The main feature of ultrasound is that it does not use harmful ionizing radiation, as is the case with x-rays. In addition, ultrasound does not show a static picture, but an image, so to speak, online. This allows specialists to evaluate the movement of organs and blood flow in the vessels.

Indications for pelvic ultrasound

So, the doctor may prescribe a pelvic ultrasound in one of the following cases:

Using ultrasound, you can determine pregnancy literally in the first days after conception.

The doctor prescribes an ultrasound for women for any problems or irregularities in the menstrual cycle, be it a delay in the onset of menstruation or too much early menstruation, bleeding in the middle of the cycle and so on. Ultrasound is also prescribed for excessively strong or weak menstruation, for unclear vaginal discharge, for discharge after menopause and, of course, if there is no menstruation at all.

Ultrasound of the uterus is prescribed if a disease that is difficult to treat is suspected - uterine fibroids.

Ultrasound can also identify all formations on the uterus and ovary (both malignant and benign).

Various inflammations of the pelvic organs are also indications for ultrasound diagnostics.

The gynecologist may prescribe a study to monitor the intrauterine contraceptive device (IUD), as well as in case of complaints about side effects on the part of such a contraceptive.

A pelvic ultrasound is performed on both sexes if there are any problems with genitourinary system.

Obstetricians prescribe ultrasound for early detection everyone pathological disorders fetus, checking the condition and tone of the uterus during pregnancy and simply to monitor the development of the child.

Also ultrasound - mandatory procedure when searching for the cause of infertility in men and women.

An ultrasound is always prescribed for possible obstruction of the fallopian tubes in women.

It is important to note that ultrasound is prescribed for men if any pathology is suspected prostate gland(prostate) and seminal vesicles.

Children are also sometimes prescribed a pelvic ultrasound for severe pain in the pelvic area.

What can a pelvic ultrasound reveal?

In addition to monitoring pregnancy and the process of fetal development, pelvic ultrasound in women can promptly detect a number of serious illnesses. First of all, these are, of course, neoplasms, such as cysts, polyps and fibroids. An ultrasound can also show whether a woman has ovarian or uterine cancer. Ultrasound can detect almost all uterine abnormalities, including scars on the uterus.

In both men and women, pelvic ultrasound reveals diseases of the bladder, including a tumor (cancer) of the bladder, as well as the presence of stones and sand in the kidneys. As for children, ultrasound reveals various neoplasms and anomalies in the pelvic area, heterogeneity of the genital organs. U little girls Ultrasound can show too early or too late puberty.

A special type of ultrasound, Doppler ultrasound, shows such nuances as congenital vascular malformation, blockages and blood clots in the bloodstream, narrowing in the vessels, and the appearance of blockages in the vessels.

Preventive ultrasound of the pelvic organs

They do not always send for an ultrasound only if there are any diseases. The purpose of ultrasound is early diagnosis illnesses, after all, at the most early stages any disease is much more treatable. So it is very necessary to undergo an ultrasound for preventive purposes, this is especially important for women.

How often should this be done? Healthy young women need to undergo such an ultrasound for preventive purposes at least once every two years. Women over forty need to do this ultrasound more often - once a year.

For the most reliable result, it is important to undergo a preventive ultrasound at the beginning of the menstrual cycle - on the fifth to seventh day after the start of menstruation.

The simplest and available method detection of gynecological diseases is an ultrasound examination. It is based on a method of converting reflected sound waves into an image on the screen, which a special sensor can read. Ultrasound of the pelvis in women and its subsequent interpretation is an important measure in the framework of health control.

The method of performing the manipulation has a significant impact on the completeness and reliability of the information received by the doctor. Eg, with an ultrasound scan using a vaginal probe, the uterus, tubes and ovaries are visible much more clearly than in studies performed through the abdominal wall. But if it is necessary to assess the condition of the bladder and abdominal wall, then it is better to choose the transabdominal method, discussed in detail earlier.

The data obtained is interpreted by a diagnostician, but the final diagnosis must be made by the attending physician, since ultrasound alone may not be enough to provide a complete picture of the disease. In this case, the doctor additionally prescribes tests or other diagnostic procedures that can confirm or refute the preliminary diagnosis. At the stage of deciphering an ultrasound of the pelvic organs, pregnancy, abnormalities in fetal development or diseases of the female genital organs can be detected.

At the beginning of the examination, the sonologist evaluates the development and general state pelvic organs female patients. During the procedure, their location, shape and structural features fabrics. In addition, the doctor takes the necessary measurements that will allow him to record existing deviations from the norms or establish compliance with them.

Reference! If the echostructure of the tissues is not disturbed, then the ultrasonic waves pass freely through the pelvic cavity, and a uniform echographic picture will be reflected on the screen. This means that visually the organs will have a uniform color without light and dark areas.

If the clinic’s equipment allows, and the doctor deems it necessary, the ultrasound procedure can be supplemented with color Doppler mapping to obtain data:

• about the resistance index;
• about the speed and volume of blood flow;

Uterus

The female uterus is a pear-shaped organ consisting of a cervix, fundus and body. Physiologically normal is the position of the uterus in which it is slightly tilted forward. A healthy organ does not have blurred external contours; their blurring on the screen may indicate the development of inflammation of the tissue adjacent to the uterus.

The echostructure of a normal uterus is characterized by homogeneity and average intensity. Ultrasound also identifies the following parameters, which must comply with the specified standards:

• neck length – 35 – 40 mm;
• anteroposterior size – up to 28 – 30 mm;
• diameter of the endocervix (internal canal of the cervix) – up to 3 mm;
• uterine length – 4.5 – 7.6 cm;
• organ thickness – 2.9 – 4.2 cm;
• width – from 4.5 to 6.2 cm.

For women who have entered menopause, slightly different parameters are adopted, due to age-related changes organ: length – up to 4 cm, width – up to 4.3 cm, thickness – up to 3.0 cm.

If it is necessary to assess the thickness of the inner mucous membrane of the uterus using ultrasound, then a special M-mode is used. The thickness parameters of this layer depend on what period of the cycle the woman is in:

• From days 1 to 4 the norm will be 1 – 4 mm;
• From 5 to 10 days – from 3 to 10 mm, and the endometrium has an anechogenic structure;
• From 11 to 14 days - thickness normal endometrium should be from 8 to 15 mm;
• From 15 to 23 days – 10 – 20 mm;
• From 24 to 28 days - from 10 to 17 mm, however, the structure changes and becomes hyperechoic.

