How to: Female Transvaginal Ultrasound Exam

if you do a trans abdominal examination the pelvis for early pregnancy and you cannot find a definitive gestational sac inside the uterus the next step you need to do is an inter cavity examination of the uterus and cervix and the initial area to determine where the pregnancy is whether it’s intrauterine or extruder and so what I’m going to do right now is walk through the steps on how you would do that examination and we’re going to use this phantom by blue phantom that will actually demonstrate an ectopic pregnancy so the first stage of the prep for the intricate Viteri transducer is that we need to cover it with a sheath when you do this we need to remove any air gaps that are inside the sheath next to the transducer face so what we will do is we’ll put a little bit of gel inside the the cover position that over the tip of the transducer and then just pull down the covering over the transducer and pull this down right over the handle so you’ve got good coverage and then just make sure that you examine the tip here and make sure you eliminate any air bubbles that are covering the transducer face so once you’ve got the air bubbles eliminated then you can move on to the next step we’re going to put a little bit of gel on the outside of the latex cover now and again your orientation for this examination is very important so for the long axis or sagittal view we want the orientation marker up and then when we go to the coronal view we’re going to turn that so it faces the patient’s right after we’ve inserted the transducer in a long axis view the first thing that we’re going to see is a long axis of the uterus in this Phantom representation of the uterus we see an endometrial stripe which is represented by the white line so if I was doing this as a real pelvic exam I would scan to the right of the patient all the way through to the right of next and then back over all the way back through the uterus over to the left of nexor and the reason I’m doing this is because I don’t see the pregnancy inside the uterus so I’m suspecting that it’s extra uterine or an ectopic pregnancy I do have some hints though here using this phantom in the posterior cul-de-sac region I’m seeing a black anechoic area which would represent free fluid or blood if I scan all the way over to the left at Nixa in this case the first structure that I come across this echogenic area represents the ovary if I keep scanning to the left in the pelvis I encounter this other area and this represents in this case our ectopic pregnancy when I’m medial just right beside the uterus I see the ovary and I scan out a little bit more and this represents the ectopic pregnancy and this is what you should see a round circular structure like this with a bright echogenic brim and it is possible to sometimes see a fetal heartbeat inside the ectopic pregnancy as well now I’m going to change the orientation of the transducer so I’m in a coronal view to do that I’m going to turn the transducer counterclockwise the uterus will appear circular because I’m cutting it cross-sectional view of it and I tilt the handle the transducer up to move inferiorly down to the region of the cervix and then bring the transducer handle down to scan superiorly into the area the fundus of the uterus again in this case I can see that there’s no pregnancy inside the uterus itself if I scan over to the left of the Fantom again we see the left ovary and then right beside it we see our representation of the ectopic pregnancy this bright circular area moving back towards the midline the anechoic area just posterior to the uterus is represented as free fluid or blood in this case so those are the views that you would need to do a thorough assessment of the pelvis for early pregnancy

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