3. Transvaginal Pelvic Ultrasound Protocol

Step 3: Obtain View of Ovaries

In general, you can use either a sagittal or transverse view to identify the ovaries, which are usually located lateral and/or posterior to the uterus (Sohoni 2014).

Tip: If you have trouble viewing the ovary, try directing the endocavitary probe more posteriorly.

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

  • Posterior and lateral to uterus
  • Typically measures 2-3 cm in diameter
  • Less echogenic than surrounding tissue
  • Static (compared to surrounding bowel)
  • Anechoic follicular structures
Normal Ovary Transvaginal Ultrasound Pelvic
Normal ovary with follicle/cyst; transvaginal ultrasound

Step 4: Disinfect Endocavitary Probe

When you complete your transvaginal ultrasound exam it is imperative that you disinfect the probe properly using your hospital approved process.

3. Transvaginal Pelvic Ultrasound Protocol

Step 2: Obtain Transverse View of Uterus

  • Rotate the probe 90 degrees counterclockwise (toward the patient’s right, or the 9 o’clock position) to obtain a good view of the bladder, myometrium, and endometrium of the uterus. Tilt/Fan superiorly and inferiorly to view then entire uterus in the transverse view.
Transvaginal Ultrasound Uterus Transverse View
Normal Uterus; Transverse transvaginal ultrasound
3. Transvaginal Pelvic Ultrasound Protocol

Step 1: Obtain Sagittal/Longitudinal View of Uterus

  • Gently insert the probe into the patient’s vagina with the indicator at 12 o’clock (toward the ceiling).

Tip: Aligning your thumb with the probe indicator helps you know the exact orientation of the probe despite any manipulation you do throughout the exam.

  • Keep an eye on the ultrasound monitor as you insert the probe because the depth of insertion will vary depending on patient anatomy. The goal is to orient the hyperechoic endometrial stripe in the center of the image.
  • Tilt/Fan your probe to medially and laterally to visualize the entire uterus in the sagittal/longitudinal view.

Identify the following structures:

  • Bladder
  • Uterine fundus
  • Endometrium/Endometrial stripe
  • Myometrium
  • Cervix
  • Pouch of Douglas (Posterior cul-de-sac)
  • Rectum
Transvaginal Ultrasound Uterus Sagittal View
Sagittal transvaginal Ultrasound with free fluid in pouch of Douglas
3. Transvaginal Pelvic Ultrasound Protocol

Ultrasound Machine Preparation

  • Transducer: Transvaginal/Endocavitary probe.
  • Preset: Gyn/Pelvic
  • Will also need a sterile condom (or sterile glove) and sterile gel.
Endocavitary Transvaginal Ultrasound Probe Setup
  • The indicator is located at the 12 o’clock position of the probe.
  • Place gel at the tip of the endocavitary probe.
  • Apply sterile glove or sterile condom over the endocavitary probe
  • Apply sterile gel to the tip of the covered endocavitary probe.
Endocavitary Transvaginal Ultrasound Probe Gel
Endocavitary Transvaginal Ultrasound Probe Gel with Sterile Glove Condom Cover
  • Machine Positioning: 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 other hand. Also position a chair at the foot of the bed to sit in while performing the scan.
3. Transvaginal Pelvic Ultrasound Protocol

Transvaginal Pelvic Ultrasound Protocol

Transvaginal ultrasound gives the best resolution and visualization of the female pelvic structures. However, it is considered more invasive than the transabdominal approach.

Patient Preparation

  • Dorsal Lithotomy position. Make sure to have a drape/sheet and cover the patient properly. Position them similarly to how you would perform a normal pelvic exam.
  • Empty bladder (if possible)
  • Have a chaperone present in the room with you.