Ovaries

The ovaries are part endocrine system, performing the series essential functions in the female body:

• regulatory – regulate the course of the menstrual cycle;
• producing – they produce not only eggs, but also hormones without which conception and normal pregnancy are impossible.

On ultrasound they appear as oval formations with uniform reflective properties and minor fibrous inclusions. Normally, the dimensions of the ovaries are as follows: width - from 20 to 30 mm, length - 25-30 mm, anteroposterior size - 17-25 mm, and the volume of the organ should be from 30 to 80 mm³.

Bladder

The pelvic ultrasound procedure allows you to get an idea of:

• condition and functioning of the bladder;
• the thickness of its walls;
• the presence or absence of neoplasms in the cavity;
• volume of residual urine.

Norms

The wall thickness is 2-4 mm, this indicator is the same for patients of any age. The organ cavity should be homogeneous and hypoechoic without foreign inclusions. But the volume of residual urine in children and adults differs and is:

• for children – no more than 10 ml;
• for adults - no more than 18 - 20 ml.

To calculate this parameter, a universal formula is used: of the primary volume of the bladder, the volume of residual urine should occupy no more than 10%.

Pathologies

There is a whole list of pathologies that are detected on ultrasound of the pelvic organs:

• various anomalies of organ formation (saddle or infantile uterus, aplasia, duplication, etc.);
• myomatous formations;
• endometriosis;
• chorionic carcinoma and other malignant tumors in the female genital area;
• bladder diseases;
• polycystic or single cysts and their complications.

Uterine malformations

For aplasia of the uterus and vagina(the second name is Rokitansky-Küstner syndrome) it is typical that these organs are not detected on an ultrasound machine. If hypoplasia is noted, then all parameters of the uterus are reduced, and at the same time, underdevelopment of the cervix is ​​noted.

Vaginal atresia(in case of disease, the entrance hole is covered with a fibrous film) is detected on ultrasound using a hematometer varying degrees expressiveness, which means accumulation bloody discharge in the cervix and uterine cavity due to obstacles to its separation.

Infantile uterus characterized by a significant lag in the thickness of the organ from the norm (and is no more than 15 mm) with a length corresponding to the length of the normal organ.

Saddle uterus is a type of bicornuate uterus; with this pathology, the bottom of the organ is split in the shape of a saddle. On ultrasound it is determined by the bulging of the membrane within the uterine fundus and if the readings exceed 10 mm, then the diagnosis is considered confirmed. The full form of a double uterus is characterized by a significant divergence of two “horns”, the length of which does not exceed two-thirds of the normal size.

Anomalies of the structure of the uterus

Ultrasound makes it possible to recognize abnormalities in the development of the genital organs.

Duplication of the uterus– an extremely rare pathology, which is characterized by the presence of a double set of vaginas and cervical canals. The function of pregnancy and birth is preserved.

Bicornus- this anomaly in the structure of the uterus gives the baby developing in the womb less space, otherwise reproductive functions women don't suffer.

Arc-shaped structure of the uterus– characterized by the presence of a “pit” at the bottom of the organ, while its upper part corresponds to the norm.

One-horned– the anomaly consists in the small size of the uterus (half the usual size) and the presence of one fallopian tube. However, if its patency is normal and the ovary is healthy, then the prognosis for pregnancy is favorable.

Formation of the septum– characterized by the formation of an additional wall inside the uterus, formed from muscle or fibrous tissue. May interfere with pregnancy.

Agenesia– a very rare pathology in which the uterus is either completely absent or has a small size. The vagina is also seriously underdeveloped. The complex of pathologies associated with this anomaly makes conception impossible.

Myomatous formations in the uterine cavity are considered benign and are formed from smooth muscle cells under the influence of an imbalance between estrogen and progesterone. On ultrasound this pathology is determined by the enlargement of the uterine body and the heterogeneity of its contours; in addition, one or more nodes are fixed in the endometrium. The diagnostician notices a neoplasm with reduced echogenicity, the contours of which are blurred.

When deciphering, the doctor determines the parameters and localization of formations. In addition, ultrasound examinations help to track the dynamics of the growth of nodular formations in order to make a timely decision on surgical intervention. Patients with a history of fibroids must repeat an ultrasound examination of the pelvis twice a year.

An essential criterion for diagnosing fibroids is the layering of the formation, that is, more pronounced echogenic properties of each of the subsequent contours. According to Doppler, the resistance index and blood flow velocity are lower than normal.

Endometriosis

This pathology means that the epithelium, which normally lines only the uterus, spreads to other organs and appears in the vagina, on the walls of the pelvis and in abdominal cavity. The disease poses a threat to pregnancy and may cause infertility, therefore, interpretation of ultrasound for endometriosis is carried out at the stage of preparation for conception.

During an ultrasound examination of the uterus and appendages, the sonologist can pay attention to small bubbles in the structure of the muscles of the tubes and cervical canal. In addition, it can be found focal formations or endometrioid cysts in the ovarian cavity. Ultrasound can also detect adenomyosis of internal organs, that is, penetration of the endometrium into the uterine wall.

The disease goes through several stages of development and at the first it is noted:

• the appearance of anechoic tubular structures with a diameter of up to 1 mm;
• local thickening of the endometrium;
• slight deformation of the endometrial layer;
• the appearance of small areas where the uterine epithelium is absent.

An advanced form of the disease is characterized by an increase in the thickness of the uterus, asymmetry of its walls and the appearance of anechoic cavities in the myometrium, with a diameter of about 3 mm.

Polycystic ovary syndrome

The signs of this disease are physiological changes in the structure of ovarian tissue, which are manifested by the formation of multiple cysts, hormonal imbalance and pathological proliferation of fibrous tissue.

In this case, the parameters of the uterus are reduced, and the ovaries, on the contrary, increase. The corpus luteum or dominant follicle is not detected, and the ovaries themselves are diffusely located follicles with fibrous strands between them.

Cystitis and stones in the bladder

A great advantage of ultrasound examination of the pelvic organs is the identification of pathologies of the bladder. There are many of them, and they all have certain ultrasound signs. Thus, uniform thickening of the walls indicates cystitis in chronic form. But local thickening is a symptom of a tumor or polyp.

