Pelvic ultrasound — transabdominal and transvaginal
Uterus, endometrium, both ovaries, adnexa, pouch of Douglas
When to use it
- Acute pelvic pain, suspected ovarian torsion or adnexal mass.
- Abnormal uterine bleeding; endometrial thickness assessment.
- Early pregnancy assessment including suspected ectopic pregnancy.
Technique
- Transvaginal imaging materially outperforms transabdominal for the endometrium and adnexa; transabdominal alone is usually insufficient for these questions.
- Doppler assessment of ovarian flow where torsion is suspected.
Where it goes wrong
- Normal ovarian Doppler flow does NOT exclude torsion — the diagnosis is clinical and morphological as much as vascular.
Clinical questions that reach this study
Suspected ectopic pregnancyAcute pelvic pain in the reproductive age group (including suspected PID and tubo-ovarian abscess)Suspected ovarian (adnexal) torsionAdnexal mass — characterisation and risk stratificationSuspected endometriosis, including deep diseaseAbnormal uterine bleeding and endometrial assessmentSuspected ovarian cancer or indeterminate adnexal mass
Contrast
None
Acquisition
- Preparation
- Full bladder for the transabdominal component; emptied before transvaginal.