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  1. 1. Transvaginal US
  2. 2. TVS Gynaecologic US Earlt first trimester obstetric US Obstetric complications later in pregnancy E.g. Placenta previa Fetal spine in breech Evaluation of fetal intra..... in cephalic fetuses Evaluation of nuchal region before 14w
  3. 3. TVS Suspected ectopic pregnancy Follicle monitoring Monitoring of assisted reproductive technology (ART)
  4. 4. Generally : TAS with full bladder then empty the bladder Followed by TVS Not to be done in virginal pt, no consent to vaginal examination
  5. 5. Orientation of TV probe (manoeuvres) Rotation 0 to 90 degrees about its longitudinal axis from capital to coronal Angled or pointed in any direction for plane of section Advance or withdraw
  6. 6. As a marker note the position of the urinary bladder- angle of the bladder is consistent .... the variable positions of the uterus and ovaries
  7. 7. 1st manouvre Sagittal plane Sweep Then rotation in coronal plane from cervix to uterine fundus
  8. 8. Sagittal plane: Cervix, endocervical canal Post cul de sac Uterus and endometrium Right ovary and adnexa Left ovary and adnexa
  9. 9. Coronal plane: Vagina Cervix and post cul de sac Uterine corpus and endometrium Uterine fundus and endometrium R ovary and L ovary and adnexa
  10. 10. Applying pressure on ant abd wall for high ovary
  11. 11. The Uterus Before menarche- ratio of uterus to cervix is half Nulliparous women- corpus and cervix equal length Multip- corpus is double the size Size of uterus is variable in adults: 6-8.5cm in length in multips Width - 3 -5 cm in nulliparous, 4-6cm in multips AP diameter- 2-4cm in nulliparous, 3-6cm in multips
  12. 12. After menopause- atrophy >5 years menopause: 3.5-7cm length 2-4 cm width 1.7- 3.3cm AP Prepubertal uterus 2-4.4cm Position is highly variable and changes with varying degree of bladder and rectal distension
  13. 13. Muscular layers- 3 distinct layers The endometrium: thickness 4-8mm proliferative phase 6-10mm periovulatory 7-14mm secretory phase Post menopausal < 8mm If the endometrium > 5mm in PMB--> investigate
  14. 14. The Ovaries Ellipsoid Location is variable
  15. 15. Recruitment of follicles: TVS can pick up when follicle is 2mm Day 5-7 Day 8-12 one or more dominant follicles are seen
  16. 16. Rate of growth of dominant follicles: 2-3mm per day To reach max mean diameter of approx. 20mm (range 16-28mm) 24 hrs before ovulation: The granulosa layer separates from the theca layer resulting in a hypoechoic ring