Lecture 1 DR/ AMR SALAH
1
Introduction and
2
anatomy
3
Normal female organs 4
tube tube
Uterus ovary
ovary
5
6
Transabdominal
7
ultrasound
8
9
LS section 10
head leg
Ant
head
leg
rectum post
11
12
13
Rectum
14
15
16
Upper TS section 17
LT
LT
RT
Lower TS section
18
LT
ANT
RT LT
UB
RT
U/C
R post
19
20
21
22
23
24
Cervix 25
26
Cervix 27
Isthmus 28
Uterine position 29
ANT
Head
post
Post
depends upon fundus face towards ant
Anteverted retroverted
abdominal wall or towards rectum, spine
30
retroverted usually cause LBP
31
32
33
34
35
36
Version and flextion 37
Anteverted vs anteverted anteflexed 38
ub
ub
AV AF AV 39
41
associated with pelvic adhesion, secondary infertility
Z shape uterus >>anteverted retroflexed 42
?? 43
AV / RV / axial 44
45
risk of recurrent abortion
Axial uterus
leg
head
46
Retroverted 47
Retroverted vs. retroflexed uterus 48
?? 49
May look like fibroid 50
?? 51
?? 52
Transvaginal
53
ultrasound
54
55
56
57
58
59
60
61
62
Cervix by TV/sus 63
Cervix by TV/us 64
65
66
67
68
RVF uterus transvaginally 69
70
UB
UB
post
ant
post ant
Anteverted retroverted 71
72
?? 73
74
75
76
UB
77
AV AV AF 78
RV RV RF 79
Axial uterus 80
81
Ls to ts 82
83
84
85
86
87
Don’t do transvaginal only 88
Pelvic ultrasound 89
• 1- Uterus
• 2- Myometrium
• 3- Endometrium
• 4- Cervix
• 5- Vagina
• 6- Adnexa
• 7- Pelvic cavity and relations
90
Uterus in pediatric age group 91
• Neonatal uterus: The uterus is relatively prominent because of exposure to
maternal hormones with an average uterine length of 3.5 cm and thickness of
1.5 cm.
• Pediatric uterus : The uterus is usually less than 3 cm and becomes 3–4.5 cm in
the prepubertal age group.
• The cervix in the pediatric age group is prominent and equal in proportion to
the uterine body.
• At puberty : the uterus is usually 5–8 cm long. the uterine body becomes
thicker and pear shaped with a uterine body to cervix ratio of about 1.5: 1.
Uterus in pediatric age group 92
93
94
95
Uterus in the reproductive age group 96
• Dimensions of a normal uterus are about 8 cm in length, 4 cm in AP diameter and 5 cm
in width, with the multiparous uterus being about a centimeter larger in each
dimension.
• The uterine body is approximately twice the size of the cervix.
• After delivery, the uterus undergoes physiological evolution during the 6–8 weeks of
puerperium to return to its normal size.
• Immediately after delivery, the uterus is about 20 cm in length, and after 3 weeks, it is
about 11 cm in length.
Uterus in the reproductive age group 97
Blood supply 98
Arcuate vessels 99
Between intermediate and outer layers of myometrium
Arcuate arteries and veins
No visible in intermediate layers
Arcuate veins 100
• Normal in childbearing years
• Serpentine , tubular structures in periphery
• Doppler : venous flow
101
102
Postmenopausal uterus 103
• The uterus is smaller in size, usually less than 7.5 cm.
• This of course depends on the time since menopause, parity of the patient and the presence of
pre-existing myometrial pathology.
• The uterine body to cervix ratio approaches 1:1.
• In elderly postmenopausal women (particularly those with vascular disease, diabetes or
hypertension), calcified arcuate vessels are noted.
• These are seen in the outer myometrium as peripheral bright scattered foci with some
shadowing which are arranged circumferentially around the uterus.
Postmenopausal uterus 104
105
106
Pelvic ultrasound 107
• 1- Uterus
• 2- Myometrium
• 3- Endometrium
• 4- Cervix
• 5- Vagina
• 6- Adnexa
• 7- Pelvic cavity and relations
2 myometrium 108
2 myometrium 109
2 myometrium 110
3- Endometrium 111
3- Endometrium 112
113
Endometrium 114
It has a basal layer adjacent to the myometrium and a functional layer containing glandular tissue. In
women of menstrual age, the functional layer changes markedly during the menstrual cycle & shed
during menstruation.
