Pelvic

- [Narrator] A curved or phased array transducer
with an obstetric exam type is used
to perform a trans-abdominal examination
to evaluate an ectopic pregnancy.
It is helpful for the patients to have a full bladder
to complete this examination.
The transducer is placed in a longitudinal orientation
in the midline at the level of the symphysis pubis.
The orientation marker is directed
towards the patient's head.
The transducer is placed above the pubic symphysis
and angled into the pelvis to visualize the bladder
which appears as an anechoic triangular structure.
The uterus is echogenic or gray in appearance
and can be seen directly posterior to the bladder.
The endometrial stripe will appear
as a bright echogenic line
from the uterine fundus to the cervix.
Posterior to the uterus is the rectouterine pouch
which should be evaluated for free fluid.
The transducer should be swept from side to side
to see the entire uterus.
The transducer is then placed in a transverse orientation
in the midline at the level of the symphysis pubis.
The orientation marker is directed
towards the patient's right.
The transducer is placed above the pubic symphysis
and angled into the pelvis to visualize the bladder.
The uterus can be seen as an echogenic circular structure
directly posterior to the bladder.
The endometrium will appear
as a hyperechoic horizontal line.
The transducer should be swept superiorly to inferiorly
to see the entire uterus.
In a patient with a suspected ectopic pregnancy,
the presence of an intrauterine pregnancy
makes the diagnosis unlikely.
The earliest sign of pregnancy seen by ultrasound
is the gestational sac.
However, a decidual cyst or pseudogestational sac,
which can be seen in an ectopic pregnancy
may be confused for a gestational sac.
Therefore definitive sonographic evidence
of an intrauterine pregnancy should only be established
when a gestational sac containing a yolk sac
is identified in to planes within the endometrium.
A gestational sac can be seen within the uterine cavity
by about six weeks gestational age
using trans-abdominal ultrasound.
The gestational sac appears
as an anechoic fluid filled circular structure
surrounded by two hypoechoic rings
within the mid-portion of the uterus.
The yolk sac can be seen by six and a half weeks
and appears as a small bright hyperechoic ring
within the gestational sac.
A fetal pole or fetus can be seen attached to the yolk sac
by seven weeks
and fetal cardiac motion should be seen after seven weeks.
If no evidence of an intrauterine pregnancy can be seen,
the adnexal structures can be evaluated
for signs of an ectopic pregnancy.
The transducer should be slowly swept to the lateral aspects
of the pelvis.
The ovaries appear as round
or oval shaped hypoechoic structures
and are often located anterior to the iliac vessels.
Follicles may appear
as multiple hypoechoic cystic structures within the ovaries.
Some follicles may be quite prominent
depending on the luteal stage.
After ovulation, a ruptured follicle may develop
into a corpus luteum cyst
which will appear as a large anechoic round structure
within the ovary and may persist for up to three months.
An ectopic pregnancy will appear
as a complex echogenic structure
and may contain identifiable embryonic structures,
including a gestational sac or fetus.
Doppler ultrasound may demonstrate
a hypervascular ring of fire sign,
associated with ectopic pregnancy.
Documentation of fetal heart activity
in an extrauterine location confirms the diagnosis
of an ectopic pregnancy.
The adnexal structures should be evaluated bilaterally
for evidence of pathology.
In patients with a ruptured ectopic pregnancy,
free fluid will appear
as a hypoechoic or anechoic collection
posterior to the uterus.
If fluid is seen in the pelvis,
a view of Morrison's pouch should be obtained.
The probe is moved to the right upper quadrant
in the mid-axillary line
with the marker facing the patients head.
Hemoperitoneum can be seen
as a dark hypoechoic stripe between the liver and kidney.

Brightcove ID

5750480200001

https://youtu.be/AP2YzFosOWo

3D Animation: Pregnancy 1st Trimester TV

Read more about 3D Animation: Pregnancy 1st Trimester TV

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3D Animation: Pregnancy 1st Trimester TV

Applications

Gynecology

Clinical Specialties

OB/GYN

Publication Date

Fri, 06/16/2017 - 12:00

Media Library Type

Media Library Tag

Subtitles

- [Narrator] An intracavitary transducer
with an OB exam type
is used to perform a transvaginal examination
of an intrauterine pregnancy in the first trimester.
The patient is placed in stirrups
or a modified frog-leg position for the examination.
The transducer is placed in a protective sheath
containing gel to reduce air interference
and then inserted into the vaginal canal.
It is helpful for the patient to have an empty bladder
to reduce uterine distortion
and minimize discomfort for the examination.
The uterus is a gray echogenic structure
superior and posterior to the bladder.
The endometrial stripe will appear
as a bright, echogenic line
from the uterine fundus to the cervix.
Posterior to the uterus is the rectouterine pouch,
which should be evaluated for free fluid.
The transducer should be swept from side to side
to see the entire uterus.
The transducer is then rotated
to obtain a short axis view of the uterus.
The orientation marker is directed
toward the patient's right.
The uterus can be seen as an echogenic circular structure
directly posterior to the bladder.
The endometrium will appear
as a hyperechoic horizontal line.
The transducer should be swept anteriorly to posteriorly
to see the entire uterus.
The ovaries can occasionally be seen
in the longitudinal or transverse views
by sweeping the transducer
to the lateral aspects of the pelvis.
The ovaries appear as round
or oval-shaped hypoechoic structures
and are often located anterior to the iliac vessels.
The adnexal structures should be evaluated bilaterally
for evidence of pathology.
The earliest sign of pregnancy seen by ultrasound
is the gestational sac.
However, a decidual cyst or pseudogestational sac,
which can be seen in ectopic pregnancy,
may be confused for a gestational sac.
Therefore, definitive sonographic evidence
of an intrauterine pregnancy should only be established
when a gestational sac containing a yolk sac
is identified in two planes within the endometrium.
A gestational sac can be seen within the uterine cavity
by about five weeks gestational age
using transvaginal ultrasound.
The gestational sac appears as an anechoic,
fluid-filled circular structure.
The yolk sac can be seen by 5 1/2 weeks
and appears as a small, bright, hyperechoic ring
within the gestational sac.
A fetal pole or fetus can be seen attached
to the yolk sac by six weeks
and fetal cardiac motion should be seen after six weeks.
If a yolk sac or fetus
is not identified with the gestational sac,
an ectopic pregnancy cannot be excluded.
An accurate determination of the fetal age
in the first trimester
can be done by measuring the crown-rump length.
The transducer is oriented
to obtain a longitudinal view of the fetus
from the top of the head to the sacral area.
The image is frozen,
and the distance from the crown
to the sacral area is measured.
Using calculation software,
this measurement is converted to a gestational age.
Fetal cardiac activity is first seen as a flickering motion
after six weeks gestational age.
Fetal heart rate can be obtained using M-mode ultrasound.
The M-mode cursor should be placed over the beating heart
to generate an M-mode tracing.
Using an OB calculation software,
a measurement from the start of one wave
to the start of the next wave
is converted to beats per minute.

Brightcove ID

5508114715001

https://youtu.be/7lkvR_wIIKM