Ultrasound in Gynecology Narendra Malhotra, Kuldeep Singh
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IntroductionChapter 1

  • 21.1 FILLING UP OF FORMS
  • 1.2 RELEVANT HISTORY
  • 1.3 PREPARATION AND POSITIONING OF PATIENTS
  • 1.4 MACHINE AND TRANSDUCERS
  • 1.5 REPORTING
 
1.1 FILLING UP OF FORMS
Maintain a form for further follow up in your clinic. One never knows when the information is required.
The routine information required in these forms is:
  1. Name
  2. Age
  3. Address
  4. Telephone Number
  5. Referred by.
 
1.2 RELEVANT HISTORY
Always spend few minutes with your patient to take the details of the history. Gives confidence to the patient and you get your perspective of what all to expect.
The history to be taken routinely is:
  1. Symptoms and their details. Check for menstrual history (duration and regularity). Check in the patient's language about menorrhagia, metror-rhagia, meno-metrorrhagia, inter-menstrual spotting, dyspaurenia, pain lower abdomen, pain in the lower back and any urinary and lower complaints.
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  2. Check duration and cyclicity of symptoms.
  3. Any ultrasound done previously. Check the records carefully.
  4. Last menstrual period.
  5. Any tests done and their reports.
  6. Referring doctors requisition slip.
 
1.3 PREPARATION AND POSITIONING OF PATIENTS
  1. The patient need not be fasting unless and until an upper abdomen scan is also asked for.
  2. Make it a practice to have a full bladder for all gynecological ultrasounds. This will enable you to have a broader perspective and overview of all pelvic organs.
  3. The patient is almost always scanned supine with little jelly on the abdomen.
  4. Whenever, a transvaginal scan is asked for the bladder must be emptied immediately before the examination. It should be performed with the same respect for privacy and gentleness, as is with the placement of a speculum. Scanning is performed with the patient supine and with her thighs abducted and knees flexed. Elevation of the buttock may be necessary. The probe should be covered with a condom or sheath containing a small amount of gel. Additional gel should be placed on the outside of sheathed tip. The probe is inserted by a gentle push posteriorly towards the rectum while the patient relaxes. Four types of probe movements are required:
    1. Pushing and Pulling
    2. Rotation
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    3. “Rocking” or upwards and downwards
    4. Side to side or “Panning”.
After removal of the transvaginal probe, the sheath is removed and the coupling gel is wiped off with a damp towel. The TV probe may be disinfected by Cidex.
 
1.4 MACHINE AND TRANSDUCERS
  1. For a transabdominal scan, a 3.5 to 5.0 MHz transducer and for a transvaginal scan, a 5.0 to 8.0 MHz transducer is used.
  2. Basic controls of every machine are more or less the same. The placement of knobs is different for all machines. Check for the manual of your machine or somebody from the company can always come and explain you.
    The routine knobology is:
    1. Patient name and entry of last menstrual period after you select the obstetric mode.
    2. Freeze
    3. B, B+B, B+M or only M mode
    4. Depth and focus
    5. Overall gain
    6. Time gain (TGC)
    7. Comments on screen
    8. Measurement (Set and Select) for linear, area and volume.
    9. Track ball or screen or joy stick to move the cursor
    10. Color flow map, Power Doppler, Doppler and 3D and 4D.
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    11. After freezing the images these can be stored and a print taken on a camera, thermal printer or from a computer.
 
1.5 REPORTING
In your reporting the salient features that require to be mentioned are:
  1. Uterus: Size, shape, mobility and probe tenderness.
  2. Endometrium: Thickness and morphology. Any focal abnormality to be mentioned with size and echo pattern.
  3. Myometrium: Echopattern and presence of fibroids and their location.
  4. Ovaries: Size (all three dimensions with total volume) and echo pattern. Any abnormality to be mentioned in terms of size, echopattern, walls and focal abnormalities within it.
  5. Extra-ovarian adnexal areas: Report whether any mass is delineated or not.
  6. Free fluid or fluid loculi in the pouch of Douglas or adnexa.