Transvaginal Ultrasonography

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Chapter 251 Transvaginal Ultrasonography

DESCRIPTION

Transvaginal ultrasonography is a technique of ultrasonographic visualization of the uterus and adnexa using an ultrasonography probe placed in the vaginal canal.

INDICATIONS

Any situation in which imaging of the pelvic organs is appropriate and greater resolution than that which is possible with transabdominal approaches is desirable. (The resolution of transvaginal ultrasonography derives from the proximity of the ultrasound transducer and the higher frequencies of sound waves used by these devices. In some cases, this resolution may be as small as 0.2 mm.) Typical gynecologic indications include uterine size, shape, and orientation; evaluation of endometrium, myometrium, and cervix; identification and morphology of ovaries, assessment of the uterus and adnexa for masses, cysts, hydrosalpinges, and fluid collections; and evaluation of the cul-de-sac for free fluid or masses. Common obstetric indications include the assessment of cervical length, placental location, or the evaluation of fetal parts low in the pelvis.

CONTRAINDICATIONS

Known or suspected allergy to latex.

REQUIRED EQUIPMENT

• Sheath for the ultrasonographic probe (condom, glove, or similar)

• Ultrasonographic coupling media (gel)

• Appropriate ultrasonographic equipment and probe

TECHNIQUE

The patient should be placed in the dorsal lithotomy position with an empty bladder. The vaginal probe should be lubricated with ultrasonographic coupling media (gel) and the probe should be inserted into an appropriate covering sheath such as a condom. (This sheath may be further lubricated with a water-soluble lubricant to facilitate its insertion into the vagina. It may also be more comfortable for the patient if she inserts the probe herself.) The sheath-covered probe is gently advanced up the vaginal canal until it rests against the cervix. Alternatively, the probe may be brought to rest in the anterior, posterior, or one of the lateral vaginal fornices, depending on the anatomic area of greatest interest.

The pelvic structures should be surveyed in a systematic manner by rocking the probe up and down, left and right so that all structures are fully seen. Rotating the probe 90 degrees right or left will change the plane of observation, further facilitating a full evaluation. Some ultrasonographic equipment is capable of forming three-dimensional renderings of the anatomy seen, but this has yet to be shown to be superior to other modalities.

COMPLICATIONS

A small amount of discomfort (pelvic or vaginal fullness) may be experienced during the procedure, but this is considered normal.

FOLLOW-UP

Based on indications.

CPT CODE(S)

76830 Ultrasound, transvaginal

76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal

American College of Obstetricians and Gynecologists. The role of the generalist obstetrician–gynecologist in the early detection of ovarian cancer. ACOG Committee Opinion 280. Obstet Gynecol. 2002;100:1413.

American College of Obstetricians and Gynecologists. Ultrasonography in pregnancy. ACOG Practice Bulletin 58. Obstet Gynecol. 2004;104:1449.

Clark TJ. Outpatient hysteroscopy and ultrasonography in the management of endometrial disease. Curr Opin Obstet Gynecol. 2004;16:305.

Katz VL. Diagnostic procedures. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:215.

Timor-Tritsch IE, Monteagudo A. Scanning techniques in obstetrics and gynecology. Clin Obstet Gynecol. 1996;39:167.

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