Gynecological Ultrasonography

 

Introduction

Gynecological ultrasonography is a non-invasive imaging technique used to visualize the female pelvic organs, including the uterus, ovaries, fallopian tubes, cervix, and the surrounding structures. It plays a crucial role in diagnosing gynecologic conditions, monitoring treatments, and guiding interventions. It is widely used in both routine and emergency gynecological care.

Types of Gynecological Ultrasound

1. Transabdominal Ultrasound (TAS)

  • Performed over the lower abdomen.

  • Requires a full bladder to act as an acoustic window.

  • Ideal for a general overview of pelvic anatomy.

2. Transvaginal Ultrasound (TVS)

3. Saline Infusion Sonohysterography (SIS)

  • Saline is infused into the uterine cavity to enhance visualization.

  • Helps in detecting intrauterine abnormalities like polyps or submucosal fibroids.

4. 3D/4D Ultrasound

  • Provides three-dimensional views.

  • Useful in evaluating uterine anomalies, fibroids, and congenital malformations.

Indications for Gynecological Ultrasound

  • Pelvic pain

  • Abnormal uterine bleeding

  • Amenorrhea or oligomenorrhea

  • Infertility assessment

  • Suspected pelvic masses

  • Postmenopausal bleeding

  • Follow-up of known gynecological disorders

  • Evaluation of IUD placement

Normal Pelvic Anatomy in Ultrasound

Uterus

  • Position (anteverted/retroverted)

  • Size and shape

  • Endometrial thickness and pattern depending on menstrual cycle phase








Ovaries

  • Follicular development

  • Corpus luteum

  • Volume and echotexture

Endometrium

  • Thickness varies:

    • Early proliferative: 4–6 mm

    • Late proliferative: 6–10 mm

    • Secretory: 8–14 mm

    • Postmenopausal: <5 mm (without HRT)

Common Conditions Diagnosed

1. Uterine Fibroids (Leiomyomas)

  • Hypoechoic, well-defined masses

  • Can be submucosal, intramural, or subserosal

2. Endometrial Polyps

  • Focal echogenic thickening within endometrium

  • Better visualized with SIS

3. Adenomyosis

  • Diffuse enlargement of the uterus

  • Myometrial cysts, heterogeneous texture

4. Ovarian Cysts

  • Simple: Anechoic, thin-walled

  • Complex: Septations, internal echoes, solid components

5. Polycystic Ovarian Syndrome (PCOS)

  • Enlarged ovaries with multiple peripheral follicles ("string of pearls" appearance)

6. Endometriosis

  • Endometriomas: Ground-glass echogenicity

  • Difficult to detect peritoneal implants unless large

7. Ectopic Pregnancy

  • Empty uterus with adnexal mass and/or free fluid

  • TVS is the modality of choice

Ultrasound in Infertility Evaluation

  • Folliculometry: Monitoring ovulation

  • Uterine anomalies (e.g., septate uterus)

  • Endometrial thickness assessment for implantation window

  • Assessment of tubal patency via hysterosalpingo-contrast sonography (HyCoSy)

Role in Gynecologic Oncology

  • Characterization of adnexal masses

  • Features suggestive of malignancy:

    • Solid components

    • Papillary projections

    • Ascites

    • Irregular borders

Advantages of Gynecological Ultrasound

  • Safe and radiation-free

  • Widely available and cost-effective

  • Real-time and dynamic imaging

  • Useful in both outpatient and inpatient settings

Limitations

  • Operator-dependent

  • Limited by obesity or bowel gas

  • May require adjunct imaging (MRI/CT) in complex cases

Future Trends

  • Integration with artificial intelligence (AI) for pattern recognition

  • Contrast-enhanced ultrasound

  • Improved resolution with high-frequency probes

  • Use in robotic and image-guided interventions

Conclusion

Gynecological ultrasonography is an indispensable tool in women's health. It allows early detection, diagnosis, and management of a wide range of gynecological conditions. With continuous advancements in technology, its role is expanding beyond diagnostics to include therapeutic guidance and real-time interventions, making it a cornerstone of modern gynecology.

Comments

Post a Comment

Popular Posts