OB unit 1
Parity
# of viable pregnancies
Pourcelot Resistive Index
(A-B/A) A=peak systole, B=end diastole
Pulsatility Index
(A-B/mean) A= peak systole, B=end diastole
Transvaginal Advantages
- ^ f transducers= better resolution -examine pts. unable to fill bladder -examine obese pts. -evaluation of retroverted uterus -better distinction btwn adnexal masses & bowel loops -better characterization of pelvic masses -^ detail of pelvic lesion & endometrium
Interstitial (Portion of Fallopian Tubes)
-1cm long, narrowest part of tube -contained w/in muscular wall of uterus
TA Protocol Sagittal
-1st: Survey area -midline might not be true anatomical sag due to deviation -cervix below angle of bladder -identify bladder- r/o midline cysts, complex mass, or free fluid -measure length of uterus from fundus to cervix & AP -uterus right lateral edge -right lateral adnexa -return ML -uterus left lateral edge -left lateral adnexa -angle right: R ovary (w/ & w/o measures) -angle left: L ovary (w/ & w/o measures)
Ovary Landmarks
-Iliopsoas Muscles (anterolateral) -External Iliac Vessels (anterolateral) -Internal Iliac Vessels (posterior)
Uterus Septus (Septate)
-Incomplete resorption of sagittal septum -2 uterine cavities, closely spaced, with 1 fundus -highest incidence of fertility problems, septum can be surgically removed
TA Protocol Transverse
-Inf: bladder, vagina, cervix -Mid: bladder, uterus body, endometrium -Sup: endometrium, fundus -R Ovary (w/ & w/o measures) -L Ovary (w/ & w/o measures)
Layers of Myometrium
-Inner: relatively hypovascular -Intermediate: thickest, uniformly homogenous, low to moderate echogenicity -Outer: less echogenic than intermediate layer, arcuate vessels separate outer & intermediate layers
Pelvic Diaphragm
-TA transverse views of most inferior portion of true pelvis -low level mildly curved, linear echoes -levator ani & coccygeus
Gonadotropin
-a hormonal substance that stimulates the function of the testes & ovaries -in females, FSH & LH are gonadotropins
Polymenorrhea
-abnormally frequent recurrence of the menstrual cycle -a menstrual cycle of less than 21 days
Menorrhagia
-abnormally heavy or long periods -associated w/: IUD, fibroids, hormonal imbalance
Oligomenorrhea
-abnormally light menses -associated w/: polycystic ovarian syndrome, emotional stress, chronic illness, heavy exercise, poor nutrition
Amenorrhea
-absence of menstruation -primary: menarche delayed beyond 18 y/o -secondary: cessation of uterine bleeding in women who previously menstruated -due to: uterine/vaginal stenosis, infection, trauma, ovarian dysfunction, athletic
Arcuate Venous Plexus
-accompanies arcuate arteries -pass circumferentially w/in myometrium -larger than associated arteries -frequently identified by TA & TV sonography
On the transabdominal imagining of the female pelvis, what does the urinary bladder do?