After menstruation, the endometrium enters its proliferative phase, during which the functional layer
regenerates in response to stimulation by estrogen produced by ovarian follicles.
This phase continues until ovulation, at mid-cycle, when a dominant ovarian follicle ruptures.
The resulting corpus luteum produces progesterone. Under the influence of progesterone, the
endometrium enters its secretory phase, during which its glands begin to secrete. The secretory phase
continues until menstruation begins anew.
115
116
117
118
119
120
121
122
In premenopausal patients, there is significant variation at different stages
of the menstrual cycle.
• secretory phase: 16 mm
• following dilatation and curettage or spontaneous abortion: <5 mm, if it is
thicker consider retained products of conception
Postmenopausal
• vaginal bleeding upper limit is 6 mm
• no history of vaginal bleeding: upper limit 8 mm
Thickened endometrium 123
Pelvic ultrasound 124
• 1- Uterus
• 2- Myometrium
• 3- Endometrium
• 4- Cervix
• 5- Vagina
• 6- Adnexa
• 7- Pelvic cavity and relations
4-cervix 125
126
Transvaginal ultrasound 127
Cervical cysts 128
129
130
131
Pelvic ultrasound 132
• 1- Uterus
• 2- Myometrium
• 3- Endometrium
• 4- Cervix
• 5- Vagina
• 6- Adnexa
• 7- Pelvic cavity and relations
Vagina 133
134
5- vagina 135
136
137
Pelvic ultrasound 138
• 1- Uterus
• 2- Myometrium
• 3- Endometrium
• 4- Cervix
• 5- Vagina
• 6- Adnexa
• 7- Pelvic cavity and relations
6- Adnexa 139
Uterine tube 140
• also known as the Fallopian tube or less commonly the oviduct
• The uterine tube is approximately 10-12 cm long and 1-4 mm
divided into 5 anatomic segments (from lateral to medial, the direction
an ovum would pass following ovulation): 141
• Fimbriae: ~25 finger-like
projections that drape over the
ovary
• infundibulum: a funnel-shaped
lateral part that drapes over the
ovary with the fimbriae emanating
from it
• it opens into the peritoneal
cavity at the abdominal ostium
• Ampulla: the widest and longest
section, forming over half the
length
• Isthmus: immediately lateral to the
uterus, it is the narrowest segment,
as its name suggests
• Interstitial or intramural segment:
the section within the myometrium
Four INches Across IS Impossible 142
• Four inches (10 cm) is the
approximate length of the
Fallopian tube.
Mnemonic
• F: fimbriae
• IN: infundibulum
• A: ampulla
• IS: isthmus
• IM: intramural (interstitial)
143
144
145
Ovaries 146
• Proliferative phase: many follicles that are stimulated by both (FSH) and (LH)
develop
• Day 8 or 9 one follicle becomes dominant, destined for ovulation, and
increases in size, reaching up to 2.0 to 2.5 cm at ovulation
• After ovulation, the corpus luteum develops and may be identified
sonographically as a small, hypoechoic or isoechoic structure peripherally
within the ovary. The corpus luteum involutes before menstruation
Ovulatory cycle 147
menstruation
148
149
150
151
152
153
Ovaries 154
155
156
Ovaries 157
Pelvic ultrasound 158
• 1- Uterus
• 2- Myometrium
• 3- Endometrium
• 4- Cervix
• 5- Vagina
• 6- Adnexa
• 7- Pelvic cavity and relations
159
160
161
Normal hysterosalpingography 162
Normal hysterosalpingography 163
164
165
Saline infusion sonohyesteraphy ( SIS) 166
Value of saline infusion sonohyesteraphy ( SIS) 167
Confirmed endometrial
Lesion hardly seen by
poly
Transvaginal U.S
By SIS
Value of saline infusion sonohyesteraphy ( SIS) 168
Confirmed endometrial
Lesion hardly seen by
poly
Transvaginal U.S
By SIS
Quiz 169
Position ?? 170
171
172
Age ?? 173
174
175
176
177
Age 178
179
180
181
182
183
Thank you
