Pelvic ultrasound uses sound waves to make images of organs and structures in the lower abdomen (pelvis)

A pelvic ultrasound looks at:
The bladder, ovaries, uterus, cervix and fallopian tubes of a woman

It can be done in three ways: Transabdominal, transrectal and transvaginal approach

Indications for a pelvic ultrasound include:
  1. Finding out causes of pelvic pain
  2. Looking for the cause(s) of vaginal bleeding
  3. Look for signs of Pelvic Inflammatory Disease (PID)
  4. Finding an Intrauterine Device (IUD)
  5. Looking at the size and shape of the uterus and the thickness of the uterine lining (endometrium)
  6. Looking at the size and shape of the ovaries
  7. Checking the condition and the size of the ovaries during treatment for infertility
  8. Confirming a pregnancy, whether it is in the uterus. It may be used early in pregnancy to check the age of the pregnancy or to find a tubal pregnancy (ectopic gestation) or multiple pregnancies (twins or triplets etc.)
  9. Checking the cervical length in a pregnant woman at risk for preterm labor
  10. Checking out a "lump” or mass found during a pelvic examination
  11. Guiding a procedure (ultrasound guided) to remove an ovarian follicle for In Vitro Fertilization (IVF), to check the patency of fallopian tubes and confirm presence and location of endometrial polyps/ submucous myoma (HSSG/SISH).

TRANSABDOMINAL ULTRASOUND

The ultrasound probe called transducer is passed back and forth over the lower abdomen after a transducing agent (ultrasound gel) is applied liberally over the area of interest.

This procedure may require a fluid-filled bladder and as such the sonologist may require you to drink plenty of fluids (commonly water) before the procedure.

TRANSRECTAL ULTRASOUND

The transducer shaped to fit the anus is covered by a probe cover or most commonly a condom then placed inside the anal canal after a small amount of lubricant is placed over the covered probe for ease of insertion into the anus. This is preferably done after adequate bowel preparation.

This is the procedure of choice when the transabdominal or transvaginal approach is not ideal (patients with no sexual contact).

TRANSVAGINAL ULTRASOUND

The transducer covered by a probe cover or condom is placed inside a woman’s vaginal canal after appropriate lubrication of the probe is done.

This is the procedure of choice in female patients who are already sexually active or those who have given birth in the past.

HOW DOES THE PROCEDURE FEEL?

If you have the transabdominal ultrasound, you will likely feel pressure in your bladder and a strong urge to urinate because your bladder is full.

The gel may feel cold when it is put on your abdomen.

If you have the transrectal or transvaginal ultrasound, you most likely will have a little but tolerable pain or discomfort during the procedure. You will feel pressure from the transducer probe as it is put into your rectum or vagina and rotated to adjust the view displayed on the monitor.

FETAL ULTRASOUND

This is a test done during pregnancy that uses reflected sound waves to produce an image of the fetus, the placenta and the amniotic fluid. The image is displayed on a TV screen (if the center is equipped) and may be in black and white or in color (3D/4D scan).

This is the safest way to check for problems and get information about your fetus, such as its size and position. It does not use radiation that may harm your fetus. It can be done as early as the 5th week of pregnancy. The sex of your fetus can sometimes be determined by about the 18th week of pregnancy.

WHY IS IT DONE?

  1. Fetal ultrasound is done to learn about the health of your baby.
  2. Different information is gained at different times (trimesters) during your pregnancy.

FIRST TRIMESTER ULTRASOUND IS DONE TO:

  1. Determine how your pregnancy is progressing
  2. Finding out if you are pregnant with more than one fetus (twins, triplets, etc.)
  3. Estimate the age of the fetus (gestational age), ideal for those patients who are unsure of the dates of their last menstrual period (LMP)
  4. Estimate the risk of a chromosome defect, such as Down’s syndrome
  5. Check for both defects that affect the brain or spinal cord
  6. Check for abnormalities in the uterus (fibroids) or the ovaries (tumors)

SECOND TRIMESTER FETAL ULTRASOUND IS DONE TO:

  1. Estimate the age of the fetus (gestational age) however it is less accurate in dating a pregnancy compared to a first trimester scan
  2. Look at the size and the position of the fetus, placenta and amniotic fluid
  3. Detect major birth defects such as neural tube defect or heart problems (Congenital Anomaly Scan)