-acts as an acoustic window to view the pelvic anatomy -serves as a "cystic" reference -displaces bowel into false pelvis
True Facts About the Ovaries
-almond shaped -attached to the posterior aspect of the broad ligaments -lie in the ovarian fossa -receive blood from the ovarian and uterine arteries
Ovaries
-almond shaped, 3cm long -normal ovarian volume varies w/ phase of menstrual cycle & age -divided into: outer cortex, inner medulla, tunica albuginea (fibrous capsule) -secrete estrogen during follicular phase
Cornu, Cornua
-any projection like a horn -refers to the fundus of the uterus where the fallopian tubes arise
Obturator Internus Muscle
-arises from the anterolateral pelvic wall surrounding the obturator foramen to insert on the greater trochanter of the femur -rotates & abducts to thigh -level of the cervix & vagina
Urinary Bladder - "Sonic Window"
-as bladder fills, dome of bladder extends into false pelvis & displaces loops of small bowel -mass characterization: location, size, texture, characteristics, transmission, external contour
Corpus Albicans
-atrophied corpus luteum -not usually sonographically visible -hyperechoic focus w/in ovarian stroma
Postmenopausal Ovary
-atrophied, decreasing in size w/ ^ age -no follicles -difficult to visualize sonographically (no news is good news= can't see it= no patho)
Gestational/Menstrual Age
-based on menstrual dates -begins 2 weeks b4 fertilization -visible event
Embryologic Event
-begins w/ conception, 2 weeks less than GA -non-visible event, more precise
Scanning Ovarian Volume
-best method for determining ovarian size due to variability in shape - based on formula for ellipse (0.523 x length x width x height)
Ovarian Arteries
-blood flow varies according to the stage of menstrual cycle in the dominant ovary -arise from lateral margin or aorta, inferior to renal arteries
External Genitalia
-both sexes similar until 7th week of gestation -external organs fully develop by 12th week -urethra & vagina open into urogenital sinus
Uterine Artery
-branch of internal iliac artery -provides main arterial supply to uterus (& cervix) -ascends lateral to uterus, producing multiple branches that pierce uterine wall -first branch is the arcuate arteries
Broad Ligament
-broad fold of peritoneum draped over fallopian tubes, uterus, and ovaries -extends from sides of uterus to sidewalls of pelvis, dividing pelvis from side to side & creating the vesicouterine pouch anterior to the uterus & retouterine pouch posteriorly -divided into mesometrium, mesosalpinx, & mesovarium -contains vasculature, fat, nerves
Uterus Location
-btwn 2 layers of broad ligament, laterally -bladder anteriorly -rectosigmoid colon posteriorly -lies in true pelvis
Retroverted
-cervical canal forms an angle >90 degrees w/ vaginal canal -entire uterus tilted posteriorly -fundus poorly echoes due to attenuated sound by the uterus (Fundus on RIGHT of screen)
Sagittal Retroverted Uterus
-cervix on L, fundus on R
Scanning Ovaries w/ Color/Spectral
-color, power, & spectral can be added to exam, depending on clinical situation & pathology demonstrated on gray scale
Iliopsoas
-combination of psoas major & iliacus muscle -low gray echoes w/ distant, central, hyperechoic focus -courses anteriorly along linea terminalis, over pelvic brim, inserting into lesser trochanter of femur -anteriror & lateral to ovary -lateral to walls of bladder
Echogenic Ovarian Foci
-commonly seen in otherwise NL ovary -tiny 1-3 mm non-shadowing foci -usually multiple & peripherally located -caused by specular reflection of tiny cysts below the US threshold for spatial resolution
Corpus Luteum
-consists of a spheroid of yellowish tissue that grows within the ruptured ovarian follicle after ovulation -acts as a short-lived endocrine organ that secretes progesterone to maintain the decidual layer of the endometrium should conception occur -post ovulation -irregular in shape -contains internal echoes due to hemorrhage
Isthmus (Portion of Fallopian Tubes)
-constitutes medial third -slightly wider -continuous w/ ampulla
Cortex of Ovaries
-contains ovarian follicles in varying stages of development (stimulated by FSH) -covered by a layer of connective tissue, the tunica albuginea & thin layer of germinal epithelium
Myometrium & Cervix evaluated for:
-contour changes -echogenicity -masses & cysts
Infantile Uterus
-corpus 1/2 the length of cervix -length= 2-4.4cm (cervix 2/3) -tubular or inverse pear shaped appearance
No Conception
-corpus luteum degenerates 9-11 days after ovulation -progesterone levels decline
