PRACTICAL BASICS OF OBGYN ULTRASOUND

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PRACTICAL BASICS OF OBGYN ULTRASOUND

• MAISURI T. CHALID
• Sub bagian Fetomaternal
• Bagian OBGIN FK-UNHAS

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GETTING STARTED

• OBTAINING THE BEST IMAGE
• OPERATOR
• MACHINES FAMILIARITY WITH YOUR EQUIPMENT
• PREPARATION OF THE PATIENT
• SCANNING TECHNIQUE
• CONCLUSION OF THE EXAMINATIONS
• REPORTING FINDINGS

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MAXIMAZING THE POTENTIAL OF YOUR MACHINE

• CHOICE OF TRANSDUCER
• THE FREQUENCY gt THE IMAGE RESOLUTION
• THE HIGHER gt BETTER TISSUE TEXTURE/ RESOLUTION,
  SMALLER DEPTH

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• FOCAL ZONE
• AREA OF INTERESTgt CENTRE, THE HIGHEST DENSITY
• DEPTH
• ZOOM CONTROLS
• WRITE READ ZOOM

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GAIN

• TOO LOW
• TOO HIGH
• HIGH SETTINGS

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TGC SETTINGS
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DYNAMIC RANGE

• INCREASING DECREASING
• TRACKBALL FREEZE

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PATIENT FACTOR

• OBESITAS
• TVS OR ABD
• FETUS WZ OLIGO, AN, POLYHYDRAMNIOS

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HOW TO ORIENTATE

• PATIENT SUPINE
• TRANSVERSE VIEW gt LEFT-RIGHT
• BLADDER ON THE RIGHT SIDE
• BEFORE STARTING TO SCANgt CHECK WICH SIDE THE
  TRANSDUCER PRODUCES THE IMAGE ON THE SCREEN

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FIRST TRIMESTER SCAN
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18-23 W SCAN
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GYNECOLOGICAL US

• SCANNING TECHNIQUE
• ORIENTATION
• FULL BLADDER (MARKER, ACCOUSTIC WINDOW)
• UTERUS
• TVS gt INTERNAL ILIAC VESSELS, OVARY IN
  ANTEROMEDIAL

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• SCANNING PLANES
• SAGITTAL (LONGITUDINAL, VERTICAL, ANTERO-POST)
• CORONAL ( HORIZONTAL, TRANSVERSE, CS,
  TRANS-PELVIC)
• LEFT-RIGHT ORIENTATION
• TRANSDUCER
• TRANS ABD gt 3.5-5 MHz
• TRANSV gt 5-8 MHz
• BIG MASS gt EMPTYING BLADDER

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REPORTING FINDINGS

• THE UTERUS CERVIX
• ANTEVERTED/RETRO
• ENDOMETRIAL THICKNES
• DECIDUAL REACTION
• UTERINE CAVITY ABNORMALITY
• CERVICAL ABNORMALITY

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• THE ADNEXAE (TUBES OVARIES)
• HYDROSALPINX
• OVARIAN CYST
• PCO
• POUCH OF DOUGLAS
• FREE FLUID
• SOLID MASSES
• OTHER PATHOLOGY

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NORMAL PELVIC ANATOMY

• THE UTERUS
• POSITION gt NEXT TO BLADDER (ANTEVERTED), LOOPS
  OF BOWEL FILLING THE SPACE BETWEEN BLADDER
  UTERUS.
• THE SIZE SHAPE (AGE, PARITY)
• PRE PUBERTAL 1.0-3.3 LENGTH, 0.5-1.0 WIDTH
• NULLI 7X4X4 CM, MULTI 1.2 CM
• POST-MENOPAUSAL 3.5-6.5 LONG, 1.2-1.8 W

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THE MYOMETRIUM

• TEXTURE OF NORMALgt
• HOMOGENOUS
• LOW-MEDIUM ECHOGENICITY
• SMALL 1-2 mm BLOOD VESSELS

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THE ENDOMETRIUM

• THICKNES TEXTURE AFTER MENARCHE gt CYCLICAL
  CHANGES
• EARLY MENSTRUAL PHASE gt ANECHOIC gt BLOOD
• VERY THIN 1-4 mm (AP width)
• PROLIFERATIVE 4-8 mm, isoechoic or slightly
  hyperechoic relative to the outer
• LATE PROLIFERATIVE (PERIOVULATORY)gt A
  MULTILAYERED ENDOMETRIUM

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• THE SECRETORY PHASEgt ECHOGENIC, 8-16 mm
• Outline endomet cavitygt regular, except polyp,
  submucous fibroid.
• Oligomenorhoea, amenorrhoea gt gt16 mm, prolonged
  unopposed estrogen effect
• Normal postmenopausalgt atropic, thin, lt 4mm

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THE OVARIES

• Not easily seen during trans-abd US
• Ovoid structures antero-medial to the internal
  iliac vessels gt TVS
• Size varies gt hormonal status
• Adolescencegt 4.2 cm3
• Premeno adultgt 9.8 cm3
• Postmeno gt 5.8 cm3

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• Small, rounded,
• anechoic spacesgt follicles or corpus luteum in
  reproductive age
• 60 postmenopausal ovaries can be identified.
• Simple functional cysts are solitary and measure
  4-7 cm in diameter.

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