Transvaginal ultrasound is a procedure that can be prescribed to a woman both for therapeutic and diagnostic purposes and for preventive purposes. The point is that ultrasound diagnostics can detect pathological changes in internal organs at the earliest stages, when other methods of research are not very effective.
For preventive purposes, this procedure is recommended for adult women at least once every 2 years. And after a woman turns 40 years old (and at a mature age the risk of cancer and gynecological pathologies increases significantly), doctors recommend to be examined by ultrasound every year.
As for therapeutic and diagnostic measures, transvaginal ultrasound is most often prescribed for pathologies of the genitourinary system, inflammatory and dysplastic gynecological diseases, suspicion of oncology in the pelvic organs, diagnosis of pregnancy in the first 10-12 weeks. Transvaginal ultrasound may also be prescribed in urgent situations, for example, if it is impossible to establish a source of bleeding from female genital organs.
Let's consider, in what situations the transvaginal ultrasound of the pelvic organs gives the maximum benefit:
- when there is pain in the lower abdomen for an unknown reason,
- with complaints of pain during intercourse,
- if the menstrual cycle is disturbed (a woman may complain of a delay in menstruation, their absence for a long time, bleeding in periods between menstruation, too much or, conversely, a short duration of menstrual bleeding)
- when there are suspicious discharges from the female genitalia (bloody veins, smear, purulent discharge with odor, etc.)
- at suspicion on development of an inflammation in internal genitals,
- with suspected benign and malignant neoplasms in the uterus and ovaries, among which the most frequent are myoma, endometriosis and uterine dysplasia, cyst and ovarian cancer, etc.,
- if there is a suspicion of female infertility, if a woman can not become a mother for six months or more, despite regular sex life (determining the shape and features of the ovaries, patency of the fallopian tubes with contrast agents),
- at suspicion on an ectopic pregnancy,
- with bleeding from the genital tract of unknown etiology (helps determine the cause of hemorrhage),
- with suspicion of varicose veins of the pelvis (pathology affects the work of the reproductive organs of a woman, as a violation of blood circulation in the uterus and ovaries provokes malfunctions of the menstrual cycle, regular pain in the lower abdomen and even problems with conception of the child)
- if you suspect a pathology of the urinary system (for example, in cases of violations of the act of urination: pain, delay or incontinence, the appearance of mucus in the urine), in this case, appoint a transvaginal ultrasound of the bladder.
Transvaginal ultrasound of the intestine is less often due to violations of defecation. More information in this regard is provided by transrectal examination using ultrasound. But if it is difficult, for example, due to intestinal obstruction or in the presence of tumors (polyps, hemorrhoids), which can be damaged by a tube of an ultrasound device inserted into the rectum, transvaginal examination comes to the rescue. In this case, it is more effective than the abdominal because the large intestine is located near the thin walls of the vagina. An examination of the intestine through the abdominal wall can not give as accurate results as a study from the side of the vagina.
Using transvaginal ultrasound, a procedure for in vitro fertilization (IVF) is also monitored. After all, after the fertilization of the fertilized egg in the female body, all the processes proceed secretly from the human eye and it is possible to trace them safely only through ultrasound.
Transvaginal ultrasound in gynecology
Transvaginal ultrasound is prescribed both for clarification of the alleged diagnosis, and for informational purposes to determine the boundaries, size and condition of specific organs. For example, with its help you can get information about the structure and health of the main reproductive organ of a woman - the uterus. Using vaginal ultrasound, you can measure the length of the cervix, the size and shape of the uterus, the thickness of the mucous layer (endometrium), which constantly changes depending on the phase of the menstrual cycle.
The smallest thickness of the endometrium (of the order of 1 mm) is noted on the 1st and 2nd day of the menstrual cycle. On the 3rd and 4th day it increases to 3-4 mm. Research these days is not very informative. From 5 to 7 days, the thickness of the uterine mucosa can reach 6 mm, and before menstruation - 10-20 mm. In this case, the endometrium should have a uniform structure without any kind of condensation and bulges, which can speak of inflammatory (endometritis) or tumor processes.