Menstruation
-days 1-4 of the menstrual cycle -endometrial canal appears as a hyperechoic central line representing blood & tissue
Menstrual Phase (Follicular Phase)
-days 1-5 -uterus sheds superficial layer -endometrium thin & echogenic -low estrogen, progesterone, LH -increasing FSH
Proliferative Phase (Late)
-days 10-14 of the menstrual cycle -ovulation occurs -the endometrium increases in thickness & echogenicity, hypoechoic functional layer -3 line sign
Secretory (Luteal) Phase
-days 15-28 of the menstrual cycle -the endometrium is at its greatest thickness & echogenicity w/ posterior enhancement
Proliferative Phase (Early)
-days 5-9 of the menstrual cycle -endometrium appears as a single thin stripe w/ a hypoechoic halo encompassing it
Routine Protocol for Adnexa
-determine relationship of adnexal abnormalities to ovaries & uterus (document size & characteristic also)
Genital Ducts
-development occurs simultaneously w/ gonads -Wolffian Ducts arise from mesonephros (male duct) -Mullerian Ducts arise lateral to the cranial end of each Wolffian duct (female duct)
Primordial Germ Cells
-differentiate from cells in caudal yolk sac -stimulate gonadal growth -produce female/maleness -migrate from yolk sac to the urogenital ridges during 5th week -invade gonadal ridges during 6th week
Sacrum & Coccyx
-distal segment of vertebral spine -form posterior border of the pelvic cavity
Internal Iliac Arteries
-divide into anterior & posterior trunks -ureters, ovaries, & fimbriated ends of uterine tubes are anterior -internal iliac veins are posterior
Urogenital Sinus
-elongated cavity formed by the division of the cloaca in early embryonic development -upper: urinary bladder -lower: vagina & external genitalia
TV Patient Instruction
-empty bladder -re-obtain consent to this portion -male sonographer's have chaperone -adequately explain procedure -7.5 MHz+ transducer
Innominate Bones (Ilium, Ischium, & Pubis)
-encircle most of pelvic cavity -form lateral & anterior margins -join posteriorly @ sacrum & coccyx -fuse anteriorly @ pubis symphysis
TV Scan Protocol-Uterus (Sagittal)
-endometrial cavity measured in long axis -angle slowly to R of uterus -angle slowly to L of uterus
XX Embryo
-female -cortex differentiates into ovary, medulla regresses
Ovum
-female egg -a secondary oocyte released from the ovary at ovulation
Vagina
-fibromuscular canal that lies in the midline & runs from the cervix to the vestibule of the external genitalia -upper region origin: mullerian ducts -lower region origin: urogenital sinus -measures 9cm in length posteriorly
False Pelvis Bounded By:
-flanged portions of the iliac bones -base of sacrum, posteriorly -abdominal wall anteriorly & laterally -muscles of false pelvis include: iliopsoas, rectus abdominus, transverse abdominus
Cortical Cords/Pluger's Tubules
-form the outer epithelium of female gonad -primordial germ cells are incorporated w/in -primitive germ cells differentiate into Oogonia
Common Iliac Veins
-formed from internal segements (drain pelvic organs & muscles) & external segements (drains legs) -left CIV courses posterior to right CIA before entering IVC
Rectus Abdominus
-forms anterior wall of abdominopelvic cavity -extends from 6th ribs to xiphoid process down to pubic symphysis -wrapped in muscular sheath
Sagittal Anteverted Uterus
-fundus located on L of image -ant. on L, post. on R -far field is cranial -cervix on R, fundus on L
Infundibulum (Portion of Fallopian Tubes)
-funnel shaped end portion of oviduct -opens into peritoneal cavity -fimbrae: fringe-like extensions which overlie ovary & direct the release of ovum into tube
Mullerian Ducts
-fuse together in the midline to form a single duct, the Uterovaginal Canal
Sterilization
-highest level of infection control -complete destruction of all micros (including spores) -autoclave: hot, high pressure steam -high level chemical disinfectant: submersion (cidex)
Sonographic Appearance of Ovaries
-homogenous -may exhibit a central, more echogenic medulla -small anechoic or cystic follicles may be seen peripherally in cortex -appearance varies w/ age & menstrual cycle -hypoechoic to myometrium
Sonographic Appearance of Piriformis
-hypoechoic bilateral -long: round -transverse: in length -located on either side of midline post. to upper half of uterine body & fundus -most commonly mistaken for ovary
Cumulous Oophorus
-hypoechoic ring -important for fertility studies -24hrs from ovulation
Coronal TV Scan
