Category: 2. Transabdominal Pelvic Ultrasound Protocol

The ovaries can be difficult to find because of the overlying bowel gas. Having a full bladder can help visualize the ovaries in a transabdominal view since the bladder can be used as an acoustic window. For the most part, transvaginal ultrasound should be used to evaluate the ovaries.

• With the probe still in the transverse position, rock the tail of the probe to the patient’s left to visualize the right ovary.
• You can visualize the left ovary using a similar technique (rock the tail of the probe to the patient’s right).

An ovary can be identified on ultrasound by the following characteristics:

• Lateral and/or posterior to the uterus
• Typically measures 2-3 cm in diameter
• Less echogenic than surrounding tissue
• Static (compared to surrounding bowel)
• Anechoic follicular structures

• Rotate the probe 90 degrees counterclockwise with the indicator towards the patient’s right.

• Obtain a good view of the fundus of the uterus as well as the endometrium and myometrium.
• Tilt/fan your probe through the entire uterus in the transverse view.

The sagittal view of the uterus is also known as the longitudinal view on ultrasound.

• Position the curvilinear probe with the probe indicator toward the patient’s head along the midline of the patient’s abdomen in the suprapubic area.

Identify the following structures:

• Bladder (use as acoustic window)
• Uterine fundus
• Uterine body
• Endometrial Stripe
• Cervix
• Vagina
• Posterior Cul-de-Sac (Pouch of Douglas)
• Rectum

• You may see Nabothian cysts (small, anechoic/hypoechoic circular structures on the cervix) on ultrasound. Nabothian cysts are usually considered benign findings and can occur in about 12% of the population (Fogel 1982).

Transabdominal Pelvic Ultrasound can detect most larger abnormalities such as large fibroids, ovarian cysts, neoplasms, etc. However, its views may be limited by abdominal structures such as bowel gas.

In general for POCUS exams, it is usually good to start with the transabdominal ultrasound and then use the transvaginal approach if needed.

Patient Preparation

• Supine
• Full bladder (if possible)

Ultrasound Machine Preparation

• Transducer: Curvilinear Ultrasound Probe (Ideal Choice) or Phased Array Probe.
• Preset: Pelvic or Abdomen
• Machine Placement: Position the ultrasound machine on the right side of the patient with the screen facing you. With this configuration you can face both the patient and the ultrasound screen, scanning with your right hand and manipulating buttons on the machine with the left hand.