Stones in bladder are formations that are characterized by:

• mobility;
• roundness;
• hyperechogenicity;
• distal ultrasound amplification.

Ovarian cysts

Cystic formations in the ovaries are determined by ultrasound as round hypoechoic (anechoic) structures, the contours of which are smooth and clear. The neoplasm, up to 20 cm in diameter, is filled with fluid and attached to the wall of the ovary. Cysts are divided into functional, endometriotic and germinal.

Important! A large formation (more than 5 cm in diameter) poses a danger to women's health! If the doctor prescribed hormonal replacement therapy, but it turned out to be ineffective, then surgery is indicated for the patient.

To obtain an accurate and informative picture of the disease, an ultrasound scan performed immediately after the end of the menstrual cycle is deciphered. It must be remembered that a number of gynecological diseases are asymptomatic and they are discovered by chance - during a routine examination or when studying the picture of other pathologies. If the doctor finds lumps in the cyst, then most likely he will consider it necessary to refer the patient for additional tests of tumor markers, for example CA-125.

Conclusion

Despite all the information content of ultrasound and other advantages of this method, the final diagnosis is not made based on the results of ultrasound diagnostics alone. However, the conclusion of the diagnostician plays a significant role in determining the strategy and tactics of further treatment.

Under any circumstances, a correctly interpreted and timely ultrasound is the most important factor:

• maintaining women's health;
• early detection of tumors;
• timely detection of pathologies.

Content

Sometimes, after a gynecological examination, a woman receives a referral for a transvaginal ultrasound of the pelvic organs, which becomes a cause for concern, but should she worry in advance? An indication for prescribing a study may be the doctor’s uncertainty about the preliminary diagnosis. In order to eliminate the slightest possibility of risk, it is necessary to listen to the recommendations of the gynecologist and undergo the procedure as soon as possible.

What is pelvic ultrasound

One of the most high-precision and safe methods diagnostics used in gynecological practice is ultrasound examination of the pelvic organs (ultrasound examination of the pelvic organs). The essence of this method is to reflect internal organs sent by sensors sound wave. The reflected radiation is converted with the help of technical instruments into a graphic image, which is interpreted by a diagnostician. Using ultrasound, you can track the pelvic organs over time, which allows you to make accurate conclusions.

What is included in the female pelvic organs

Space that is limited pelvic bones, called the small pelvis. The organs located in it belong to the reproductive and excretory systems. The excretory system includes the bladder and rectum, which are the same in men and women. Organs reproductive system for each gender are individual, for women it is:

• vagina;
• uterus (cervix, cervical canal);
• ovaries;
• fallopian (or fallopian) tubes;
• rectum;
• bladder.

Indications

Pass this procedure It is recommended, regardless of indications (for prevention purposes), every year, since some diseases of the reproductive and excretory systems may be asymptomatic. The reason for prescribing an ultrasound examination after a gynecological examination is the gynecologist’s suspicion about the presence of neoplasms (fibroids, cancer, tumors, cysts). In addition, indications for the study are:

• menstrual irregularities;
• signs of inflammation of the uterine appendages;
• pregnancy (a cervicometry procedure is prescribed to assess the condition of the cervix);
• the presence of an intrauterine device (to control its position);
• transferred inflammatory diseases and others gynecological diseases(adnexitis, endometritis, cervicitis, vulvitis, colpitis);
• infertility (to determine the cause, folliculometry is performed, i.e., identifying disorders of the ovulatory mechanism);
• previous surgical interventions (to control the condition).

What does it show

During the examination, the specialist performing the procedure evaluates the anatomical structure of the organs. The assessment is based on a comparison of the observed picture with established standards. Deviations cannot clearly indicate pathology; to confirm the diagnosis, you should take a necessary tests. The following main indicators are used for diagnosis:

Index	Meaning
	An increase in the size of the uterus occurs when inflammatory process, decrease – with fibrosis
	A change in the natural shape may indicate structural defects of the uterus
Wall thickness	Thickening of the uterine walls may be a sign of malignant tumors, inflammatory process
Echogenicity	Tissue density increases in the presence of pathology
Structure	Heterogeneity may indicate fibrosis of the uterus or prostate gland
Presence of neoplasms, compactions, stones	This indicator identifies tumors, stones

How to prepare

Preparation for an ultrasound for women depends on how the diagnosis will be carried out. The transvaginal method does not require preliminary preparation, but it is better that the bladder is emptied before the examination. Prepare for a transrectal ultrasound, which involves examining the pelvic organs through the rectum, and for a transabdominal ultrasound as follows:

• two days before the procedure, stop consuming foods and drinks that contribute to gas formation (legumes, dairy, carbonated and alcoholic drinks, fresh vegetables and fruits);
• eat in small portions;
• 3 hours before the procedure, cleanse the intestines (using an enema or taking laxatives);
• an hour before the diagnosis, you should fill your bladder (drink 1 liter - 1.5 liters of still water);
• On the day of the examination, you must refrain from smoking and taking medications.

Is it possible to eat before an ultrasound?

Eating on the day of a transabdominal examination is not recommended if the procedure is scheduled for the morning. If the study is scheduled to take place later than 2 o'clock in the afternoon, a light breakfast is allowed, which must be no later than 11 o'clock in the morning. During transvaginal examination of the pelvic organs, there are no restrictions on eating time.

On what day is an ultrasound performed?

Due to the fact that female organs small pelvis undergo changes throughout the menstrual cycle, it is important to carry out diagnostics in the phase in which clinical picture more accurate. The most favorable period for conducting examinations of the pelvic organs is 5-7 days after the start of the last menstruation. In order to assess ovarian function, the procedure is prescribed several times during one cycle. Men can undergo the procedure at any time.

How to do a pelvic ultrasound

During a gynecological or urological examination, the doctor prescribes an ultrasound if it is detected possible deviations. The method of diagnosis depends on the expected diagnosis and can be transvaginal, transabdominal and transrectal. Procedure ultrasound examination lasts 10-20 minutes. and is carried out in the absence of direct contraindications, which may include an allergy to latex (for transvaginal) or open skin lesions on the abdomen (for transabdominal).

