A PRESENTATION ON UTRASOUND IN GYNAECOLOGY

UTRASOUND IN GYNAECOLOGY 

1. UTRASOUND IN GYNAECOLOGY 

2. Introduction Ultrasound is a medical imaging technique that uses high- frequency sound waves to produce images of internal body structures . Ultrasound uses the pulse-echo principle of sound above 20 kHz, i.e. a frequency above the human audible range ( frequencies of 1–15 MHz are used ) Each pulse of sound transmitted into the patient generates echoes through reflection and scatter, at different depths within the tissue , therefore producing a reliable image. Using modern equipment ensures that reliable images are produced, together with the appropriate technique (transabdominal versus transvaginal).

3. Patient preparation for Ultrasound Knowing the patient's presenting complaint and medical history is essential. As well as obtaining consent to perform an ultrasound P reparatory steps include checking the patient’s identity and asking her to empty her bladder before performing a TV ultrasound. If performing a TA ultrasound, the bladder should be full. It is a good practice in Gynaecological US scanning, to begin with transabdominal US mapping followed by TV scanning as abdominal US provides an overall wide view of the abdomen. In patients that not yet sexually active, only TA ultrasound is advised/indicated.

4. Components of an Ultrasound machine

5. Parts of an Gynaecology  Ultrasound and Their Functions 1.Transducer (Probe) Emits sound waves and detects echoes to create images. Types: transabdominal and transvaginal. 2.Monitor/Display Screen Displays real-time images of the fetus and other structures. 3.Control Panel Adjusts settings like depth, gain, and focus to optimize image quality. 4.Central Processing Unit (CPU) Processes signals from the transducer to create images. 5.Transducer Connector Connects the transducer to the main unit. 6.Printer Prints ultrasound images for records or personal keepsakes. 7.Data Storage Stores images and data from the examination. 8.Battery or Power Supply Provides power to the ultrasound machine.

6. Uses of ultrasound scan in gynecology To assess pelvic organs  To diagnose acute appendicitis  To diagnose and manage gynrcologic problems including endometriosis, leiomyoma, adenomyosis, ovarian cysts and lesions To identify adnexal masses, including ectopic pregnancy To diagnose gynecologic cancer, such as ovarian cancer In fertility treatments to track the response of ovarian follicles to fertility medication. However, it often underestimtes the true ovarian volume.  Egg recovery for IVF IUCD and implantation recovery

7. . Evaluation of primary amenorrhea  Investigation of mennorhagia   Pelvic pain evaluation  Evaluation of congenital uterine anomalies

8. Types of ultrasound Transabdominal sonography  Transvaginal sonography Transrectal sonography Endoscopic ultrasound  Sonohysterography   contrast sonography

9. TRANSABOMINAL ULTRASOUND Obtained while the patient was lying supine and utilising the curvilinear probe. The indicator-equipped probe is positioned above the patient's pubis symphysis in the midline. The pelvic organs can be seen in wide view during a transabdominal examination.  Bladder should be full [ Full bladder will push bowel away from the field- hence good for better results. Preparing patient for procedure:   Gain consent [verbal]   Privacy   be gentle * Brief Gynecological history  * Examination findings - abdominal and vaginal

10. TRANSVAGINAL ULTRASOUND An ultrasound transducer is inserted into the vagina during vaginal ultrasonography, a type of medical ultrasonography, to view the organs inside the pelvic cavity.   It has a range of about 8-10 cm.  procedure :  Ask patient to empty bladder Gain consent [verbal]  Privacy   be gentle  Brief Gynecological history  Wear a pair of Gloves

11. Trans-vaginal probe movements: Penetrating - introducing into vagina  Rocking - antero-posterior movement   Sliding - lateral movement  Roatating - to 45 to 90 degrees  Contraindications:  . Virgins  .  Elderly Postmenopausal women   . Post radiation stenosis  . Children  .  Psycho-sexual disorder

12. SONOHYSTEROGRAM Another type of ultrasound examination is called a sonohysterogram . Another name for it is SIS, or saline infusion sonography. With a small plastic tube inserted through the cervix, fluid is introduced into the uterus. Next, pictures of the uterine lining are produced using sound waves. When using the fluid instead of ultrasonography alone, more detail can be seen.

