Learn about the scan used to study the organs that are part of the female pelvis to facilitate accurate diagnosis.

Summary

  • The pelvic ultrasound test is a non-invasive diagnostic exam that produces images that are used to assess organs and structures within the female pelvis.
  • The scan is done either transabdominally or transvaginally.
  • The transvaginal ultrasound often makes a clearer picture than transabdominal ultrasound because the transducer probe gets closer to the organs being viewed.

A pelvic ultrasound is a diagnostic exam that produces images that are used to assess organs and structures within the female pelvis. A pelvic ultrasound allows quick visualization of the female pelvic organs and structures including the uterus, cervix, vagina, fallopian tubes and ovaries.

Pelvic ultrasound may be performed using one or both of 2 methods:

  • Transabdominal (through the abdomen). A transducer is placed on the abdomen
  • Transvaginal (through the vagina). A long, thin transducer is covered with aplastic/latex sheath is inserted into the vagina

The type of ultrasound procedure performed depends on the reason for the ultrasound. Occasionally both methods may be needed to provide the information needed for diagnosis or treatment.

Overview

A pelvic ultrasound uses sound waves to make a picture of the organs and structures in the lower abdomen(pelvis).

Organs and structures that are solid and uniform (such as the uterus or ovaries) or that are fluid-filled (such as the bladder) show up clearly on a pelvic ultrasound. Bones may block other organs from being seen. Air-filled organs, such as the intestines, can make the image less clear.

What are female pelvic organs?

The organs and structures of the female pelvis are:

  • Endometrium. The lining of the uterus
  • Uterus (also known as the womb). The uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. It sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
  • Ovaries. Two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones,estrogen and progesterone, are produced.
  • Cervix. The lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body.
  • Vagina (also known as the birth canal). The passageway through which fluid passes out of the body during menstrual periods. The vagina connects the cervix and the vulva (the external genitalia).
  • Vulva. The external portion of the female genital organs

Why is the testconducted?

Pelvic ultrasound may be used for evaluation of female pelvic organs. Ultrasound assessment of the pelvis may include examination of, but not limited to, the following:

  • Size, shape, and position of the uterus and ovaries
  • Abnormalities in the anatomic structure of the uterus, including endometrial conditions
  • Thickness, echogenicity (darkness or lightness of the image related to the density of the tissue), and presence of fluids or masses in the endometrium, myometrium (uterine muscle tissue), fallopian tubes, or in or near the bladder
  • Length and thickness of the cervix
  • Changes in bladder shape
  • Blood flow through pelvic organs
  • Fibroid tumors (benign growths), masses, cysts, and other types of tumors within the pelvis
  • Presence and position of an intrauterine contraceptive device (IUD)
  • Pelvic inflammatory disease (PID) and other types of inflammation or infection
  • Postmenopausal bleeding
  • Monitoring of ovarian follicle size for infertility evaluation
  • Aspiration of follicle fluid and eggs from ovaries for in vitro fertilization
  • Ectopic pregnancy (pregnancy occurring outside of the uterus, usually in the fallopian tube)
  • Monitoring fetal development during pregnancy
  • Assessing certain fetal conditions
  • Confirm a pregnancy and whether it is in the uterus. Pelvic ultrasound may be used early in pregnancy to check the age of the pregnancy or to find a tubal pregnancy (ectopic pregnancy) or multiple pregnancy.

Transabdominal ultrasound

In case of a transabdominal ultrasound, the doctor will ask the patientto drink 4 to 6 glasses of juice or water about an hour before the test to fill herbladder. A full bladder pushes the intestines (which contain air) out of the way of the pelvic organs. This makes the ultrasound picture clearer.Gel will be put on the patient’s abdomen to improve the quality of the sound waves. A small, handheld instrument called a transducer is gently moved over theabdomen. A picture of the organs and blood vessels can be seen on a screen.

Transvaginal ultrasound

A thin, lubricated transducer probe will be gently inserted into the vagina. Only the tip of the transducer is insertedin the vagina. The patient willneed to lie very still while the ultrasound scan is being done.

Transvaginal ultrasound may give more information than transabdominal ultrasound for women who:

  • Are very overweight.
  • Are being checked or treated for infertility.
  • Have a hard time with a full bladder.
  • Have a lot of gas in the intestines. This makes it harder for thedoctor to see all the organs in the pelvis.

Transvaginal ultrasound often makes a clearer picture than transabdominal ultrasound because the transducer probe gets closer to the organs being viewed. It is often used in early pregnancy. But transvaginal ultrasound looks at a smaller area than transabdominal ultrasound. It is used only for patients who are married.

In rare cases, sterile saline is put in the uterus through a thin tube (catheter), to allow the doctor to look at the inside of the uterus (hysterosonogram).

If both a transabdominal and transvaginal ultrasound will be done, the transabdominal ultrasound will usually be done first.

A pelvic ultrasound uses sound waves to make a picture of the organs and structures in the lower abdomen(pelvis).

Results

Normal The ovaries, cervix, and uterus have a normal shape and size and are in the normal place. No growths, tumors, fluid, or other problems, such as cysts, are present. Small cysts (follicles) in the ovaries of women who are able to have children are normal.
If the patientis using an intrauterine device (IUD), it is in the uterus.
If the patient is in the first trimester of pregnancy, the baby (fetus) is developing inside the uterus.
Thebladder is normal in size and shape. If the bladder is checked before and after urination, it empties completely.
Abnormal Theuterus is big or abnormally shaped because of uterine fibroids. Cysts or tumors are present, such as cancerous or noncancerous tumors of the ovaries, uterus, or cervix.
The thickness of the lining of the uterus (endometrium), called the endometrial stripe, is greater than normal. In some age groups, a thicker endometrial stripe (also called endometrial hyperplasia) may mean a higher chance of endometrial cancer.
Pelvic inflammatory disease (PID), abscesses,  or other problems are present.
An ectopic pregnancy is present.
An abnormal amount of fluid is present in the pelvis.
The bladder has an abnormal shape or a thick wall. If the bladder is checked before and after urination, it may not empty completely during urination.

What impacts the test quality / results

Reasons the patientmay not be able to have the test or why the results may not be helpful include:

  • Stool (faeces), air or other gas, or X-ray contrast material (such as barium) in the intestines or rectum.
  • Inability to remain still during the test.
  • Obesity.
  • Having an open wound on the abdomen.

Key Takeaways

  • With pelvic ultrasound, thedoctor can tell the difference between a fluid-filled cyst, a solid tumor, or another type of mass. This is one of the main advantages of an ultrasound. An abnormal massneeds more testing. A follow-up ultrasound is often done in 6 to 8 weeks because many problems get resolvedon their own within that time. Pelvic ultrasound cannot determine whether a massis cancerous (malignant) or noncancerous (benign). A biopsy may have to be done for this.
  • Transvaginal ultrasound is used during fertility checks to help guide the removal of ovarian follicles for in vitro fertilization.

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