Transvaginal ultrasound

The transvaginal ultrasound procedure is practically painless (except in cases acute inflammation genital or abdominal organs). The research proceeds as follows:

1. Woman takes off clothes bottom part body and lies down on the gynecological chair.
2. The specialist places a disposable condom on the tip of the vaginal sensor (transducer), lubricating it with a special gel.
3. The transducer is inserted into the vagina.
4. The sensor sends a signal to the device screen.
5. The doctor deciphers the resulting picture, dictating his observations to the assistant.

Transabdominal ultrasound

Transvaginal pelvic ultrasound is not prescribed for young girls whose hymen is not broken, so in such cases a transabdominal examination is used, which is indicated for both women and men. You must prepare for this procedure in advance by following your doctor's instructions. The sequence of actions when carrying out diagnostics is as follows:

1. Diagnosed takes horizontal position on the couch and frees his stomach from clothes.
2. A conductive gel is applied to the skin of the abdomen and the sensor.
3. The specialist moves the sensor over the surface of the abdomen, studying the indicators of the internal organs.
4. After the procedure is completed, the remaining gel is removed and the patient can immediately return to their normal lifestyle.

Decoding the results

The patient has the opportunity to receive the results with their interpretation immediately after the end of the procedure. During the procedure, the diagnostician voices sonological conclusions regarding the observed picture, but the gynecologist must make an accurate diagnosis based on the diagnostic results. Deviations from the established norm may indicate that individual characteristics the subject and the presence of pathologies. During the examination of organs, their size, echogenicity, and structure are assessed:

		Deviations
	Dimensions (length, width) – 70, 60 mm, no thickenings	Thickening of the walls was noted, heterogeneity of the structure was revealed, the size was reduced or increased, there were abnormal formations, cavities
	Dimensions (width, length, thickness) – 25, 30, 15 mm, uniform structure	Increased size, presence of cysts, fluid-filled cavities
Bladder	Free flow of urine through the ureters, complete emptying occurs after urination	Presence of stones, changes in size and position
The fallopian tubes	Not viewed	There are oval, round formations, adhesions, thickening of the walls

For men

During an ultrasound scan of a man’s pelvic organs, the diagnostician determines the correspondence of the size and structure of the prostate gland and bladder normal indicators. When interpreting the research results, the following data is taken into account:

• The normal size of the prostate gland is 30/25/1.7 mm (length, width, thickness). An upward deviation in size may indicate prostatitis or prostate adenoma.
• The structure is homogeneous, there are no inclusions or compactions. The presence of compactions or thickenings indicates the possibility of tumor formations.

Price

Cost of ultrasound procedure in different diagnostic centers Moscow is different. This examination can be carried out at a price from 1000 to 6000 rubles:

Medical institution	Cost of transabdominal examination, rub.	Cost of transvaginal examination, rub.
Affordable Health
MedicCity
SM-Clinic
Center V.I. Dikulya
Best Clinic
Ramsey Diagnostics
Perinatal Medical Center
Eurasian clinic

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Ultrasound of the pelvic organs - what it shows, types (transabdominal, transvaginal), on what day of the cycle it is performed in women, indications and contraindications, preparation and conduct of the procedure, explanation, where to do it, reviews, price

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The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Ultrasound of the pelvic organs is a method instrumental examination, during which the organs located in the pelvis are visualized on a monitor using ultrasound waves.

What is pelvic ultrasound?

Ultrasound (ultrasound examination) pelvic organs is an instrumental method diagnostics various diseases, based on obtaining an image of the pelvic organs on a monitor after ultrasonic waves pass through them. Ultrasonic waves have a very high vibration frequency, so the human ear is not able to hear them, but various equipment tuned to the appropriate frequencies perfectly receives these vibrations. Next, the vibrations perceived by the equipment are translated into an image on the monitor, similar to how waves are translated into sound in a radio.

That is, the essence of ultrasound examinations of any organs, including the pelvis, is the following - a special device (ultrasound scanner) emits waves with a high frequency of vibrations that pass through biological tissues, where part of them is absorbed, scattered or reflected back, after which the same the device captures the returning waves and converts them into the form of an image on the monitor. As a result of using an ultrasound scanner, the doctor can see images of the organs being studied on the screen.

By appearance organs and surrounding tissues, the doctor takes measurements of length, width and other dimensions, evaluates the structure, condition of tissues, large blood and lymphatic vessels, the presence of physiological and pathological inclusions in them, etc. And after such a detailed analysis of images of organs from various angles, he makes a conclusion about the presence or absence of pathology. If there are any pathological changes, their nature is described in detail and an assumption is made as to what they may be caused by (what pathological processes).

When the ultrasound scanner on its own technical specifications allows you to do this, the doctor can additionally switch it to Doppler scanning mode and evaluate the blood flow in the vessels of the studied area of ​​the body.

Using a pelvic ultrasound, you can assess the condition and presence of diseases of organs located within the pelvis (genital and urinary organs). Thus, ultrasound determines the presence of an inflammatory process, tumors, diffuse changes, deformations, incorrect positioning, etc.

Sensitivity and informativeness of ultrasound in diagnosing diseases genitourinary organs quite high, so the method is prescribed and used very often. And given its complete painlessness and safety, it is one of the main and frequently used diagnostic methods, including in pregnant women, children and the elderly.

The duration of an ultrasound of the pelvic organs is usually 10–20 minutes. During the study, the person usually does not experience any discomfort, so ultrasound is easily tolerated.

Ultrasound of the pelvic organs can be performed both for diagnostic purposes and for preventive examination, when a person does not have any complaints from the genitourinary organs. Diagnostic ultrasound is performed when a person has any complaints indicating a disease of the genitourinary organs (for example, pain in the lower abdomen, urinary disorders, irregular menstruation, infertility, etc.). In such situations, ultrasound is necessary to clarify the diagnosis, as well as the nature and extent of pathological changes in tissues. But a preventive ultrasound can be carried out as part of a routine annual examination, when nothing bothers the person at all, or after undergoing serious illnesses, when the state of health must be periodically monitored so as not to miss a relapse of the pathology.

Ultrasound of the pelvic organs in women and men

When it comes to ultrasound of the pelvic organs, in almost all cases this study is meant to be performed exclusively on women. This state of affairs is due to the anatomical features of the female and male pelvis.