13. TRASRECTAL ULTRASONOGRAPHY  When a transvaginal ultrasound is necessary but not feasible, transrectal ultrasonography is an examination that has been shown to be safe and helpful. As a complement to and improvement over the pelvic ultrasound exam, this procedure is something to think about.

14. PATHOLOGIES FOUND ON AN ULTRASOUND IN GYNECOLOGY   Uterus fibroids Adenomyosis Retained product of conception Ovaries Ovarian cyst Endometriosis Teratomas Vagina  Epidermal cyst Vaginal carcinoma Cervix  Polyp Cervical fibroids

15. Benefits of Ultrasound in Gynaecology Quick, cheap and widely available Safe P ortable and does not involve ionizing radiation Non-invasive Provides detailed information about the foetus and anatomy of the woman Can be used to diagnose conditions such as fibroids, Ovarian cysts, Endometrial CA Can be used as a Screening , diagnosing, and treatment progression monitor

16. Benefits of Ultrasound in Obstetrics Establishing gestational age and estimate due date Identifying the location of pregnancy Confirming fetal viability Identifying fetal abnormalities (including CVS/amniocentesis) Screening for pre-eclampsia Evaluating placental location Uterine fibroids and adnexal masses which may interfere with labour

17. Limitations of Ultrasound in Obstetrics & Gynaecology Cannot detect fetal anomalies especially in early pregnancy or more subtle defects Difficult to perform in obese patients Bowel gas may interfere with accuracy of results Endometrial lining may be too thick Not suitable in all patients

18. References Abinader, R., & Warsof, S. L. (2019). Benefits and Pitfalls of Ultrasound in Obstetrics and Gynecology. Obstetrics and gynecology clinics of North America, 46(2), 367–378. https://doi.org/10.1016/j.ogc.2019.01.011 Al Wattar, B. H., Frank, M., Fage, E., & Gupta, P. (2014). Use of ultrasound in emergency gynaecology. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 34(2), 172–173. https://doi.org/10.3109/01443615.2013.839641 Campbell S. (2013). A short history of sonography in obstetrics and gynaecology.  Facts, views & vision in ObGyn ,  5 (3), 213–229. Jain, V., O'Quinn, C., & Van den Hof, M. (2021). Guideline No. 421: Point of Care Ultrasound in Obstetrics and Gynaecology. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 43(9), 1094–1099.e1. https://doi.org/10.1016/j.jogc.2021.07.003 Ji, X., Duan, H., Wang, S., & Chang, Y. (2023). Low-intensity pulsed ultrasound in obstetrics and gynecology: advances in clinical application and research progress. Frontiers in endocrinology, 14, 1233187. https://doi.org/10.3389/fendo.2023.123318 Kurjak, A., Medjedovic, E., & Stanojević, M. (2022). Use and misuse of ultrasound in obstetrics with reference to developing countries. Journal of perinatal medicine, 51(2), 240–252. https://doi.org/10.1515/jpm-2022-0438

19. References continued Merz, E., Evans, D. H., Dong, Y., Jenssen, C., & Dietrich, C. F. (2023). History of ultrasound in obstetrics and gynaecology from 1971 to 2021 on occasion of the 50 years anniversary of EFSUMB. Medical ultrasonography, 25(2), 175–188. https://doi.org/10.11152/mu-3845 Be cker, F., Weber, E., Strizek, B., Gembruch, U., Westerway, S. C., & Dietrich, C. F. (2021). Point-of-care ultrasound in obstetrics and gynecology. Archives of gynecology and obstetrics, 303(4), 871–876. https://doi.org/10.1007/s00404-021-05972-5