first scan has been done, the patient is asked to empty their bladder. Then, a transvaginal ultrasound is prepared. This involves cleaning a special ultrasound device and coating it with a lubricating gel so it can be inserted comfortably. It’s essential to ensure that no bubbles are present in the gel, as these could cause issues with the quality of the scan pictures.
How is Sonography Transvaginal Assessment, Protocols, and Interpretation performed
During the procedure, a medical instrument called a transvaginal transducer is inserted carefully. This tool helps in getting detailed images of specific parts of the body. The orientation of these images is particularly important – in some cases, it indicates the top from the bottom, and in some, the right from the left side of the body. However, different clinics could use different methods.
The transducer is placed in the vagina, close to the entrance of the cervix. The depth of the transducer can be adjusted to focus on different areas. The instrument is swung from one side to the other to capture the image from one adnexa to the other. If it is turned 90 degrees, we can get a different view. There is a general examination done by moving the probe from the middle to the sides, and then rotating it 90 degrees and moving it from front to back.
Images of the cervix, internal os, endocervical canal, and sometimes the external os are taken in both sagittal (long-axis) and transverse (short-axis) view. The cervix is normally 2.5 to 3 cm long, and it might be measured in case of issues like recurrent miscarriages. Small, benign cysts could also be present, which will be anechoic, or echo-free.
The uterus is also scrutinized for its size, orientation, contour irregularities, and myometrial pattern. Its length is measured from the fundus (top) to the external cervical os (bottom). Any abnormalities in the uterus might indicate conditions like adenomyosis or fibroids. If fibroids are present, information about their location and dimensions should be noted down.
The endometrium, also known as the endometrial stripe, is marked by its echo-rich nature and is indeed very important. If there are any contents like fluid or an intrauterine device, they should be documented. The thickness of the endometrium could vary as per the menstrual cycle in a premenopausal woman, but in postmenopausal women, it’s usually around 5 mm.
Other important aspects checked during the ultrasound are early pregnancies, location of masses or cysts, and the mobility of the organs. Abnormalities in these areas may indicate various conditions, like ectopic pregnancy and ovarian torsion. Once the ultrasound is over, the probe is cleaned and sterilized for future use.
Possible Complications of Sonography Transvaginal Assessment, Protocols, and Interpretation
Usually, this procedure does not have any serious problems. You might feel a bit uncomfortable, but you shouldn’t feel any pain.
What Else Should I Know About Sonography Transvaginal Assessment, Protocols, and Interpretation?
An ultrasound, which is an affordable, convenient, and quick tool, is often used for diagnosing urgent health issues. One such condition is ovarian torsion, a condition where the ovary becomes twisted around the tissue that supports it. The twist can cut off the blood flow to the ovary.
In an ultrasound, typically, the blood flow might seem to be absent due to thinner veins compared to arteries. The healthy ovary is compared with the affected one to check for differences in blood flow due to the twist.
The ultrasound scan can show signs such as the ovary appearing enlarged and swollen, and there might be fluid around the pelvic region. Another indicator often seen is the ‘whirlpool sign’; this is a cross-section image that shows the twist in the tissue supporting the ovary.
These findings often point to ovarian torsion. However, note that because there are two blood arteries supplying the ovary, sometimes, a patient might not show any symptoms even if there is a lack of blood flow to the ovary.
Moreover, the ovary might temporarily untwist and then twist again, meaning that the ultrasound might not always capture these signs. Therefore, though ultrasounds can often correctly diagnose ovarian torsion about 84% of the time, this method can sometimes fall short because just ultrasound alone might be insufficient for a diagnosis.
In other words, while an ultrasound can offer good clues, the final diagnosis often depends on the direct observation of the ovary, possibly through a surgical procedure.