-image L side is pt's R side -image R side is pt's L side -near field=inferior region of pelvis -far field= superior region of pelvis -image uterus from cervix to fundus
Linea Terminalis (Iliopectineal line)
-imaginary line from pubic symphysis to sacrum -separates true & false pelvis
Fertilization
-interrupts normal menstrual cycle -developing placenta secretes hCG, which maintains corpus luteum -placenta takes over endocrine function
FSH & LH Relationship
-inversely related
TV Scan Protocol-Ovaries
-length & thickness measured on long view -ovaries demarcated by follicles -ovarian size is determined by it's volume -size depends on stage of menstrual cycle
Adult Nulliparous Uterus
-length: 6-8.5cm -width: 3-5cm -AP: 3-5cm -corpus & cervix same length
Adult Multiparous Uterus
-length: 8-10.5cm -width: 5-6cm -AP: 5-6cm -corpus approximately 2x the length of cervix
Sonographic Appearance of Obturator Internus
-level of vagina & cervix -thin bilateral, linear, low-level echoes -seen @ post. lateral corners of bladder
Space of Retzius
-located between the anterior bladder wall & the pubic symphasis -contains extraperitoneal fat
Cervix
-located posterior to the angle of the bladder -opens into the upper vagina through the external os
Ampulla (Portion of Fallopian Tubes)
-longest most coiled portion of the tube -terminates in most distal portion -most often site of fertilization
Ovarian Volume
-lowest during luteal phase -highest during preovulatory phase
Sanitization
-lowest level of infection control -soap/detergent, warm water, & friction -routinely perform sanitization of visibly dirty, dusty, or contaminated items
XY Embryo
-male -cortex regresses, medulla differentiates into testes
TV Scan Protocol-Uterus
-midline uterus demonstrating endometrial canal -cervix visualized by withdrawing slightly & angled inferiorly -post. cul-de-sac interrogated for free fluid
Uterus Bicornis Bicolis/Unicolis (Bicornuate)
-most common congenital malformation -partial fusion of mullerian ducts is achieved -1 vagina, 1 or 2 cervix, 2 uterine bodies -no fertility problems -image looks heart shaped
Endometrium
-mucous layer which is firmly adheered to the myometrium -inner lining of the uterine cavity, which appears echogenic to hypoechoic on ultrasound, depending on menstrual cycle -functional layer thickens, contains spiral arteries -basal layer remains intact, contains straight arteries -menstration & early proliferative: thin hyperechoic line late: hypoechoic functional, hyperechoic lines (3 line sign) secretory: isoechoic, thickest point
Myometrium
-muscular layer which forms most of the substance of the uterus -middle layer of the uterine cavity that appears very homogenous -relatively hypovascular
Bladder
-muscular sac that receives & stores urine -located in anterior segment of pelvic cavity, posterior to pubic symphysis -Trigone: triangular area where openings of ureters & urethra join bladder cavity
Ureters
-muscular tube 25-30cm long -transports urine from kidneys to bladder -anterior to internal iliac artery & vein -posterior to ovary
Hysterosonography (HSG)
-new technique for endometrial evaluation -used when endometrium exceeds normal thickness or shows focal areas of thickness -diagnosis include: submucosal fibroids, polyps, hyperplastic endometrium, CA w/ biopsy -5-7 French catheter introduced into external cervical os -transvaginal transducer reintroduced to vaginal canal -10-15 ml sterile saline injected -endometrial cavity is distended
Disinfection
-next level of infection control -germicides (inactive virtually all pathogenic micros except spores) -ex: bleach, alcohol, iodine, phenols, hydrogen peroxide
Transabdominal Advantages
-non-invasive -greater depth & FOV than TV -ability to scan upper abdomen if needed -visualizes high or laterally positioned ovaries/ pelvic masses -shows size/location of large masses
Pelvic Lymph Nodes
-not usually visualized unless pathologic -contain a hilum that will display blood flow w/ color doppler
Transabdominal Limitations
-obesity -inadequate bladder filling -abdominal scarring -recent surgery limiting access -retroverted or retroflexed uterus: fundus may be located beyond focal zone -fibroids -air-filled bowel -less optimal characterization of adnexal masses
TV Scan Protocol-Ovaries (Sagittal)
-often requires significant angulation of transducer -follow fundus, then angle out to cornua & broad ligament -slowly sweep beam anteriorly & posteriorly -internal iliac vessels are a landmark -measure length & depth (AP) of each ovary -identify ovary by follicles along periphery