Endometritis (inflammation of the uterus) on the screen is seen in the form of an increase in the cavity of the organ, a decrease in the thickness of the mucous membrane with a pronounced heterogeneity of its composition, the accumulation of gas inside the uterus. The comparative characteristic of the wall thickness of the endometrium is performed depending on the phase of the menstrual cycle, otherwise the results will be inaccurate.
Measuring the length of the cervix is important if there is a risk of miscarriage. Normally, the length of the cervix is about 3.5-4 cm.
The diameter of the cervical canal of the cervix is in the range of 2 to 3 mm. In the cervical channel there is a uniform mucous secret. The change in the size of the cervix and the heterogeneity of the mucosal secretions may also indicate inflammatory or malignant processes, or the pathological proliferation of the endometrium of the uterus (endometriosis).
With uterine myoma, the organ is enlarged, its contours are changed, and the neoplasm (nodule) is determined in the muscular layer. The echogenicity of the myoma is different: from the near contour, the sound waves are reflected, and the far contour can not even be seen depending on what lies inside it (these can be cystic formations or seals formed from calcium compounds). Endometriosis reveals vesicular formation, both in the fallopian tubes, and in different parts of the uterus.
Polyposis of the uterus (as well as the intestines) is characterized by volumetric formations inside the organ caused by a viral infection, which, depending on the size and location, may influence its contours somewhat. But in most cases they are defined as rounded comparatively small formations inside the uterus, they are clearly visible in contrasting.
Cancer tumors when viewed with an ultrasound sensor have some similarities with polyps, but inflammatory edema is seen on the tissues near them. Confirm or disprove the diagnosis with biopsy. In this case, a piece of tissue for examination for malignancy is taken right during the diagnostic procedure, the vest at the end of the device has a special channel with a needle to take a biopsy.
According to the results of ultrasound, a cancer tumor of the cervix is defined as a highly echogenous neoplasm with uneven contours. Doctors also note narrowing of the uterine pharynx and an increase in regional lymph nodes. By the exact location of the tumor, it is also possible to determine the depth of penetration of the cancer tumor into the uterine tissue and nearby organs.
Suspicion of uterine cancer occurs when the following symptoms occur: spotting outside menstruation, abdominal pain, blood during copulation, copious watery discharge, swelling of the lower extremities in the absence of pathologies of the heart and kidneys, difficulty in urinating.
The possibilities of carrying out a vaginal ultrasound examination during pregnancy are somewhat limited. Transvaginal ultrasound is performed only in the early stages of pregnancy, until the procedure can not cause uterine contractions and pregnancy disruption. Increased tone of the uterus sonologist (a doctor who conducts ultrasound diagnostics) sees as a local increase in the thickness of the wall of the reproductive organ. But such a study allows you to diagnose pregnancy with great accuracy in the first weeks after conception and track the development of the child in a very responsible first trimester of pregnancy.
The determination of the size of the uterus body plays a role in the diagnosis of pregnancy for a period of 3 weeks or more. Normally, the uterus measures 4.5-6.7 cm (length) by 4.6-6.4 cm (width) and about 3-4 cm in diameter, and if transvaginal ultrasonography reveals deviations from the generally accepted indices, this is an occasion for reflection.
Small size of the uterus creates problems with the bearing of the fetus, and the increased size can speak about the onset of pregnancy. A more thorough examination in the latter case helps to confirm or disprove other possible but less pleasant diagnoses, such as uterine myoma or malignant neoplasms in it.
Starting at week 5, transvaginal ultrasound can be used to determine the heartbeat of a child, which is an important indicator of fetal development.
A large role transvaginal ultrasound of the uterus and appendages plays in the diagnosis of infertility. With its help, it is possible to evaluate both the features of the functioning of the ovaries, and the possibility of access to the uterus through the uterine tubes.
