2. TVS
Gynaecologic US
Earlt first trimester obstetric US
Obstetric complications later in pregnancy
E.g. Placenta previa
Fetal spine in breech
Evaluation of fetal intra..... in cephalic fetuses
Evaluation of nuchal region before 14w
4. Generally :
TAS with full bladder
then empty the bladder
Followed by TVS
Not to be done in virginal pt, no consent to
vaginal examination
5.
6. Orientation of TV probe (manoeuvres)
Rotation 0 to 90 degrees about its longitudinal
axis from capital to coronal
Angled or pointed in any direction for plane of
section
Advance or withdraw
7. As a marker note the position of the urinary
bladder- angle of the bladder is consistent .... the
variable positions of the uterus and ovaries
14. The Uterus
Before menarche- ratio of uterus to cervix is half
Nulliparous women- corpus and cervix equal length
Multip- corpus is double the size
Size of uterus is variable in adults:
6-8.5cm in length in multips
Width - 3 -5 cm in nulliparous, 4-6cm in multips
AP diameter- 2-4cm in nulliparous, 3-6cm in multips
15. After menopause- atrophy
>5 years menopause:
3.5-7cm length
2-4 cm width
1.7- 3.3cm AP
Prepubertal uterus 2-4.4cm
Position is highly variable and changes with
varying degree of bladder and rectal distension
16. Muscular layers- 3 distinct layers
The endometrium: thickness
4-8mm proliferative phase
6-10mm periovulatory
7-14mm secretory phase
Post menopausal < 8mm
If the endometrium > 5mm in PMB--> investigate
20. Recruitment of follicles:
TVS can pick up when follicle is 2mm
Day 5-7
Day 8-12 one or more dominant follicles are
seen
21. Rate of growth of dominant follicles:
2-3mm per day
To reach max mean diameter of approx.
20mm (range 16-28mm)
24 hrs before ovulation:
The granulosa layer separates from the theca
layer resulting in a hypoechoic ring
