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The Pelvic Scan: Early pregnancy problems Gynaecological abnormalities

The Pelvic Scan: Early pregnancy problems Gynaecological abnormalities. Normal pelvic anatomy. Anatomy of uterus and ovaries Arterial blood supply Venous blood supply Neural supply. Gynaecological scan indications. Pelvic pain Pelvic mass Irregular/ heavy vaginal bleeding

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The Pelvic Scan: Early pregnancy problems Gynaecological abnormalities

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  1. The Pelvic Scan:Early pregnancy problemsGynaecological abnormalities

  2. Normal pelvic anatomy • Anatomy of uterus and ovaries • Arterial blood supply • Venous blood supply • Neural supply

  3. Gynaecological scan indications • Pelvic pain • Pelvic mass • Irregular/ heavy vaginal bleeding • Post menopausal vaginal bleeding • Infertility • Endocrine symptoms/ signs • Recurrent miscarriage

  4. Routine • Sagittal image uterus and bladder • Length of endometrium and cervix • Measure length uterus +/- ET in AP • Check for fluid in POD • Transverse image bladder and cervix • Transverse image bladder and uterus at widest part • Image whole uterus as move cephalad • Measure ET in AP • Measure uterus width and AP • Transverse to top of uterus

  5. Routine • Transverse image broad ligament • Move to Right/Left • Check no tubal dilatation • Visualise ovary • Move caudally if unable to see • Split screen and measure ovarian volume • Cyst? • Measure volume • Septations, papillary lesions, solid areas, low level internal echoes • Check mobility with valsalva or hand on abdomen • Check for ascites • Torsion?

  6. TV Sagittal uterusEarly proliferative cycle

  7. TV Sagittal uterusLate proliferative cycle

  8. TV Sagittal uterusSecretory cycle

  9. Endometrial thickness

  10. TV Transverse uterus

  11. Normal Ovary

  12. Subserosal Fibroid

  13. Subserosal Fibroid

  14. Adenomyosis

  15. Corpus luteum

  16. Complex ovarian cyst

  17. Complex ovarian cyst

  18. Early pregnancy scan indications • Dating • Bleeding • Pain • Previous ectopic/ miscarriage/ molar pregnancy

  19. Complete miscarriage Bleeding and cramps which are usually settling

  20. Missed miscarriage Spotting only usually. Expected to be 6-12 weeks by LMP. Fetal pole seen

  21. Missed Miscarriage

  22. Other miscarriages • Anembryonic pregnancy • Spotting or nil • Gestational sac, MSD >2cm • No fetal pole • Incomplete miscarriage • Bleeding and cramps • RPOC • Doppler to diagnose • Threatened miscarriage • Bleeding +/- pain • Viable pregnancy

  23. Ectopic pregnancy • Pregnancy outside the uterine corpus • Ampulla • Cornu • Ovary • Abdominal • Life- threatening intra-abdominal bleeding • Symptoms and signs • Spotting, pain- usually one side, fainting, shouler-tip pain • URGENT referral on USS diagnosis • High index of suspicion if • previous ectopic • IUD • infertility

  24. Tubal Ectopic Pregnancy

  25. USS findings • Empty uterus • Adnexal mass • +/- FHR • Ring of blood flow on doppler • Tenderness on probe pressure over mass • Free fluid especially POD • TV scan ideally if available

  26. Ectopic with FHR

  27. Hydatidiform molar pregnancy • Abnormal placental development • Usually no recognisable fetus • ‘Snowstorm’ appearance on USS • Exaggerated symptoms of pregnancy • Hyperemesis • Thyroid hormone abnormality • Large theca-lutein cysts • Rx is ERPOC and CXR • Can recur and rarely in malignant form

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