The size of the ovaries is in the range (3-4) x (2-3) x (1.5-2.2) cm (length, width, thickness). In the middle of the menstrual cycle, the ovaries should contain several small follicles (egg embryos) up to 6 mm in size and one large to 2 cm. The presence of larger follicles can speak of a follicular cyst.
Large in comparison with the normal size of the ovaries indicate an inflammatory process in them or the presence of neoplasms in the organ.
As for the fallopian tubes, ideally they are hardly visible. To see this organ is possible only through contrasting. If the fallopian tubes can be seen without the use of contrast agents, this indicates an inflammatory process. What is always associated with the increase in the size of organs. Transvaginal ultrasound reveals the presence of liquid secretions in the fallopian tubes (this can be inflammatory exudate, pus, blood).
Another cause of the "growth" of the fallopian tubes can be an ectopic pregnancy, which is associated with obstruction of the organ due to the presence of adhesions, inflammatory process or birth defects (bend, small diameter of some sections of the tube, etc.). Such a study is carried out using contrast agents.
An important factor in the diagnosis of infertility is the location of the uterus. Normally, it should be slightly tilted forward. If such a slope is, but in the other direction (congenital defect), the probability of normal pregnancy is reduced, but there is a risk of developing an ectopic.
With the help of transvaginal ultrasound, fluid accumulation in the lower abdominal cavity can be detected, which is associated with the inflammatory processes of the internal organs (excreta discharge into the pelvic cavity) or rupture of cystic formations filled with liquid secretion.
Within 2-3 days after ovulation (from 13 to 15 days), a small amount of fluid can be detected in the cavity behind the uterus, which is considered quite normal. In other periods, the appearance of fluid near the uterus indicates the infectious processes in the organ.
Transvaginal ultrasound of ovaries is prescribed for inflammatory pathologies of the organ in which future eggs are ripening, and with severe pains in the lower abdomen (if they are not associated with menstruation). The same study will be relevant for suspected cyst or ovarian cancer. In these cases, the doctor who carries out the procedure of ultrasound, notes the increase in the size of the ovary, edema of the tissues, deformation of the body contours (with neoplasms), the presence of fluid inside the neoplasms (in the case of the ovarian cyst).
Ultrasound vaginal diagnostics can reveal pathological changes in the uterus associated with malignant neoplasms in the organ associated with pregnancy. For example, both during and after the resolution of pregnancy in the embryonic part of the placenta (chorion) in the uterus, a tumor consisting of epithelial cells can form. This new formation is called chorinoepithelioma. Less often the tumor is found out not in the body of the uterus, but on its neck or on the ovaries. It is able to destroy blood vessels, quickly gives metastases to various vital organs.
Echogram in this shows the increase in the uterus (its neck or ovary), because the tumor grows rapidly, the tone of the muscles of the organ decreases, they become soft with a non-uniform consistency. The form of the organ changes, on it appear tubercles, not peculiar to a healthy state.
Another dangerous pathology of early pregnancy is considered to be a cirrhosis. Pathology is characterized by a pathological growth of the villi of the chorion, with the formation of vesicles at their ends, the penetration of the tumor into the deep layers of the myometrium, the destruction of the uterine tissues. At the same time, fetal death is noted at an early stage of development, both with complete and partial bubble drift. But the uterus still continues to grow, though not the organ itself, but the malignant tumor that struck it.
Transvaginal ultrasound reveals uneven uterine tissue (dense mass with interspersed unusually soft areas), presence of small-cysts, large cysts on the ovaries. The size of the uterus does not correspond to the period of pregnancy, while the fetus in it can no longer be detected.
It is very important to detect the tumor as early as possible, when there were suspicions of intrauterine fetal death. After all, miscarriage in this case does not mean the disappearance of the tumor, and the woman is in serious danger.
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