So, in the pelvis in women there is a bladder, sigmoid and rectum, ureters, uterus, ovaries and fallopian tubes. Moreover, all these pelvic organs can be clearly examined using ultrasound. However, in practice, ultrasound is rarely used to diagnose intestinal diseases, since there are more informative methods, such as colonoscopy, sigmoidoscopy, irrigoscopy, etc. Therefore, ultrasound of parts of the colon is practically not used, and even if prescribed, it is done separately and specifically to identify the pathology of only this organ. As for the bladder and ureters, ultrasound of these organs is also usually prescribed separately and specifically if a person is concerned about complaints from the urinary system. Thus, it turns out that the term “ultrasound of the pelvic organs” means the study of only the female genital organs, such as the uterus, ovaries, and fallopian tubes. These organs are well visualized using ultrasound, and therefore the method is often prescribed for diagnosing the most various diseases internal genital organs in women.

The small pelvis of men contains the bladder, ureters, rectum and sigmoid colon, prostate gland, that is, the urinary organs, sections of the large intestine and internal genital organs. In order to clearly examine the bladder and ureters in men using ultrasound, it is necessary to use a special modification of the study, since the usual method used for women is not suitable for the stronger sex due to anatomical features. Because of this, ultrasound of the bladder and ureters is always prescribed for men separately and specifically. As for direct and sigmoid colon, then to diagnose their pathology, as in women, other methods are used. And if they prescribe an ultrasound of the intestines, then only with any specific purpose. Thus, from the pelvic organs in men, only the prostate gland remains. Ultrasound of this organ is performed quite often, as it is highly informative, but ultrasound of the prostate is done through anus, That's why this study is also always assigned separately. Thus, it turns out that in men, to study different pelvic organs, it is necessary to use various modifications of the method and approaches (through the anus, through the abdominal wall, etc.), due to which it is simply impossible to conduct a general ultrasound of all pelvic organs.

Based on the above, it is clear that men do not undergo ultrasound of the pelvic organs, since for each organ of this localization it is necessary to use a separate modification of the ultrasound method or special access. Therefore, most often, men are given a referral not for an ultrasound of the pelvic organs, if it is necessary to study the condition of the bladder, prostate and intestines, but three separate referrals for the study of each anatomical structure separately.

What does an ultrasound of the pelvic organs show?

Ultrasound of the pelvic organs allows you to assess the condition, structure, size, location, presence of pathogenic inclusions and formations of the uterus, ovaries, fallopian tubes and cervix. Based on the data obtained during ultrasound, the doctor can identify the following pathologies and physiological processes in the female genital organs:

• Pregnancy, its duration and location of the fetus (in the uterus, ectopic);
• Pathology of the fetus, placenta or cervix during pregnancy;
• Follicle growth and ovulation;
• The size and condition of the corpus luteum of the ovary after ovulation;
• Malformations and structural anomalies of the internal genital organs of a woman (for example, bicornuate or saddle-shaped uterus, aplasia of the uterus and vagina, vaginal atresia, children's uterus, duplication of the uterus, agenesis, septum in the uterine cavity, etc.);
• Tumor and cystic formations in the uterus and ovaries (fibroids, cysts, cystomas, polycystic disease, etc.);
• Malignant tumors of the internal genital organs or metastases in them;
• Inflammatory diseases of various genital organs (endometritis, adnexitis, salpingitis, cervicitis, etc.);
• Pathology of the fallopian tubes (hydrosalpinx, pyosalpinx);
• The presence and correct installation of an intrauterine device;
• The genitals have a normal or abnormal location and size.

Transabdominal and transvaginal ultrasound of the pelvic organs - essence, similarities, differences

Ultrasound of the pelvic organs in women can be performed in two ways - transabdominal and transvaginal. The essence of both methods is exactly the same - diagnostics various pathologies according to the image obtained on the monitor of the ultrasound machine. But the differences between them lie in the access used and information content.

Thus, transvaginal ultrasound is performed by inserting a scanner probe into the woman’s vagina. In this case, special sensors with a frequency of 4 - 10 MHz are used, which allow you to see images of tissues and organs only at a distance of 10 cm from them. Therefore, transvaginal ultrasound allows you to obtain a highly accurate image in which you can see even small details, but, unfortunately, the method makes it possible to “see” only objects located within a maximum of 10 cm from the sensor.

Transabdominal ultrasound is performed by placing a transducer on the anterior abdominal wall and obtaining an image of the organs on a monitor through the lower abdomen. The study is carried out with a full bladder, which is necessary for better visualization of the uterus. For transabdominal ultrasound, sensors with a frequency of 3–6 MHz are used, which make it possible to obtain images of organs located at a distance of up to 20 cm from the sensor. Thus, it is clear that transabdominal ultrasound allows one to obtain a kind of overview picture of the pelvic organs, but does not always make it possible to examine small details.

Considering the features of transabdominal and transvaginal ultrasound, it is clear that the first method allows you to see the picture at a glance, create general idea about the condition and relative position of organs, and the second, on the contrary, makes it possible to examine small details and clarify the nature of the existing pathological process. That is why transabdominal and transvaginal ultrasound of the pelvic organs complement each other.

There are no other differences or features between transvaginal and transabdominal ultrasound. Moreover, the norms and principles for deciphering the data obtained during their implementation are exactly the same.

Which pelvic ultrasound is best?

Due to the fact that the transvaginal ultrasound method makes it possible to examine the tissues in more detail, but with its help it is impossible to see the overall picture and large space-occupying formations, and the transabdominal method, on the contrary, allows you to consider a “panorama” of the pelvis, it is impossible to say unequivocally which method is better. Both methods of pelvic ultrasound complement each other, and therefore it is impossible to choose between them clearly the best or the worst. Indeed, in some cases more the best method It turns out to be a transvaginal ultrasound, and in others - transabdominal.

Since transvaginal ultrasound allows you to see finer details, but does not provide an overview, it is better to prefer in cases where you need to see something small, for example, growing follicles, corpus luteum ovary, cervix, etc. But transabdominal ultrasound should be preferred when you need to see an overview of the pelvis and identify possible neoplasms or organ enlargements (fibroids, ovarian cysts, ovarian appendages, etc.), since in similar cases Only such access is informative. Transvaginal ultrasound does not always manage to “find” ovaries, cysts, cystomas or fibroids, since they are large and extend beyond the boundaries of the small pelvis, where the sensor simply does not “reach” them (they are further than 10 cm from the sensor).

