This is the lecture on transabdominal ultrasound technique for students seeking help on gynaecological ultrasound approaches. In this lecture the approaches of ultrasound and types of ultrasound are explained.

1. GYNAECOLOGICAL
ULTRASOUND
Lecture 1: Transabdominal Scanning Technique (part 1)
IQRA SAEED
Lecturer MIT

2. CONTENTS
• What is an Ultrasound?
• Types of Ultrasound
• Approaches for ultrasound
• Transabdominal approach
Indications
Contraindications
Equipment
Preparation
Technique

3. WHAT IS AN ULTRASOUND?
• Ultrasound scans, also known as sonograms, use the reflection of high-
frequency sound waves to create ultrasound images in 2D, 3D and 4D.
According to The American College of Obstetricians and Gynecologists,
“The (ultrasound) sound waves come into contact with tissues, body
fluids, and bones. The waves then bounce back, like echoes. The
transducer receives these echoes, which are turned into images. The
images can be viewed as pictures on a video screen.”

4. TYPES OF ULTRASOUND
1- 2D Ultrasound
 Traditional ultrasound method that has been used for years.
 A series of flat, two-dimensional cross section images of the scanned tissue.
 Black and white picture on a screen.

5. 2- 3D Ultrasound
In recent years, 2d ultrasound images have also been projected into three-dimensional
representations.
Achieved by scanning tissue cross sections at many different angles and reconstructing the data
received into a three-dimensional image.
A common use for 3d ultrasound pictures is to provide a more complete and realistic image of a
developing fetus.
Because 3D ultrasounds allow us to view more subtle features they are helpful in the
diagnosis of cleft lip, cleft palate, and heart conditions, and give parents the unique
opportunity to see their baby’s face for the very first time.

6. 3- 4D Ultrasound
 By updating 3d ultrasound images in rapid succession, 4d images can be created.
 In the 4d ultrasound, the fourth dimension, time, adds movement and creates the most
realistic representation of all.
 In some cases, 3d and 4d ultrasound pictures may reveal abnormalities not readily seen
using 2d ultrasound.

8. 4- Doppler Ultrasound
 For the evaluation of blood flow as it flows through blood vessels
 Doppler ultrasound analysis bounces high-frequency sound waves off blood cells in motion
and records changes in frequency of the sound waves as they echo back to the transducer
probe.
 It then converts this data into a visual representation of how fast and in what direction
blood is flowing.
 4D ultrasound is different than a 3D ultrasound because it adds the dimension of time,
providing a live video of the baby in action: kicking, stretching, yawning, sucking their
thumb, opening and closing their eyes. 4D ultrasound brings the static image from a 3D
ultrasound to life.

10. ULTRASOUND APPROACHES
• Two approaches
1. Transabdominal
2. Transvaginal

11. • TRANSABDOMINAL APPROACH
 A procedure used to examine the organs in the abdomen. An ultrasound transducer (probe)
is pressed firmly against the skin of the abdomen. High-energy sound waves from the
transducer bounce off tissues and create echoes. The echoes are sent to a computer, which
makes a picture called a sonogram
TAUS sends a beam of ultrasound waves through the anterior abdominal wall, over the area
of the urinary bladder and female reproductive organs. When the bladder is distended, it acts
as an acoustic window that allows ultrasound energy to pass through it with minimal
attenuation.
The transabdominal approach can evaluate the overall pelvis, the distended bladder, and the
uterus and ovaries.

12. INDICATIONS FOR TAUS:
Transabdominal ultrasound can be applied to visualize the liver, gallbladder, kidneys, pancreas,
small and large intestine, appendix, bladder, uterus, adnexa, spleen, stomach, aorta, and IVC.
In the setting of obstetrics and gynecology (OBGYN), the transabdominal approach is usually
performed to evaluate for possible pelvic pathology or pregnancy in a less invasive manner.
 In the emergency department (ED) a transabdominal ultrasound is most commonly utilized to
evaluate for intrauterine pregnancy, cholelithiasis, intraabdominal free fluid, abdominal aortic
aneurysm, and hydronephrosis.

13.  Abdominal Pain

14. • Right Upper Quadrant: Evaluation for free fluid, cholelithiasis, choledocholithiasis, hepatic abscess
mass, hydronephrosis
• Right Lower Quadrant: Evaluation for appendicitis, intussusception, psoas abscess
• Left Upper Quadrant: Evaluation for free fluid, splenic pathology (laceration or fracture), stomach,
hydronephrosis
• Left Lower Quadrant: Evaluation for diverticulitis, small bowel obstruction
• Epigastric: Evaluation for pancreatic mass, abdominal aortic aneurysm
• Pelvic: Evaluation for free fluid, urinary retention, pregnancy, ectopic pregnancy, pelvic mass

15.  Vaginal Bleeding:
Evaluation for pregnancy, ectopic pregnancy, uterine pathology, abortion (fetal parts).
 Hypotension:
Evaluation for infectious sources listed above, vascular assessment of inferior vena cava
as a surrogate marker for volume status or volume loss from hemorrhage, abdominal aortic aneurysm.
 Hematuria
Evaluation for genitourinary mass, nephrolithiasis, hydronephrosis.

16. CONTRAINDICATIONS
There are no absolute contraindications to performing a transabdominal
ultrasound. One should take care not to scan over a wound or incision to avoid contamination
and infection. Color and pulsed Doppler should not be applied to a fetus because of the
theoretical radiation risk to the fetus

17. EQUIPMENT
Transabdominal ultrasound should be performed with a low-frequency probe, ideally
with a large convex footprint. Most common probes utilized are the curvilinear or phased array
probes.

18. PREPARATION
• Ensure that the probe and machine are cleaned before entering a patient room.
• The correct probes should be connected to the machine.
• The patient is ideally lying in a supine position on a stretcher with his or her abdomen
exposed.

19. TECHNIQUE
• A low-frequency convex probe is best for a transabdominal ultrasound. Alternatively, a
phased array probe can be used if a convex probe is not available.
• The settings on the ultrasound machine should be set to the desired exam being performed,
for example, abdominal, FAST, vascular.
• Generally, the probe indicator is always aimed cephalad (toward the patient’s head) or to the
patient’s right side.

20. • Specific scanning technique is utilized depending on the organ
or pathology being evaluated. For example, when evaluating the
gallbladder, the probe is placed in a sagittal plane (with the
indicator cephalad) in the right upper quadrant just inferior to
the costal margin. The operator then slides the probe medial and
lateral along the costal margin while maintaining the sagittal
plane (cephalad) evaluating for the optimal sonographic window
for image acquisition. Asking the patient to take a deep breath
and hold it causes the diaphragm to contract, displacing the liver
and gallbladder inferior, and aiding in image acquisition.