Imaging the reproductive system

Question 1

Describe the structure of the uterus

Answer 1

Hollow muscular organ, 7.5cm non-pregnant
Main portion- body
Elongated lower part- neck
Opening- os
Upper rounded part- fundus
Cervix connects lower part to vagina

Question 2

What supports the uterus in the pelvis cavity

Answer 2

Broad ligaments, round ligaments, cardinal ligaments, rectouterine and vesicouterine ligaments

Question 3

What is a transvaginal ultrasound used for

Answer 3

To view the endometrium (lining of uterus), including thickness
Look at ovaries
Evaluate myometrium (muscular walls of uterus)

Question 4

What is sonohyterography

Answer 4

Ultrasound where fluid is put into uterus before applying sound
More detailed than normal ultrasound
Used to detect: uterine anomalies, uterine scars, endometrial polyps, fibroids, cancer

Question 5

What is Doppler ultrasound (and principle)

Answer 5

Ultrasound that measures the direction and speed of blood cells.
Principle- Doppler effect- movement of blood cells causes change in pitch of reflected sound waves

Question 6

What are the benefits of ultrasound

Answer 6

Preferred method for pregnant women
Real time imaging- good for guiding minimally invasive procedures eg. needle biopsies
Less risk than x-ray
No known harmful effects

Question 7

What is hysterosalpingography

Answer 7

Older ultrasound technique involving small dose of radiation which is injected into uterine cavity under pressure, contrast tracks along fallopian tubes and x-ray image obtained

Question 8

When should imaging be done during pregnancy

Answer 8

Early if there is a clinical reason
12 week for dating and nuchal thickness
20 week anomaly scan
Additional depending on clinical need

Question 9

What is assessed at the 12 week scan

Answer 9

Crown rump length- date pregnancy
Heartbeat- viability
Number of fetuses
Nuchal translucency- indicator of genetic problems

Question 10

What is assessed at the 20 week scan

Answer 10

Detailed whole body scan
Nature of abnormality- viability
Extent of abnormality
Assessment of placenta + location

Question 11

What happens if an abnormality is detected at ultrasound

Answer 11

Counselling
Additional investigations- blood test, amniocentesis, further ultrasound
MRI- can give better definition of brain and soft tissues but worse for limbs. Easier for patients to understand. Only done for clinical need and not routine on NHS

Question 12

Why is post-mortem imaging important

Answer 12

Identifies problems and can be used to form advice for next pregnancy