In each specific case, the doctor must decide which ultrasound method will be best. It is possible that for the most complete and informative diagnosis, both methods of pelvic ultrasound will be required.

Indications for ultrasound of the pelvic organs

The indications for transabdominal and transvaginal ultrasound are generally the same, since they allow one to detect the same pathologies, but the doctor decides what type of examination is necessary in each specific case.

An ultrasound scan of the pelvic organs in women is indicated in the presence of the following conditions or symptoms of genital diseases:

• Pain in the lower abdomen;
• Pain on the right or left in the area of ​​the iliac wing;
• Discomfort or pain during sexual intercourse;
• Bleeding or abnormal discharge (with unpleasant smell, with admixtures of pus, mucus, blood, with flakes, yellowish, grayish, greenish in color, etc.) from the genitals;
• Infertility;
• Miscarriage (several miscarriages, missed pregnancies or premature births in the past);
• Menstrual irregularities ( irregular cycle, heavy or scanty periods, etc.);
• Carrying out folliculometry and tracking ovulation for problems with conception;
• Carrying out cervicometry for cervical pathology (isthmic-cervical insufficiency, etc.);
• Suspicion of pregnancy;
• Suspicion of ectopic pregnancy, rupture or torsion of a cyst, etc.;
• Monitoring pregnancy after using assisted reproductive technologies (IVF, ICSI, etc.);
• Suspicion of inflammatory processes in the uterine appendages (adnexitis, salpingitis);
• Suspicion of inflammatory processes in the uterus and cervix (endometritis, myometritis, parametritis, cervicitis, pyometra, hematometra, etc.);
• Suspicion of pathology of the fallopian tubes (obstruction, hydrosalpinx, pyosalpinx);
• Suspicion of endometriosis;
• Suspicion of polycystic ovary syndrome;
• Suspicion of tumors of the pelvic organs (cystadenomas, teratomas, any cystomas, fibroids, polyps, fibromas, etc.);
• Suspicion of malignant tumors of the pelvic organs;
• Vulvovaginitis revealed by the results of tests and examination;
• Control of the location of the inserted intrauterine device;
• Assessment of the condition of the pelvic organs after gynecological manipulations (abortions, operations, cauterization of erosions, etc.).

Contraindications to ultrasound of the pelvic organs

Transvaginal ultrasound is contraindicated in the following cases:

• Childhood;
• Whole hymen (girl or woman is a virgin);
• A large space-occupying formation in the pelvis, clearly felt during a gynecological examination by hand;
• Old age (not always).

In addition, transvaginal ultrasound should be postponed for 2 to 5 days after any gynecological therapeutic and diagnostic manipulations involving the vagina (for example, cauterization of cervical erosion, hysterosalpingography, hysteroscopy, diagnostic curettage, abortion, etc.).

For transabdominal ultrasound no absolute contraindications, because this type The study is safe and does not involve the penetration of instruments into body cavities. However, transabdominal ultrasound is recommended to be postponed for some time if there are wounds on the skin of the abdomen, a large number of pustular rashes, burns, severe dermatitis, urticaria or any other damage skin, since in such situations, sliding of the sensor can provoke either an increase in the severity of the pathological process, or its spread over a large area. When there is any damage to the skin in the lower abdomen where the transducer will slide, it is recommended to postpone the transabdominal ultrasound until the skin condition returns to normal.

If a woman is bothered by severe abdominal pain, against the background of which she cannot take the position necessary for an ultrasound scan, then the study can also be considered conditionally contraindicated.

However, if an ultrasound needs to be done for urgent reasons, then it is performed despite the presence of damage to the skin and severe pain in a stomach.

After various gynecological procedures (abortions, laparoscopic operations, etc.), it is advisable to perform an ultrasound several days (2 – 5) after the intervention.

On what day of the cycle should I do a pelvic ultrasound?

Typically, an ultrasound of the pelvic organs is recommended to be performed on days 5–10 of the menstrual cycle, that is, in the first half of the cycle after the end of menstruation. However, in some cases (for example, folliculometry, ovulation control, measurement of endometrial thickness, suspicion of endometriosis, etc.), ultrasound is required at other periods of the cycle, for example, on days 12–15, in the second phase (days 15–30), etc. .d. In some cases, for example, if fibroids are suspected, ultrasound is performed twice during the cycle - after the end of menstruation and 1 - 2 days before the onset of the next menstruation. In general, in each specific situation, the doctor tells the woman exactly when to go for an ultrasound.

Ultrasound of the pelvic organs during menstruation

In principle, it is not recommended to routinely perform an ultrasound of the pelvic organs during menstruation, except in cases where the study needs to be carried out specifically during menstruation.

Cases where it is recommended to routinely perform an ultrasound during menstruation include the following:

• Significant blood loss during menstruation (to identify the cause of severe menstrual bleeding It is advisable to examine the endometrium during menstruation);
• Suspicion of nodes, polyps or endometrial hyperplasia (in such cases, ultrasound is recommended to be performed on days 1–3 of the cycle, that is, during menstruation);
• Determination of ovulation and folliculometry (ultrasound is performed several times from days 1 to 15 of the cycle in order to measure the size of the growing follicle and accurately record the time of ovulation).

In addition, there are situations when an ultrasound of the pelvic organs during menstruation is not only possible, but necessary. Moreover, it is shown because we are talking about the development severe conditions, life-threatening women. Thus, an ultrasound during menstruation should be done in case of complications of inflammation of the ovaries or fallopian tubes, after an abortion, or gynecological surgery. That is, an ultrasound during menstruation is done only in emergency cases, and in all other situations, the examination should be postponed until the end of menstruation.

In all other cases, routine ultrasound during menstruation is not recommended, since the diagnosis of many pathological conditions is difficult. Therefore, when performing a routine ultrasound during menstruation, a woman runs the risk that an existing disease will be missed or a completely different pathology will be diagnosed. Such difficulties in diagnosing pathology of the pelvic organs during menstruation are due to the following factors:

• The accumulation of blood and epithelial clots in the uterine cavity creates interference and difficulties for diagnosing uterine pathologies;
• Against the background of bleeding or heavy menstruation, it is often impossible to examine small space-occupying formations (cysts, polyps, fibroids);
• Against the background of menstruation, it is impossible to determine the thickness of the endometrium, which is very important for the diagnosis of endometritis, endometriosis, hormonal disorders and chronic inflammatory processes.