Uterine Unicornis Unicolis (Unicornuate)
-one Mullerian duct fails to develop -related to infertility -long & slender (cigar-shaped) -deviated to one side
Estrogen
-one of a group of hormones that promotes the development of the female secondary sex characteristics -secreted from the ovaries, testes, placenta, & adrenal cortex -promotes the growth of the endometrial tissue during the proliferative phase of the menstrual cycle -peaks @ ovulation
Coccygeus Muscle
-one of two muscles in the pelvic diaphragm -located on posterior pelvic floor -supports coccyx
Piriformis
-originate in most post. aspect of true pelvis along lower portion of sacrum -posterior to uterus & ovaries -anterior to sacrum
Dysmenorrhea
-pain associated w/ menstration -usually from endometriosis
Round Ligaments
-paired ligaments that originate @ the uterine cornua, anterior to the fallopian tubes, & course anterolaterally w/in the broad ligament to insert into the fascia of the labia major -holds the uterus forward in its anteverted position
Iliacus Muscle
-paired triangular, flat muscles that cover the inner curved surface of the iliac fossa -arises from the iliac fossa & joins the psoas major muscles to form the lateral walls of the pelvis
True Pelvis (Minor/Lesser Pelvis)
-pelvic cavity found below the brim of the pelvis -muscles: obturator internus, piriformis, pelvic diaphragm -Normally contains: uterus, ovaries, & adnexa (also bladder & loops of small bowel)
Hypothalamus
-portion of the brain forming the floor & part of the lateral wall of the third ventricle -activates & controls endocrine processes -secrets GnRH (gonadatropin releasing hormone) to the pituitary (so it secretes FSH & LH)
False (Major) Pelvis
-portion of the pelvis found above the brim of the pelvis -the portion of the abdominal cavity that is cradled by the iliac fossa -muscles: iliopsoas, rectus abdominus, transverse abdominus
Oogonia
-precursor cell during the fetal period from which oocyte develops -differentiates into primary oocytes
Gonadal Ridges
-precursor to ovary or testicle (Y=testicle) -located on the anteromedial sides of the wolffian bodies
Transvaginal Contraindications
-premenarchal or virgin pts. -any pt who does not consent -incompetent cervix
Translabial (Transperoneal)
-prevents potential complications of TV approach -well tolerated by patient 3.5-5.0 MHz curvilinear transducer -covered w/ plastic sheath -placed at vaginal introitus -technically challenging limitations: rectal gas, & pubic symphysis may obscure visualization -elevate hips & reposition transducer on perineum
Primordial Follicle
-primary oocyte w/ a surrounding layer of granulosa cells -degenerate during childhood
Production by the Ovaries
-produce ovum reproductive cell -produces estrogen: secreted by follicles -produces progesterone: secreted by corpus luteum
Job of Cardinal & Uterosacral Ligaments
-provide rigid support for cervix -maintains normal axis of cervix, perpendicular to vagina
Infundibulopelvic & Ovarian Ligaments
-provide support for ovary -infun. supports lateral aspect -ovarian supports medial aspect
TV Technique
-pt undress waist down & in slightly reversed Trendelenburg -insert transducer or have pt insert -evaluate introduction of probe in real time (select 8-10 depth) -scan performed through (ant. vag. wall, ant. vag. fornix, lat. fornices) -probe position determined by site of optimal visualization of pelvic viscera -pelvic survey -sweep in sag. from midline to adnexas -sweep from cervix to fundus in coronal
True Pelvis Bounded By:
-pubis & pubic rami, anteriorly -sacrum & coccyx, posteriorly -fused ilium & ischium, laterally -muscles of the pelvic floor, interiorly: obturator internus, piriformis, pelvic diaphragm
Menarche
-refers to the onset of menstruation -usually occurs between 11 & 13 years of age -menses occur normally every 21-28 days
Sagittal TV Scan
-residual bladder fluid= upper left corner -anterior= left of screen -posterior= right of screen -apex of image=closest to face of transducer -angle anterior to visualize fundus -withdraw slightly & angle posterior to visualize cervix & post. cul-du-sac -angulations & tilting in oblique sagittal plane to visualize adnexa
Ovary Position Related to Uterus
-retroverted uterus= ovaries located laterally & superiorly -enlarged uterus= ovaries displaced laterally & superiorly -hysterectomy= ovaries located medially & directly superior to vaginal cuff
Ovarian Veins
