Ultrasound

Ultrasounds use sound waves to obtain images. Real-time imaging is the main sonographic technique that is used for both obstetrical and gynecological ultrasounds.

Obstetrical Ultrasounds

Obstetrical ultrasounds can be performed during all stages of the pregnancy. Ultrasounds are performed mainly using either a trans-abdominal or trans-vaginal approach.

Indications for 1^st trimester ultrasounds (before 14 0/7 weeks gestation):

• Confirm presence of an intrauterine pregnancy
• Evaluate for possible ectopic pregnancy (pregnancy outside the uterus)
• Evaluate for vaginal bleeding in pregnancy
• Evaluate for pelvic pain in pregnancy
• Estimate gestational age
• Diagnose/evaluate for multiple gestations
• Confirm cardiac activity of the fetus
• Evaluate for certain anomalies in the fetus
• Evaluate for any adnexal/ovarian masses in the mother

Most patients typically have at least one ultrasound in the 1^st trimester to confirm presence of a viable pregnancy within the uterus and also to help to estimate the gestational age of the fetus.  An ultrasound in the 1^st trimester of the pregnancy is considered to be the most accurate in estimating the gestational age of the fetus.1^st trimester ultrasounds can be done both with a trans-vaginal or trans-abdominal approach depending on what is being evaluated.

Ultrasounds in 2^nd and 3^rd trimester on the other hand are more commonly done with the trans-abdominal approach, but a trans-vaginal approach may also be used as needed.

Common indications for 2^nd and 3^rd trimester ultrasounds include:

• Screening for anomalies in the fetus
• Evaluation of the fetal anatomy
• Estimation of gestational age
• Evaluation of fetal growth
• Evaluation of vaginal bleeding
• Evaluation of abdominal/pelvic pain
• Evaluation of cervical insufficiency
• Determination of fetal presentation
• Evaluation of suspected multiple gestation
• Evaluation of maternal pelvic mass
• Suspected uterine anomalies
• Evaluation of fetal well-being
• Evaluation of suspected abnormalities of the amniotic fluid
• Evaluation of the placenta.

Most patients generally receive at least one ultrasound in the 2^nd trimester for evaluation of fetal anatomy.  According to the American College of Obstetrics and Gynecology, the optimal time for this ultrasound is at 18-22 weeks of gestation.  Ultrasonography is considered safe for the fetus when it is used appropriately to help gain medical information important for the pregnancy.

Gynecological ultrasounds

Just like obstetrical ultrasounds, gynecological ultrasounds can also be done via a trans-vaginal or trans-abdominal approach (although the trans-vaginal approach is usually more commonly used).

Indications for gynecological ultrasounds include:

• Evaluation of menstrual cycle (evaluate thickness of endometrial lining)
• Development of ovarian follicles
• Localization of intrauterine devices
• Evaluation of abnormal/heavy uterine bleeding
• Evaluation of postmenopausal bleeding
• Assessment of pelvic mass
• Evaluation of pelvic pain
• Evaluation of congenital uterine anomalies
• Adjunct for evaluation/treatment of infertility.

An additional type of gynecologic ultrasound that can also be performed at our office is the saline infusion sonohysterography (SIS).  This ultrasound involves fluid being infused into the uterine cavity through the cervix to help provide improved visualization of the endometrial cavity/lining during a trans-vaginal ultrasound.

Common indications for SIS include:

• Abnormal uterine bleeding
• Suspected uterine cavity abnormalities such as uterine fibroids and polyps
• Congenital abnormalities of the uterine cavity
• Infertility
• Recurrent pregnancy loss