Preparation for ultrasound of the pelvic organs

The basic preparation for an ultrasound of the pelvic organs through transabdominal and transvaginal approaches is the same, and consists in reducing as much as possible the amount of intestinal gases that stretch the intestine and create interference, preventing the doctor from examining the genitals. For such preparation, you need to exclude from your diet 1–2 days before the ultrasound date foods and dishes that increase gas formation in the intestines, such as beans, peas and any other legumes, vegetables with coarse fiber(radish, cabbage, radish, bell pepper, onion, garlic, etc.), carbonated drinks, alcohol, coffee, flour bread coarse or with bran, whole grain cereals, fermented milk products, hot and spicy sauces and seasonings (mustard, pepper, etc.), pasta, fatty fish and meat, fruits (melon, bananas, sweet apples, etc.), etc. In addition, in addition to reducing the amount of gases in the intestines, you can take medications that have a carminative effect, such as, for example, products with simethicone (Espumizan, Disflatil, etc.), enzyme preparations(Mezim, Panzinorm, Unienzym, etc.), sorbents (Smecta, Filtrum, Polyphepan, Activated carbon, Karbolen, etc.). On the day of the study, it is advisable to cleanse the intestines using a regular enema, Microlax microenema or glycerin suppositories. To cleanse the intestines, you can also drink a mild laxative in the evening, on the eve of the examination, for example, Duphalac, Mucofalk, etc. Cleansing the intestines is necessary to minimize the number of possible interferences during the upcoming ultrasound.

Then the doctor or nurse asks you to remove clothing from the lower half of your body, place a sheet on the couch, and lie on your back on it. Next, the woman needs to bend her legs apart at the knees, and, depending on the technical equipment of the office, place her feet either on the edge of the same couch, or on chairs installed next to the couch, or on stirrups for lithotomy (similar to stirrups on a gynecological chair , but the feet are placed on them with feet). The doctor may place a pillow under the buttocks.

After the woman takes the position required for the study, the doctor puts gloves on her hands, lubricates the sensor head with a special gel, puts a condom on top of it, and again applies the gel on top of it, which is necessary to obtain the image. good quality. Next, carefully spreading the labia to the sides, the doctor inserts the ultrasound scanner sensor into the woman’s vagina with a gentle movement and minimal effort.

After this, the doctor makes sliding and rotating movements in the vagina with a sensor to direct it in the desired direction and obtain an image of the uterus, fallopian tubes, ovaries, cervix and retrouterine space on the screen. When all organs have been examined and measured, the procedure is completed and the doctor removes the sensor from the vagina. After this, you can get up from the couch and get dressed.

While the woman is getting dressed, the doctor writes a research report, which reflects everything that he was able to see during the ultrasound.

Normal ultrasound of the pelvic organs

Parameters studied during ultrasound of the pelvic organs

During the study, the doctor must evaluate the condition, location and size of the following organs:

• Uterus – describes the position, shape, contours, dimensions (body length, width, anteroposterior size) of the organ. Also indicated is homogeneous or heterogeneous structure myometrium, and whether there are volumetric formations of the myometrium (fibroids, etc.);
• Endometrium – describes the thickness, demarcation from the myometrium (clear or unclear), echostructure (homogeneous, heterogeneous), the presence of formations in the uterine cavity (polyps, septa, etc.), whether the uterine cavity is dilated or not;
• Cervix - length, anteroposterior size, diameter of the internal canal of the cervix (endocervix) are measured, echogenicity is determined;
• Right and left ovary (described separately) - the length, width, thickness, approximate volume of the organ, its contours, shape, location are measured, the presence or absence of follicles is indicated, and the number, size of the dominant follicle, and also volumetric formations (cysts, cystomas, etc.), if, of course, there are any;
• Fallopian tubes - it is indicated whether they are visible or not, and if visible, then the accumulation of what is most likely in them (fluid or pus);
• Free fluid in the pouch of Douglas and the retrouterine space - whether it is present or not is indicated, and if present, the approximate volume;
• The veins of the pelvis are dilated or not, tortuous or not.

Normal ultrasound parameters of the pelvic organs

Below we will indicate what normal ultrasound parameters the pelvic organs have:

Uterus. The echostructure is homogeneous, medium intensity, smooth, clear contours, pear-shaped, position slightly deviated anteriorly (anteversio), body length 4.5 - 6.7 cm, width - 4.5 - 6.2 cm, anteroposterior size (thickness) 2 .8 - 4.0 cm. In women who have given birth, the size of the uterus is 1 - 2 cm larger than in those who have not given birth, so you should not be surprised if after childbirth, according to ultrasound, the uterus turns out to be slightly larger than it once was. In women in menopause The size of the uterus is 1–2 cm smaller than indicated due to the involution of the organ.

Endometrium. Normally, it is visible in the form of a clear, homogeneous hyperechoic strip with smooth edges along the inner surface of the uterus, which is noticeably different from the lighter myometrium. After ovulation, a light hypoechoic stripe of unknown origin (hallo) appears between the hyperechoic endometrium and myometrium. The thickness of the endometrium in women of reproductive age is different and depends on the day of the menstrual cycle: on days 1 – 4 – 2 – 4 mm, on days 5 – 10 – 3 – 10 mm, on days 11 – 14 – 8 – 15 mm, on days 15 – 23 days – 10 – 20 mm, on days 23 – 28 – 10 – 17 mm. In menopausal women, the thickness of the endometrium is normally 1–2 mm, but sometimes it can reach up to 4 mm.

The edges of the uterine cavity are normally smooth, the cavity itself is homogeneous, not dilated, with no formations in it. Possibly not large quantity fluid in the uterine cavity, which is normal. But the accumulation of a large amount of fluid or pus is a sign of pathology.

Cervix. The echogenic structure is homogeneous; before menstruation or during ovulation, the cervical canal can be filled with mucus or fluid, the length of the neck is 35–40 mm, the anteroposterior size is 25 mm, the diameter of the internal canal is no more than 3 mm. In women who have given birth, the anteroposterior size of the cervix may increase by 10 mm compared to women who have not given birth.