-right ovarian vein empties into IVC -left ovarian vein empties into left renal vein -emerge from hilum of ovary forming the pampiniform plexus -may become enlarged during pregnancy
TV Scan Protocol- Ovaries (Coronal)
-rotate 90 degrees from sagittal plane of ovary -measure width
TV Scan Protocol-Uterus (Coronal)
-rotate transducer 90 degrees -image uterine fundus, body w/ endometrial canal, & cervix
Fallopian Tubes
-run laterally from uterus in upper free margin of broad ligament -each tube varies from 7-12cm -divided into: interstitial, isthmus, ampulla, infundibulum
Dominant/Graafian Follicle
-seen 4-5 days b4 ovulation -grows 2-3 mm/day -maximum diameter 20 mm -anechoic w/ smooth hyperechoic walls
Parity Code
-series of 4 digits that represent the obstetrical history of the patient 1st digit: # of full term births 2nd digit: # of premature births 3rd digit: # of aborted/miscarried fetuses 4th digit: # of living children ex: 4, 1, 2, 5
Perimetrium
-serous membrane around uterus -arises from the anterior sacrum between the pelvic sacral foramina and the gluteal surface of the ilium
Transabdominal Pitfalls
-shadowing from symphysis pubis (angle transducer inferiorly) -under distention (fundal pathology could be missed) -over distention (can distort anatomy/pathology)
Sonographic Appearance of Iliopsoas
-short axis: rounded w/ hyperechoic foci -long: low gray bundle divided by femoral nerve sheath
Arcuate Uterus
-small dimple or concave surface of the fundus -more of a variant than a deviant of normal
Pituitary Gland
-small gland attached to the hypothalamus, supplying numerous hormones and conducting many vital processes -stimulates FSH & LH
Transvaginal Limitations
-smaller field of view due to higher f (less depth) -may not see ovaries that are high & lateral
Vaginal Fornix
-space between cervix & vaginal walls -divided into ant., post., & 2 lateral fornices
Endometrium evaluated for:
-thickness -focal abnormalities -presence of fluid or masses w/in cavity
Endometrial Cavity
-thin, echogenic line, result of specular reflection from interface btwn opposing surfaces of the endometrium
Uterus Didelphys
-total failure of fusion (malfusion) of the Mullerian ducts -associated w/ single or double vagina -not associated w/ fertility problems -2 endometrial echo complexes
Obturator Internus
-triangular sheets of muscle that arise from anterolateral pelvic wall -course parallel to lateral walls of true pelvis -posterior & medial to iliopsoas
Ovary location
-upper pole attached to lateral wall of pelvis by suspensory ligament -ligaments not rigid, therefore mobile -medial to external iliac vessels -anterior to ureter
Female Genitalia
-urogenital folds become the labia minora -labioscrotal swellings become labia major -phallus becomes clitoris
Postmenopause (5+ years)
-uterus atrophies -length: 3.5-7 cm -width: 1.7-3.3 cm -AP: 2-4 cm
True Pelvis Contains
-uterus, ovaries, adnexa (bladder & loops of small bowel are anterior to uterus & adnexal structure)
Cardinal Ligament
-wide bands of fibromuscular tissue arising from the lateral aspects of the cervix & inserting along the lateral pelvic floor -a continuation of the broad ligament that provides rigid support for the cervix -also called transverse cervical ligaments
Primipara
1 viable birth
Must Ask Routine Pelvic Exam Questions
1) Menstrual Status (premenarche, menarche, etc..) 2) Date of LMP 3) Hormone Regimen
Composition of Endometrium
1) Superficial (Functional) Layer 2) Deep Basal Layer -thickness changes cyclically w/ menstrual cycle
Sonographer's Role in a Pelvic Exam
1) identify referring physician's indications for the study 2) review previous imaging results 3) gather clinical history 4) tailor ultrasound to each patient 5) provide valid, reliable, & reproducible results through critical thinking
Routine Protocol for Uterus
1) uterine size, shape, & orientation 2) endometrium 3) myometrium 4) cervix
How long (minimum) should the endovaginal transducer be soaked in disinfectant?
10-20 minutes
How big typically is a mature follicle right before ovulation?
2 cm
Average Cycle
28 days
Viable
500+ grams or > 20 weeks gestation
Sonohysterography is usually performed on premenopausal women between days ______________ of the menstrual cycle
6 & 10 (early proliferative)
What is the normal size measurement of the menarchal uterus?
8 cm long x 4 cm wide
A/B Ratio
A/B: A= peak systole, B= end diastole) -need accurate angle
Bending forward of the fundus & body of the uterus is called:
Anteflexion
What separates the thin outer layer from the immediate layer of the uterus?
