Posted on May 30th, 2017 by wombwithaviewblog.com
transvaginal ultrasound, endovaginal, TV probe

TV Probe

Transvaginal Ultrasound ~
You’re Gonna Put What WHERE?!


I always know that face…the one with the saucer-like eyes and mouth gaping open in utter shock as soon as I speak the words “transvaginal ultrasound.” I point to the probe sitting so innocently on my machine. Poor thing…it gets such scathing rejection and so little credit!

I can’t really blame the patient. After all, a gynecological scan isn’t exactly something people volunteer for (unlike the OB ones – at least they have something cute to ogle!). I can’t tell you HOW MANY times patients have said, “Boy, these are more fun when there’s a baby in there.” A dollar for every one of those comments and I’d have a penthouse in Manhattan by now.

Most patients still in the baby-making stages of life are typically pretty familiar with a transvaginal ultrasound. It’s how we see Baby early in the first trimester or monitor the cervix. But many young or older women are not familiar with my long skinny friend. Some are mortified at the thought of this exam. To note, these patients are always there because of a problem which could be a whole myriad of issues from crazy periods to ovarian cysts.

The Transvaginal Ultrasound Protocol

One thing is for sure. Give me a woman with pelvic pain and, I can promise you, the last thing she wants to see is any ferociously-long object headed down south. I first apologize then promise that it’s quick and painless. I also add that at least they didn’t have to drink a gallon of water and hold it. Okay, I’m over-exaggerating. Some facilities still require patients to drink approximately 32 ozs of fluid for a transabdominal pelvic ultrasound (a scan on top the belly). You can read more about bladder preps here: How Much Water to Drink for Your Ultrasound

This little fact is usually enough to get a deliberately labored, “Okaaaaaay, what do I have to do now?” But it’s still a consent! Goal.

Transvaginal Ultrasound Provides You a Better Exam!

Vaginal ultrasound is probably, to me anyway, THE best ultrasound invention since ultrasound’s inception. I tell patients it really is the difference between night and day. It’s much like looking out of a clear glass window versus one with a sheer curtain drawn. I would say that about 95% of the time, I can see better when using the vaginal approach. A very large uterus or pelvic mass, however, would require an abdominal approach.

Did you just say you want a little Ultrasound Physics 101?? Well, I thought so! I’ll make it short. The transvaginal probe is built to deliver a higher-frequency sound wave which doesn’t penetrate very deep into the body. It offers by far the BEST resolution because the uterus and ovaries lie close to the probe. When we scan over the pelvis with a full bladder, the fluid provides a window for the uterus and ovaries behind it. However, by the time the sound waves get all the way down to those organs and back, we have a somewhat compromised image. The vaginal probe requires an empty bladder which allows us to see the uterus better.

We cover the probe with a condom or glove and insert it into the vaginal canal like a tampon. Be sure to let your sonographer know if you have a latex allergy! We place the probe against the cervix only; it does NOT enter into the uterus. The cervix remains closed (unless you’re in labor), so it cannot be inserted past this point. The sonographer obtains a magnified image of the uterus and ovaries and the areas immediately around them. We measure the uterus, endometrium (lining of the uterus), ovaries, and any pathology that we see related to those organs. Air and gas are not our friends, so sometimes those factors interfere with a good image.

How Long Does a Transvaginal Ultrasound Take?

About fifteen minutes, longer if the exam is complicated by pathology or if views we need are difficult to obtain. (By the way, “pathology” doesn’t always mean a worrisome or dangerous process!) When it’s over, the patient usually says the exam wasn’t that bad at all! Frequently, they will share the reason for their trepidation. It’s mostly because a friend had one done by a technologist with a heavy hand, making it quite a painful experience. I’ll usually respond by saying, “Firstly, you should ALWAYS tell someone when your exam is that painful. And, secondly, we don’t need to see your tonsils!” I’m not a comedienne, but that comment usually gets a much-needed laugh, and the end of the scan is very much appreciated:)

***

More coming about transvaginal ultrasound and your early OB scans with the release of my new book about first-trimester ultrasound. Hopefully, very soon! You can receive automatic updates on the book (along with a little something special when it publishes!) and the most current posts by subscribing to my blog. You’ll see where in the right margin! >>

Once again, THANKS FOR READING!

And please feel free to email me any questions you have at wombviewerblog@gmail.com.

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Posted on February 1st, 2015 by wombwithaviewblog.com

Most OB patients today get an endovaginal ultrasound for 1st Trimester dating when they establish care for a new pregnancy. Most offices maintain requirements for when this first visit should be scheduled. There is good reason for this! Most patients want to see their docs AS SOON as the pee stick demonstrates that little plus sign. However, the problem here is that very little can be determined by your doctor too early in the first trimester. Except, of course, that you’re pregnant!

Some home pregnancy tests like to brag that you can know you’re pregnant as early as your first missed day. But this isn’t always a good thing, especially for those overly-anxious mamas. Naturally, the next question they all have is “Is everything okay?” If you are less than 6 Weeks (from your LMP or last menstrual period), your healthcare provide just cannot confirm this. If you ovulated even one week later, it means we still aren’t going to see much on your endovaginal examination. The earliest we can measure an embryo and detect cardiac activity is about 6 Weeks gestational age.

Even then, it can be quite difficult to see well or measure depending on position of the embryo and uterus. If you are even a few days earlier than this, we would only see a gestational sac and possibly a yolk sac. It’s not feasible to scan you every day and your insurance company will not allow it, anyway!  All the above reasons are why some docs specify a confirmation visit no earlier than 8wks for a 1st trimester dating scan, when we should be able to confirm a fetal pole and a heartbeat.  Coming in too early if your dates are off means your doctor will then have to order a follow-up visit for you in a week or two to confirm a normal early pregnancy.  Trust me!  This will feel like the LONGEST one or two weeks of your life!

Sometimes the dates conflict. Your LMP may say you are 10wks but we see a fetal pole that measures 6wks. This just means you really became pregnant a month later. When these numbers are discrepant by more than just a few days, your doctor will typically use the gestational age we obtain by ultrasound.  See the fetal pole and report images below.

10w2d Fetus

SONY DSC

Note that on the report, the patient should have been 11w3d by her LMP of November 10 but Baby measured 10w2d instead.  With dates = 8d off at this point, her doctor will likely go with the due date of 8/25/2015 instead of 8/17.

So, take my word for it.  The only thing worse than waiting to see your doctor for your first OB visit is going to see her and then leaving without answers.  Trust your doctor’s office when you call to make this appointment and they say it’s too early!  They know what’s better for you than you do;)

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