THIRD TRIMESTER FETAL ULTRASOUND IS DONE TO:

  1. Make sure that the fetus is growing adequately
  2. Look at the size and position of the fetus, placenta and amniotic fluid
  3. A transvaginal ultrasound is occasionally done late in pregnancy to determine the location of the placenta or in high risk pregnancies to monitor the length of the cervix

FETAL ULTRASOUND RESULTS MAY BE AFFECTED BY:

  1. Being overweight or obese
  2. Stool (feces) or air in the intestines or rectum
  3. An abnormally low amount of amniotic fluid
  4. Some fetal positions that are not ideal for visualizing certain structures especially in advanced gestations
  5. Not being able to lie still during the procedure (discomfort at lying down)
  6. A very active fetus

WHAT TO THINK ABOUT:

  1. A normal fetal ultrasound result does not guarantee a normal healthy baby, as some conditions cannot be detected by ultrasound (autism)
  2. Your doctor may recommend additional tests or procedures if the results of your fetal ultrasound are not normal
  3. Your due date may change based on fetal size and development but if you have a scan done in early pregnancy (first trimester), this may help your doctor in determining your baby’s gestational age based on that.
  4. Ultrasounds do not always show birth defects
  5. In the third trimester, fetal ultrasound does not accurately determine fetal age or weight.

BIOPHYSICAL PROFILE OR BIOPHYSICAL SCORING TEST (BPP/BPS)

A Biophysical Profile or Biophysical Scoring Test measures the health of your baby during pregnancy. A BPP/BPS test may include a non-stress test with electronic fetal heart rate monitoring and a fetal ultrasound.

It measures your baby’s heart rate, muscle tone, movement, breathing and the amount of amniotic fluid around your baby.

A BPP/BPS is commonly done in the last trimester of pregnancy. If there is a chance that your pregnancy may be high risk, your doctor may choose to have it done beginning at 32 to 34 weeks or earlier.

Some women with high risk pregnancies may have a BPP/BPS test every week or twice a week in the third trimester.

WHY IS IT DONE?

Learn about and keep track of your baby’s health

Special ultrasound methods are used to keep track of movement, increase in heart rate with movement (non-stress test), muscle tone, breathing rate, and the amount of amniotic fluid surrounding your baby. If these five areas are within normal range, your baby is considered to be in good health.

NON-STRESS TEST (NST)

External Fetal heart rate Monitoring (EFM) records your baby’s heart rate while your baby is moving or not moving. It is usually done just before a fetal ultrasound.

EFM is done using two flat devices (sensors) held in place with elastic belts on your abdomen. One sensor uses reflected sound waves (ultrasound) to keep track of your baby’s heart rate. The other sensor measures the duration and intensity (if present) of your uterine contractions. The sensors are connected to a machine that records the information. Your baby’s heartbeat may be heard as a beeping sound or printed out on a graduated paper.

If your baby moves or you have a contraction, you may be asked to push a button on a hand held device connected to the machine. Your baby’s heart rate is recorded and compared to the record of movement of the baby or your uterine contractions. The test usually lasts about 30 minutes.

The results are scores on the five measurements in a 30 minute observation period.

A score of 8-10 points means that your baby is healthy. A score of 6-8 points means that you may need to be re-tested in 12 to 24 hours. A score of 4 or less may mean that the baby is having problems and further testing will be recommended.

WHAT AFFECTS THE TEST?

Reasons you may not be able to have the test or why the results may not be helpful include:
  1. The baby is in a position that makes an ultrasound scan difficult
  2. Being unable to lie still throughout the procedure
  3. Being overweight, which may make it difficult to correctly position the external monitoring device
  4. An infection in either you or your baby
  5. Low (hypoglycemia) or high (hyperglycemia) blood sugar levels
  6. Taking medications such as Magnesium Sulfate and steroids (given to help the baby’s lung mature faster)
  7. Using alcohol or illegal drugs
  8. In rare cases, stool (feces) or air in the intestines or rectum interfering with the fetal ultrasound

WHAT TO THINK ABOUT:

  1. A BPP/BPS test includes a non-stress test with EFM and a fetal ultrasound
  2. Additional tests such as Contraction Stress Test (CST) may be recommended if your results are not normal
  3. A CST records changes in your baby’s heart rate when you have uterine contractions. It may be done to check on your baby’s health. If the baby does not move enough during a non-stress test. It may help predict whether your baby can handle the stress of labor and vaginal delivery
  4. If there is a chance that you or your baby may have problems during your pregnancy, you may have a BPP/BPS test every week or twice a week during the last 12 weeks of your pregnancy
  5. A BPP/BPS may be done after an injury, such as vehicular accident or fall

YOUR CHANCE OF HAVING PROBLEMS MAY BE HIGHER IF YOU HAVE

  1. Certain medical conditions such as high blood pressure, kidney disease, diabetes, preeclampsia, or autoimmune diseases
  2. A history of a stillbirth or preeclampsia
  3. A history of Rh incompatibility
  4. A history of early labor, premature rupture of membranes (PROM), or placental problems
  5. A baby who seems small for the length of the pregnancy or is not growing (intrauterine Growth Restriction or IUGR)

HYSTEROSALPINGOSONOGRAPHY (HSSG) or Fallopian Tube patency test

HSSG is an examination carried out to determine whether the fallopian tubes are clear and whether there are any abnormalities (septa, polyps or myomas) in the uterine cavity.

HOW IT IS DONE:

  1. You will first have a transvaginal scan to make sure that you are clear to undergo the next step of the procedure, this is done to make a baseline examination. You will be asked to take medications such as pain relievers and antibiotics prior to the procedure (usually about an hour before). Your doctor usually orders this test as part of an infertility work up.
  2. A speculum is then inserted into the vagina to hold open the vaginal walls, after which a catheter is inserted into the uterine cavity through the cervix. An "anchor ball” at the end of the catheter is then filled with saline solution to prevent any back flow of fluids. This stage may cause temporary discomfort resembling menstrual pain hence the medications.
  3. A saline solution is then injected into the uterine cavity via the catheter and the flow of the fluid through the Fallopian tubes can be monitored with ultrasound. The examination also gives the sonologist an idea of the shape of the uterine cavity.
  4. If the Fallopian tubes are blocked, fluid will not be seen to move through them and no fluid or little fluid is spilled into the abdominal cavity. The injected solution may irritate the abdomen, which in turn occasionally cause a sharp pain in the shoulder. This is harmless and will pass spontaneously.

SALINE INFUSION SONOHYSTEROGRAPHY (SISH)

Similar to HSSG, however the main focus of the examination is to evaluate the uterine cavity and the endometrial lining.

Your doctor may order this test if you have a history of abnormal and irregular vaginal bleeding or if your doctor suspects that you might have polyps or fibroids within your endometrial cavity. This is sometimes done also if you have a history of multiple miscarriages or infertility, it can also be used to help determine if your uterus is shaped normally.

DOPPLER ULTRASOUND IN OBSTETRICS

One of the main goals of prenatal testing is to identify fetuses at increased risk for perinatal morbidity and mortality. Fetal hypoxia and asphyxia (lack of oxygen delivery to the fetus) often combined with Intrauterine Growth Restriction (IUGR) is associated with significantly increased risk.

Doppler ultrasound examines the blood vessels of both the mother and the fetus and studies the blood flow velocities within these vessels. There are certain maternal conditions (hypertension, diabetes) that can impair blood supply from the placenta and thus may cause impaired fetal growth.

CONGENITAL ANOMALY SCAN

Initial anatomy

Most often performed between 14 to 16 weeks. Your baby’s anatomy is evaluated for possible birth defects. It is important to note that all birth defects cannot be identified while you are pregnant and that certain birth defects can appear late during pregnancy.

Follow-up anatomy

This ultrasound is most often performed between 20 to 22 weeks. Your baby’s anatomy is re-evaluated for possible birth defects due to the fact that some features of your baby’s anatomy can now be better visualized at this point. Likewise parts of the baby are still developing and it is important to note that all birth defects cannot be identified while you are pregnant

3D/4D ULTRASOUND

The more conventional 2D ultrasound allows you to see the baby’s profile but not the entire face in one picture. 3D ultrasound, on the other hand, allows you to see the surface of the whole face in one image or picture. 4D ultrasound adds the dimension of time, so instead of seeing a 3D snapshot (still image) of the fetus, you get to see your baby moving in real time (grimacing, opening and closing of the eyes, yawning, sticking out its tongue) just like watching a movie.

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