Arcuate Arteries
What are the small vessels found along the periphery of the uterus?
Arcuate Vessels
What ligament contains the uterine blood vessels & nerves?
Broad Ligament
What is a continuation of the broad ligament that provides support to the cervix called?
Cardinal Ligament
Flexion refers to the axis of the uterine body relative to the ________________.
Cervix
How do you position the handle of the transducer to image the fundus of the uterus with endovaginal sonography?
Closer to the bed
Uterine Aplasia-congenital absence
Complete non-development
What is the vertical plane through the longitudinal axis of the body to image structures from anterior to posterior?
Coronal (TV)
In endovaginal scanning, the scanning plane 90 degrees from the sagittal plane is the:
Coronal Plane
What kind of patients are arcuate artery calcifications seen in?
Diabetic & Postmenopausal Patients
Limitations of translabial scanning may be overcome by:
Elevating the patient's hips
Where are Nabothian cysts found near?
Endocervical Canal
What is the inner lining of the uterine cavity that appears echogenic to hypoechoic on an ultrasound depending on the menstrual cycle?
Endometrium
The ovary produces two hormones. Estrogen is secreted by the _____________________, whereas progesterone is secreted by the _____________________.
Follicles; Corpus Luteum
What is a mature follicle called?
Graafian Follicle
What muscle group may be seen in the false pelvis along the lateral sidewall of the pelvis?
Iliopsoas
What phase does the endometrium demonstrate the "three-line" sign?
Late Proliferative Phase
What does the Left Ovary drain into?
Left Renal Vein
What plane should be used to measure the thickness of the endometrium?
Longitudinal Plane
What is an abnormally heavy or long menses called?
Menorrhagia
What is the middle layer of the uterus?
Myometrium
Nulligravida
Never Pregnant
What is the release of an egg from the ruptured follicle?
Ovulation
This muscle is best imaged in transverse plane w/ caudal angulation at the most inferior aspect of the bladder.
Pelvic Diaphragm: levator ani & coccygeus
Symmetric bilateral pelvic masses are likely:
Pelvic muscles
What is the Retrouterine Space also known as?
Posterior Cul-de-sac
What is the doppler measurement that takes the highest systolic peak minus the highest diastolic peak divided by the highest systolic peak?
Pourcelot Resistive Index
Gravity
Pregnancy
Multigravida
Pregnant Several Times
Primagravida
Pregnant for the 1st time
What is the physiologic status of prepuberty?
Premenarche
What is the doppler measurement that uses peak-systole minus peak-diastole divided by the mean over one cardiac cycle?
Pulsatility Index
With endovaginal sonography, for an anteverted uterus, the cervix is seen in the __________________, whereas the fundus of the uterus is found in the __________________.
Right side of the screen; Left side of the screen
What ligament occupies the space between the layers of another ligament and occurs in front and below the fallopian tube?
Round Ligament
What is the difference between peak systole & peak diastole?
S/D ratio
The endometrium is at it's greatest thickness & echogenicity w/ posterior enhancement in the ______________ phase
Secretory
What is a technique that uses a catheter inserted into the endometrial cavity with the insertion of saline or contrast media to fill the endometrial cavity to demonstrate abnormalities within the cavity or uterine tube?
Sonohysterography
What is the pelvic recess between the anterior bladder wall and the pubic symphysis?
Space of Retzius
What laterally supports the ovaries?
Suspensory Ligaments
What is the longest portion of the fallopian tube?
The Ampulla
What is the structure that lies above the uteroovarian ligament, round ligament, & tuboovarian vessels?
The Fallopian Tube
What are the ovaries's primary blood supply?
The Ovarian Artery
Menarche may be defined as:
The state after reaching puberty in which menses occurs every 21 to 28 days
What does the uterus look like during the Secretory Phase?
Thick & Hyperechoic
How does the uterus look during the Menstrual Phase?
Thin, echogenic line
What technique is the best way to measure the cervical-fundal dimension of the uterus?
Transabdominal
What is supplies blood to the fallopian tubes?
Uterine & Ovarian Arteries
What are the vagina's two sources of blood supply?
Uterine & Vaginal Artery
What is the superficial layer of glands & stroma of the endometrium called?
