Pelvic organs in females (uterus, ovaries, Fallopian tubes) may be examined with USI in two ways:
- transabdominally (via the abdominal wall);
- transvaginally applying Doppler sonography. This method of examination uses a special vaginal probe covered with disposable sheath. Therefore, this procedure is painless and safe, moreover, it gives the most accurate information on the state of ovaries and the uterine cavity.
Pelvic USI must be conducted in case of the following signs and symptoms:
- heavy or light menstrual discharge;
- strong pain during menstruation;
- any anomalies of menstrual cycle;
- discharge during the climacteric period;
- strong pain in the pelvis;
- presence of intrauterine device;
- suspected pregnancy.
Pelvic USI diagnoses congenital abnormalities of the female internal organs. Quite often, such abnormalities are the reason of infertility, miscarriage and pre-term delivery, malposition, labor disorders and embryofetal death.
Numerous female diseases give no signs at early stages, therefore, pelvic USI is recommended to be conducted at least once a year.
This investigation determines uterus position, structure of its body, cervix and cavity, basic dimensions and structure of walls. Special attention is paid to the midline uterine structures (М – echo). Internal structure is determined depending on the menstrual cycle phase, dimensions, sharpness and availability of deformities.
Use of echography allows to detect uterine abnormalities (arcuate, bicornuate or unicornuate uterus, dimetria and so on).
Uterine fibroid is a benign tumor in females. USI allows for timely detection of appearance, dimensions and localization of myomatous nodules, and for monitoring of their growth tendencies.
Endometriosis is a process of endometrium expansion beyond the uterine cavity. Ultrasound investigation allows to diagnose adenomyosis (internal endometriosis), when endometrium expands into the uterine walls, and endometrioid cysts in ovaries, as well as various kinds of hyperplasia, polyps and malignant tumors of endometrium.
USI of ovaries determines their sizes and position; special focus is given to follicular ovaries apparatus, follicles and corpora lutea. If any mass is detected in the ovary, its precise size and internal structure are defined. Owing to such precise examination, it is possible to determine the most effective therapy. USI also may detect free liquid and masses in pelvis.
Assessment of reproductive function. Folliculometry.
Ultrasound investigation helps to monitor follicle maturation and endometrium growth during the first phase of menstrual cycle. It is also possible to define quite accurately the ovulation term and whether it occurred or not. Folliculometry is performed several times over a cycle, and the terms for this procedure are determined by a sonographer depending on the investigation findings.
Echography allows to diagnose pregnancy starting from the gestation week 2.5; on the week 3-4 an embryo may be seen and its heartbeats may be heard. The possibility of such early pregnancy detection plays a crucial role for diagnostics of extrauterine pregnancy and allows to avoid complications preserving the female’s health.
Pelvic USI is highly important if any intrauterine devices (IUD) are used, as it helps to monitor the process of installation and removal of the contraceptive, to detect its incorrect position timely, drop-out of IUD from the uterine cavity (partial or full), in-growth of the contraceptive parts into the uterine wall.
Preparation to pelvic USI
For transabdominal investigation, 1.5-2 l of liquid should be drunk 2 hours before the procedure. This will ensure proper filling of bladder, which serves as a good acoustic window (transmits ultrasound waves properly) and improves the visualization quality.
Transvaginal investigation requires no special preparation.