OB/GYN lecture 1

• Endometrial stripe


  More echogenic than the uterine body
• Uterine body


  More echogenic than the urinary bladder
• Fluid filled structures


  Simple cyst, blood vessel or urinary bladder are described as being anechoic

  
• Bones, Fat, Air, Ligaments, Diaphragm


  Hyperechoic to surrounding structures
• Hypoechoic


  A comparative term used to describe a structure or organ where the echoes are not as bright as the surrounding structures
• Isoechoic


  A comparative term used to describe a structure or organ where the echoes are equal to those of the surrounding structures
• Homogeneous


  Uniform in texture and composition
• Heterogeneous


  Non-uniform in texture and composition
• Patient Positioning Review


  1. Different patient positions are used during an ultrasound examination depending on the area of interest being evaluated

  2. The best patient position(s) is determined by what will produce the optimal view

  3. It is standard practice to use different patient positions during a study to evaluate various structures
• Sagittal scanning


  • Ultrasound beam entering the body from either an anterior or posterior direction, visualizing anterior, posterior, superior, and inferior anatomic portions

  
• Transverse scanning


  • Ultrasound beam entering the body from anterior, posterior, or lateral direction, visualizing anterior, posterior, right lateral, and left lateral anatomic portions

  
• Coronal scanning


  • Ultrasound beam entering the body from right or left lateral direction, visualizing lateral, medial, superior, and inferior anatomic portions

  
• Indications for Pelvic Ultrasound

  • Pelvic Pain
  • Dysmenorrhea -painful menses
  • Amenorrhea -lack of menses
  • Menorrhagia -excessive menstrual bleeding
  • Metrorrhagia-irregular bleeding
  • Menometrorrhagia-excessive, irregular bleeding
  • Infertility
  • Postmenopausal Bleeding
• Contraindications for Pelvic Ultrasound

  • Transabdominal - can be uncomfortable due to full urinary bladder
  • Endovaginal - should be avoided in patients with an intact hymen or prior to having had intercourse
  • Transperineal/Translabial sonography can be performed when needed
  • Patients may decline study due to being uncomfortable with procedure
• Patient Preparation for Transabdominal Pelvic Ultrasound


  1. Patient must have a full bladder

  2. Patients are typically required to drink (or by Foley catheter) 32 ounces of water before the examination

  3. Urinary bladder must be distended adequately to visualize the entire uterus and adnexa

  
• Patient Preparation for Transvaginal Pelvic Ultrasound


  1. Patient bladder is empty

  2. Obtain a verbal consent

  3. If the examiner is a male, it is essential to have a female staff member as a chaperone
• Probe Preparation


  1. Gel is put on the transducer face and then covered with a sterile latex-free probe cover

  2. A sterile external lubricant is then applied to the outside of the probe cover

  3. At the end of the exam remove the probe cover, clean the probe with a detergent/water solution then dry the probe
• Disinfection


  1. Disinfect TV probe according to the instrument manufacturer instructions - Soaking in a solution of Glutaraldehyde for 20 minutes - Trophon machine for about 7 minutes

  2. NEVER AUTOCLAVE A TRANSDUCER IT WILL RUIN IT
• Gathering Patient History


  1. Look up and review prior imaging reports related to the exam you are about to perform INCLUDING: CT, MRI, Nuclear Medicine, Ultrasound

  2. Analyze and interpret relevant clinical history, such as blood tests and biopsy reports and relevant history
• Questions to ask patient

  • Why did your doctor send you for a pelvic ultrasound?
  • Do you have any pain?
  • When was your last menstrual period?
  • How many children do you have?
  • Are you sexually active? (Prior to performing T.V.)
• Gravida


  A woman who currently is pregnant or has been in the past, irrespective of the pregnancy outcome
• Gravidity


  The number of pregnancies, current and past, regardless of the pregnancy outcome
• Parity


  The number of pregnancies reaching 20 weeks and 0 days of gestation or beyond, regardless of the number of fetuses or outcomes
• Abortion


  Number of failed pregnancies (spontaneous or induced)
• Term


  Number of live births - that is a fetus that was/is viable or able to live outside the womb on their own
• Term classification


  • Early term (37-38 weeks of gestation)
  • Full term (39 - 40 weeks of gestation)
  • Late term (41 - 41 weeks of gestation)
  • Postterm (42 weeks of gestation and beyond)
• TPAL


  T stands for "term", P stands for "preterm", A refers to "abortions" -- spontaneous or induced, L refers to number of "live births"
• Normal Anatomy of the Female Pelvis

  • Pelvic Bones
  • Pelvic Muscles
  • Pelvic Blood Vessels
  • Pelvic Organs
• Pelvic Blood Vessels


  • Common iliac arteries bifurcate into the external and internal iliac arteries at the level of the superior margin of the sacrum
  • External iliac arteries continue inferiorly as the common femoral arteries, supplying blood to the lower extremities
  • Internal iliac arteries extend into the pelvic cavity, along the posterior wall and give off multiple branches that perfuse pelvic structures including: the urinary bladder, uterus, vagina, and rectum

  
• Uterine Arterial Supply


  • Blood supply to the uterus is via the paired uterine arteries (right & left)
  • The uterine arteries branch off of the internal iliac arteries
  • Uterine arteries continue to branch into smaller arteries as they travel through the layers of the uterus
• Supply to Uterus from Superficial to Deep

  • Uterine Arteries: supply the serosal layer of uterus (outer layer)
  • Arcuate Arteries: supply the myometrial layer of uterus (muscle layer)
  • Radial Arteries: supply deeper layer of myometrium
  • Straight Arteries – AKA Basal Arteries: Supply basal layer of endometrium
  • Spiral Arteries: supply functional layer of endometrium
• Venous Drainage


  • All venous vessels mirror their arterial counterparts draining blood from the uterus to the uterine vein to the internal iliac vein and finally the IVC
  • Except for the left ovarian vein which drains into the left renal vein
• Female Pelvic Organs


  • Urinary Bladder
  • Two Ureters
  • Uterus
  • Vaginal Canal
  • Cervix
  • Two Ovaries
  • Two Fallopian tubes

  
• Urinary Bladder


  • Located in the anterior portion of the pelvic cavity posterior to pubic symphysis
  • Empty: pyramid shape
  • Full: dome shape
  • Remains in true pelvis when empty, but rises upward to false pelvis as it fills

  
• Urinary Bladder Wall Layers

  • Mucosa
  • Submucosa
  • Muscular
  • Serosa

  
• Urinary Bladder Openings


  • Two openings where the ureters drain into the bladder
  • One opening where the urethra drains the bladder

  
• Ureters


  • Extend from the kidney hilum and drain into the posterior aspect of the urinary bladder
  • Run anterior to internal iliac artery and posterior to the ovary
  • Ureters are NOT normally seen sonographicaly unless obstructed
  • Ureteral jets may be visualized by color doppler as the empty urine into the bladder

  
• Urethra


  • Muscular tube that extends from the bladder to the genitals
  • Responsible for the expulsion of urine from the body