Zona Functionalis
Luteinizing Hormone (LH)
a hormone secreted by the anterior pituitary gland that stimulates ovulation & then induces luteinization of the ruptured follicle to form the corpus luteum
Anovulation
absence of ovulation, a cause of infertility
Translabial
across or through the labias
Transperoneal
across or through the perineum
Oocyte
an incompletely developed or immature ovum
Introitus
an opening or entrance into a canal or cavity, as the vagina
Menarcheal Years
an ovum is released once a month by one of the two ovaries
Rectouterine Pouch (Pouch of Douglas/ Posterior cul-du-sac)
area in the pelvic cavity between the rectum & the uterus that is likely to accumulate free fluid
Vesicouterine Recess (Anterior cul-de-sac)
area in the pelvic cavity between the urinary bladder and the uterus
Senile Vaginitis
atrophy of the vagina
Blood Source of Vagina
branch of uterine & internal iliac arteries
Menopause
cessation of menstration
Medulla of Ovaries
composed of connective tissue containing blood, nerves, lymphatic vessels, & smooth muscle
DUB
dysfunctional uterine bleeding
EDC
estimated date of confinement
Liquor Folliculi
fluid collection w/in the antrum of the mature follicle
Multipara
given birth to more than 1 viable fetus
What is the sonographer required to wear when handling glutaraldehyde?
goggles, gloves, & gown
Follice-Stimulating Hormone (FSH)
hormone secreted by the pituitary gland that stimulates the growth & maturation of gfraafian follicles in the ovary
Internal OS
inner surface of the cervical os
LMP
last menstrual period
Version
long axis of the cervix to the long axis of the vagina
Flexion
long axis of the uterine body w/ the long axis of the cervix ("bend" of the uterus)
Premenarchal Uterus Dimension
normal: 2.5 x 1.0 x 2.0 cm -cervix is bulky compared to body of uterus
Levator Ani Muscles
one of two muscles of the pelvic diaphragm that stretch across the floor of the pelvic cavity like a hammock, supporting the pelvic organs & surrounding the urethra, vagina, & rectum
Blood Source of Ovaries
ovarian & uterine arteries
Ovarian Ligament (Utero-ovarian ligament)
paired ligament that extends from the inferior/medial pole of the ovary to the uterine cornua
Suspensory Ligament
paired ligaments that extend from the indundibulum of the fallopian tube and the lateral aspect of the ovary to the lateral pelvic wall
Psoas Major Muscle
paired muscles that originate at the lumbar vertebrae & extend inferiorly through the false pelvis on the pelvic sidewall, where it unites with the iliacus muscle to form the iliopsoas muscle, flexes the thigh toward pelvis
Menses
periodic flow of blood & cellular debris that occurs during menstruation
Mesovarium
posterior portion of the broad ligament that is drawn out to enclose & hold the ovary in place
Uterine Cavity
potential space allowing for the dynamic changes during the normal menstrual cycle & pregnancy
Mesometrium
potion of the broad ligament below the mesovarium, composed of the layers of peritoneum that separates to enclose the uterus
Anteverted
refers to the position of the uterus when it is tipped slightly forward so that the cervix forms a 90 degree angle or less w/ the vaginal canal (most common uterine position) (fundus on LEFT of screen)
Anteflexed
refers to the position of the uterus when the uterine fundus bends forward toward cervix
Retroflexed
refers to the position of the uterus when the uterine fundus bends posteriorly upon the cervix
Arcuate Vessels
small vessels found along the periphery of the uterus split into radial-->straight--> spiral arteries
Metrorrhagia
spotting between periods
Progesterone
steroidal hormone produced by the corpus luteum that helps prepare & maintain the endometrium for the arrival and implantation of an embryo
Adnexa
structure or tissue next to or near another related structure; the ovaries & fallopian tubes are adnexa of the uterus
Sonohysterography
technique that uses a catheter inserted into the endometrial cavity, with the insertion of saline solution or contrast medium, to fill the endometrial cavity for the purpose of demonstrating abnormalities within the cavity or uterine tubes
Zona Pellucida
thick membrane that encloses the ovary
Premenarche
time period in young girls before the onset of menstruation
Postmenopause
time period of life after menopause
Mesosalpinx
upper portion of the broad ligament that encloses the fallopian tubes
Leukorrhea
whitish, viscous discharge from the uterus/vagina