Pelvic ultrasonography and sonohysterography in women

Pelvic Ultrasonography and Sonohysterography in Women
Nevit Dilmen 2011
In women, pelvic ultrasonography is a diagnostic modality that evaluates the female reproductive organs, uterus and ovaries and adjacent areas. Sonohysterography is an ultrasound examination performed by filling the uterus with sterile liquid with the help of a thin cannula.
Ultrasound imaging is a modality that uses sound waves and their reflections to create images. The image brightness on the screen is a derivative of acoustic impedance, which is the sound reflection feature of the tissue. Tissues with similar sound-reflective properties cannot be distinguished by ultrasound and appear to have the same tone. No beam is used in ultrasound imaging, so it is a suitable method for pregnant women. The review is done in real time by watching the screen. During the examination, the properties of the flow in the vessels can be examined with the Doppler mode. For communication with other physicians and for later comparison, the patient is given a report containing the image and a summary of the examination. The examination can be done by obstetricians and radiologists. Imaging of the female reproductive organs with ultrasound is done from two perspectives, transabdominal and transvaginal. Each has its own advantages and disadvantages. Sonohysterography is used as a complement to the transvaginal method.
When is a gynecological ultrasound necessary?
Today, it is used as a complement to gynecological examination in applications with complaints such as delayed menstruation, pain, abnormal bleeding, menstrual irregularity and infertility. Radiologists perform this examination as the first evaluation when a second/independent opinion is requested by the obstetrician or the patient, or when deemed necessary.
Transabdominal method:
The uterus (womb) and ovaries (ovaries) are visualized with a probe (sound receiver/transmitter) placed on the abdomen, under the umbilicus. With this method, when necessary, a very large area can be examined (almost the entire abdomen), but the intervening gaseous bowel sections and the distance of the probe from the examined organs negatively affect the image quality. The bladder is empty, full, or both, depending on the physician’s preference for the examination.
Transvaginal sonography (TVS):
It is done with a thin long probe. The examination is done with the bladder empty. Virginity is an obstacle to doing the review. In practice in our country, this method is not applied to unmarried people. Transvaginal ultrasound examination is less troublesome than normal examination due to the special structure of the probe. With this method, the uterus is monitored very closely. In the diagnosis of early pregnancy, it gives results much earlier than the ultrasound performed from above. A pillow is placed under the hip to give the probe the necessary angles. Although it shows the regions close to the probe very well, any formations that are far away may be missed. Therefore, TVS should often be used in conjunction with transabdominal evaluation. The ovaries are usually close to the uterus and probe, and their internal structures can be easily observed. The layer lining the inside of the uterus is called the endometrium. Sonohysterography may be required when the presence of a structure that is difficult to distinguish from the endometrium is suspected.
Conditions requiring sonohysterography:
The reasons for the examination are not limited to these, but mostly: submucous fibroids, endometrial polyps, Asherman’s syndrome, congenital disorders, mass and tumors.
What is the working principle of sonohysterography?
Sonohysterography aims to obtain findings that cannot be obtained with normal transvaginal ultrasound. Sterile isotonic serum with the same properties as body fluids is given with a thin cannula into the endometrial cavity. A non-adherent endometrium is easily opened with this fluid. (Normal finding) An endometrium that does not contain a mass is filled with this fluid (normal finding). Filling is not complete in endometriums with formations such as filling defect, abnormal finding. The given serum passes through both tubes and reaches the peritoneum. Monitoring of serum in the peritoneum indicates that at least one of the two tubes is open.
How should the patient be prepared for the examination?
While coming for the examination, clean your body and wear comfortable clothes. According to the clinic, the examination is done with the patient’s own clothing or a patient’s gown. Do not bring jewelery or valuables with you when you come to the clinic. The best time for sonohysterography is 5-9 days after the end of menstruation. As it shows that there is no pregnancy, this is the period when the endometrium is most suitable and the risk of infection is the lowest. Sonohysterography is not a painful method, but sensitive patients can take a pain reliever they brought with them half an hour before the examination, with the approval of the examining physician.
How sonohysterography is done:
Following the standard transvaginal ultrasound, the area is cleaned with antiseptics, and a thin cannula is inserted through the cervix with the help of a speculum. The speculum is removed, the probe is inserted. The examination is performed by real-time monitoring of the endometrial cavity during serum administration. The probe and cannula are removed.
Sonohysterography applications take between 20-40 minutes.
After review:
In sonohysterography, there may be a feeling of discomfort during the delivery of serum to the endometrium. This discomfort is temporary and is less felt with painkillers used before the procedure.
Possible difficulties, Limits:
Cervical stenosis is one of the possible difficulties. An excessively wide cervix can cause the fluid to escape. Sonohysterography examination should be delayed until the end of treatment in women with active infection.
Ultrasonography is not a method used instead of obstetrics examination, it is complementary to the examination. Pelvic ultrasonography and hysterosonography cannot be used as a substitute for pathology, or MRI or tomography, which helps us to obtain other information, and cell type cannot be determined by looking at US images alone. Tubes are evaluated with indirect findings, not direct findings. Lesions with the same sound reflecting properties as the uterus cannot be observed in ultrasonography. Intestinal gases and distance from the probe adversely affect the examination.
During the selection of a physician, you can make a choice in terms of experience and gender within the framework of the possibilities of the institution. Due to the sensitivity of the examination area, you may want to have a trusted person (friend / relative) with you during the examination or to be alone. The physician conducting the examination may request female assistant health personnel to be present in the room to assist him. The quality of the device and the experience of the physician are complementary. Unlike MR and tomography, ultrasonography is a practitioner-dependent modality.
Evaluation and result:
The obstetrician who carried out the examination will evaluate all your tests and results and give you verbal information about the result of the examination and the treatment.
The radiologist conducting the examination will prepare a detailed report containing the results and send it to the physician requesting the examination. In small and medium-sized institutions, verbal information is usually given to the physician who wants to additionally examine it. Oral information given to the patient is short. Detailed information, information on treatment and approach is provided by the physician responsible for the patient.
Information usually found in the report: Uterine shape, position, length, width and height information, calculated volume accordingly. Both ovary length, width and height information, calculated volumes accordingly. Endometrial thickness. Whether there is a finding of these organs and tissues that needs to be described. It is whether an additional finding is detected in the vicinity of the reproductive organs.

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