transvaginal ultrasound(redirected from Gynecologic ultrasonography)
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Transvaginal ultrasound is a imaging technique used to create a picture of the genital tract in women. The hand-held device that produces the ultrasound waves is inserted directly into the vagina, close to the pelvic structures, thus often producing a clearer and less distorted image than obtained through transabdominal ultrasound technology, where the probe is located externally on the skin of the abdomen.
Transvaginal ultrasound can used to evaluate problems or abnormalities of the female genital tract. It may provide more accurate information than transabdominal ultrasound for women who are obese, for women who are being evaluated or treated for infertility, or for women who have difficulty keeping a full bladder. However, it does provide a view of a smaller area than the transabdominal ultrasound. Types of conditions or abnormalities that can be examined include:
- the endometrium of women with infertility problems or who are experiencing abnormal bleeding
- sources of unexplained pain
- congenital malformations of the ovaries and uterus
- ovarian cysts and tumors
- pelvic infections, such as pelvic inflammatory disease
- bladder abnormalities
- a misplaced IUD (intrauterine device)
- other causes of infertility
Transvaginal ultrasound can also be used during pregnancy. Its capability of producing more complete images means that it is especially useful for identifying ectopic pregnancy, fetal heartbeat, and abnormalities of the uterus, placenta, and associated pelvic structures.
Transvaginal ultrasound is performed by an ultrasound technologist, who is supervised by a radiologist or a specialist such as an obstetrician.
Studies have shown that ultrasound is not hazardous and has no harmful side effects.
A ultrasound, or sonogram, is a procedure that utilizes reflected sound waves to produce a picture of organs and structures within the body. A transducer sends out high-pitched sounds, sounds that are above the range of human hearing, that are reflected back to the transducer. A computer is used to analyze the sound waves, transforming them into a picture (which is called a sonogram, echogram, or ultrasound scan) on a video monitor. These pictures can be saved as a permanent record of the test.
A transvaginal ultrasound is used for looking at organs and structures within the pelvic area that are solid and uniform, like the uterus, and ovaries, or for organs that are fluid-filled, like the bladder. Mineralized structures, like bones, or air-filled organs, such as the intestines, do not show up well on a sonogram and may disrupt the ultrasound beam so that deeper organs and structures cannot be seen clearly.
The transvaginal transducer that produces the ultrasound waves is shaped to fit within a woman's vagina. It is lubricated and covered with a sheath such as a condom. A woman should tell the health care provider if she is allergic to latex so that a latex-free cover can be applied to the transducer before it is inserted into the vagina.
Sometimes a woman may have both transvaginal and transabdominal ultrasound scans done to obtain a complete evaluation of the pelvic area.
There is no special preparation required by a woman before a transvaginal ultrasound. She can continue to take medications prescribed by her health care provider, although she should not drink liquids for four hours before the test. A full bladder is not required for a transvaginal ultrasound, as is required for a transabdominal ultrasound. The test can be administered during any stage of the woman's menstrual cycle.
During the procedure, the woman lies on her back, with her hips slightly raised. The thin, lubricated tip of the transducer is inserted gently into the vagina. The transducer is moved and rotated to adjust the view of the pelvic structures displayed on the monitor. The woman must lie very still during the ultrasound scan. She may feel a mild discomfort from the pressure of the vaginal transducer. The procedure usually takes from 15 to 30 minutes.
Occasionally, hysterosonography is done on a nonpregnant woman to evaluate the inside of the uterus (endometrial cavity) and fallopian tubes by filling the uterus with fluid during a transvaginal ultrasound.
There is a slight risk of infection associated with a transvaginal ultrasound, especially if a biopsy was done in conjunction with the procedure. Therefore the patient should be aware of symptoms of an infection and seek care from a health care professional as necessary.
Since no ionizing radiation is associated with transvaginal ultrasound, there has been no documented adverse effects on patients or their fetuses with the use of the procedure.
In a normal transvaginal ultrasound, the pelvic structures or organs or the fetus are found to have no abnormalities.
Abnormal ultrasound results can be due to a variety of conditions and diseases. In non-pregnant women, these abnormal results may include:
- cancerous tumors or non-cancerous growths of the uterus, ovaries, vagina, or other pelvic structures
- ovarian torsion
- infections such as PID
- congenital malformations.
In pregnant women, the following abnormalities may be diagnosed through transvaginal ultrasound:
- ectopic pregnancies
- multiple pregnancies
- fetal death
- short cervix length, which may indicate the risk of preterm labor
- placental abnormalities such as placental previa and placental abruption
- tumors of pregnancy, including gestational trophoblastic disease.
A biopsy is needed to determine whether a tumor that is found during the transvaginal ultrasound scan is cancerous or non-cancerous.
Dodson, Melvin G. Transvaginal Ultrasound. Philadelphia: W.B Saunders and Company, 1995.
Smith, Norman C., and Smith, Pat M. Obstetric Ultrasound Make Easy. London: Churchill Livingstone, 2001.
Singh, K., and Malhotra, N. Step-by-Step Ultrasound in Gynecology. New York: McGraw Hill Companies, 2004.
Singh, K., and Malhotra, N. Step-by-Step Ultrasound in Infertility. New York: McGraw Hill Companies, 2004.
The American Institute of Ultrasound in Medicine, 14750 Sweitzer Lane, Suite 100, Laurel, MD 20707. Telephone: 301-498-4100. Web site: www.aium.org/
Ectopic pregnancy — Pregnancy that develops outside the uterus, usually in one of the fallopian tubes
Endometrium — The mucous membrane that makes up the inner layer of the uterine wall
Gestational trophoblastic disease — A rare, aggressive, malignant, often metastatic (spreading to other organs) cancer in women of childbearing age in which cancer cells grow in the tissues that are formed in the uterus after conception
Intrauterine device (IUD) — Contraceptive device consisting of a piece of bent plastic or metal that is inserted through the vagina into the uterus
Ovarian torsion — Twisting of the ovary due to the influence of another condition or disease, resulting in extreme lower abdominal pain
Pelvic inflammatory disease (PID) — Inflammation of the female genital tract, especially of the fallopian tubes, caused by any of several microorganisms, chiefly chlamydia and gonococci, and characterized by severe abdominal pain, high fever, vaginal discharge, and in some cases destruction of tissue that can result in sterility
Placenta previa — A low-lying placenta that covers part or all of the inner opening of the cervix. This can result in heavy bleeding during labor and delivery, which can be dangerous for mother and baby.
Placental abruption — Premature separation of the placenta from the uterus
Transabdominal ultrasound — A small handheld instrument called a transducer is passed back and forth over the pelvic area to provide images of the abdomen
ultrasonography of the female pelvis with the transducer placed inside the vagina.