Ovaries. Visible in the form of oval formations with a homogeneous structure, with foci of fibrosis and with a few anechoic inclusions (no more than 12), representing follicles. The contour of the ovaries is clear, but not even, often lumpy due to protruding follicles. Normally, in the first half of the cycle, the dominant follicle is clearly visible, from which the egg will be released during ovulation. In the second half of the cycle, the corpus luteum is determined in place of the dominant follicle. The width of the ovary is 20 - 30 mm, length - 25 - 30 mm, thickness - 15 - 20 mm, and volume 30 - 80 mm 3. In menopausal women, the ovaries have clear uneven outline, but they lack anechoic inclusions, and the sizes are smaller than the specified norms for women of reproductive age.

The fallopian tubes. Normally they are not visible on ultrasound.

Douglas and retrouterine space. Normally, during the period of ovulation (days 12 - 15 of the menstrual cycle), a small amount of fluid may be visible, pouring out from the ruptured follicle from which the egg was released.

Veins of the small pelvis. Normally, they are not expanded or tortuous.

Interpretation of ultrasound of the pelvic organs

Below we will look at what the various ultrasound characteristics of the pelvic organs identified during an ultrasound may mean, and what pathologies this may indicate.

Uterus

Ultrasound allows you to detect abnormalities in the structure of the uterus, myomatous nodes, adenomyosis, endometriosis, cancer, etc.

An irregular shape of the uterus with one, two or more cavities, or greatly reduced size, indicates an abnormal structure of the organ due to developmental defects.

The presence of hypoechoic or hyperechoic homogeneous nodes of a round shape with a blurred contour with a large number of vessels in the capsule surrounding them, combined with an increase in the size of the uterine body and the heterogeneity of its contours, indicate the presence of fibroids.

Small multiple cystic areas in the myometrium with a diameter of 1–2 mm to 1–2 cm in combination with an enlarged uterus may indicate adenomyosis.

Severe posterior deviation of the uterus may be a sign of widespread pelvic endometriosis. In addition, signs of endometriosis may include numerous anechoic tubular structures with a diameter of 1 mm in the fallopian tubes and cervical canal, thickening of the endometrium with its deformation, areas in the uterine cavity with absent endometrium, asymmetry and thickening of the walls of the uterus.

An increase in the size of the uterus may be a sign of pregnancy, benign or malignant tumor. At the same time, the heterogeneous echostructure of the uterine body speaks in favor of the tumor.

Endometrium

Ultrasound can detect polyps, cancer, endometrial hyperplasia.

The presence of isoechoic or hyperechoic formations with cystic inclusions inside them indicates endometrial polyps. In addition, signs of endometrial polyps are the expansion of the uterine cavity and the presence of fluid in it.

Endometrial cancer is characterized by an increased thickness of the endometrium, poorly demarcated from the myometrium, its edges are uneven, increased echogenicity, and there may be fluid in the uterine cavity.

If the endometrium is thicker than normal, especially in women in menopause, and this is combined with bleeding, then most likely we are talking about endometrial hyperplasia.

Cervix

Based on the results of an ultrasound of the cervix, endometriosis, cancer, Nabothian cysts, fibroids, polyps, etc. can be detected.

An increase in the diameter of the cervical canal of more than 3 mm indicates endometriosis or cancer.

The presence of single or numerous round anechoic formations with a diameter of 5–10 mm indicates nabothian cysts.

Hyperechoic homogeneous nodes in the cervical area may be fibroids or polyps of the cervical canal.

An increased size of the uterus, accumulation of blood or pus in its cavity, combined with enlargement of the pelvic lymph nodes may be signs of cervical cancer. However, ultrasound is a very unreliable method for diagnosing this formidable pathology.

Ovaries

Ultrasound data can reveal cysts, polycystic ovaries, cystomas, cancer, serosocele, adnexitis, etc.

If a thin-walled single-chamber formation filled with fluid is visible on the ovary, sometimes with hyperechoic dense inclusions of various sizes, without papillary growths on the walls, then this indicates a cyst.

If the ovary shows a single-chamber or multi-chamber dense round formation with thick walls and papillary growths, hypoechoic or anechoic structure, of any size, then this may be a sign benign tumor– cystomas (cystadenomas, teratomas) or ovarian cancer.

Dense hypoechoic homogeneous education on the ovaries, sometimes with anechoic inclusions, may be fibroma.

Multi-chamber formations of various sizes and indeterminate form, appeared after transferred gynecological operations or inflammatory processes in the pelvis, may be serosoceles (cysts of the peritoneum adjacent to the ovaries).

If the ovaries have a large volume, more than 12 follicles (anechoic inclusions) are identified in them, randomly located throughout the tissue of the organ, and the dominant follicle is not visible, then this indicates polycystic ovaries.

If the ovaries are enlarged in size, their contours are unclear, and their echogenicity is heterogeneous, then these are signs of adnexitis (inflammation of the ovaries).

The fallopian tubes

If the doctor sees fallopian tube on an ultrasound, this may indicate an ectopic pregnancy, an inflammatory process in the organ area (salpingitis) or an accumulation of fluid in the tube (hydrosalpinx) and/or pus (pyosalpinx).

Free fluid in the space of Douglas and retrouterine space

Normally, a small amount of fluid in the pelvis and pouch of Douglas can be detected on days 12–15 of the menstrual cycle (ovulation period). But the appearance of a large amount of fluid in the pelvis and pouch of Douglas on any day of the menstrual cycle is a sign of the following diseases:

• Ectopic pregnancy;
• Endometritis;
• Endometriosis;
• Adnexitis;
• Ovarian cyst;
• Purulent salpingitis;
• Internal bleeding;

Pelvic veins

If they are expanded or tortuous, this may indicate stagnation of blood circulation in the pelvis or malignant tumors.

Where to do an ultrasound of the pelvic organs

Ultrasound of the pelvic organs can be done in almost any municipal city or district clinic on the basis of the department functional diagnostics or in antenatal clinics. Also, ultrasound of the pelvic organs can be performed in hospitals with gynecological or urological departments or specialized research institutes. IN government institutions, if you have a referral from a doctor, ultrasound of the pelvic organs is performed free of charge on a first-come, first-served basis.

On a paid basis, ultrasound of the pelvic organs can be performed in public clinics and hospitals out of turn or in numerous private medical centers.

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