TOPICS TO BE COVERED

FEMALE REPRODUCTIVE SYSTEM ANATOMY

Uterus
Vagina
Ovaries
Fallopian Tubes

Location

Physiology
Sonographic appearance
Normal variants
Patient preparation
Patient positioning
Transducer choice
Breathing technique

The Female pelvis

Serves three principal functions
1It provide a weight-bearing bridge
between the spinal column and the bone of the
lower limbs through the sacrum and the in
nominate bone.
2It directs the pathway of the fetal head
during childbirth
3- It protects the organ of reproduction.

LOCATION
The urinary bladder is posterior to the symphysis
pubis
The uterus, cervix, and vagina are posterior to the
distended bladder and anterior to the rectum
The fundus of the uterus usually lies just to the right
or left of midline
The cervix and vagina usually lie in the midline of he
pelvic cavity.
The ovaries are lateral to the uterus an lie against the
pelvic side walls
The ureter and internal iliac vessels are posterior to
the ovary

ANATOMY
The female pelvic cavity consists of the female reproductive
organs, a portion of the ureters, the urinary bladder,
musculature, and intestinal tract
The female reproductive system consists of the vagina, uterus,
two fallopian tubes, and two ovaries
The adnexa consists of the ovaries, fallopian tubes, pelvic
ligaments, and pelvic side walls
The vagina is a muscular, tubular structure that extends from
the cervix of the uterus to the vulva
The uterus is a muscular, hollow organ. The size of the uterus is
variable depending on patient parity and age
Postpubertal size is usually 7 to 8 cm long, 3 to 5 cm wide, and
3 to 5 cm thick

 The uterus consists of three muscle layers

Endometrium: the inner mucous layer.
Myometrium: the middle, smooth muscle, thickest layer.
Serous: the outer peritoneal layer.
The uterus is pear-shaped; its rounded superior portion is the
fundus and inferior tapering portion is the cervix or neck.
The middle portion of the uterus is referred to as its body.
The uterus has a centrally located endometrial cavity. The
cervical portion of the cavity where it meets the vagina is
referred to as the external os and where it meets the uterine
body is referred to as the internal os.

 The uterine cavity is continuous with the centrally located vaginal

canal.
The fallopian tubes arise from the uterus and course within the
broad ligament for about 10 cm (4in) toward the ovaries.
The ovaries are oval-shaped organs that lie within the ovarian
fossa against the pelvic sidewalls. The size of the ovaries is
variable and depends on age.
Postpubertal size is approximately 2 cm long, 2 cm wide, and 3
cm to 4 cm thick.
The two ureters are long, narrow tubular structures that extend
from the hilum of each kidney to the urinary bladder. The ureters
are less than 1.4 in wide and 10 to 12 in long. The ureters
decrease in diameter as they course to the bladder.

 The urinary bladder is a symmetrical, hollow, muscular

organ. Bladder shape is variable depending on distention.
The bladder can hold as much as 16 to ounces of urine.
The normal distended urinary bladder wall measures 1 cm
or less.
Pelvic side wall musculature includes:
Obturator internus muscle.
Iliopsoas muscle.
Piriformis muscle.
Pubococcygeal sling muscle.

Muscle

Location

Rectus abdominis

Anterior wall

Psoas Major

Posterior

Illiacus

Iliac fossa

Obtrator Internrus

Lateral wall

Priformis

Posterior wall

Coccygeus

Posterior floor

Levator Ani

Middle and anterior floor

PHYSIOLOGY
The function of the uterus, vagina, and ovaries is
reproduction.
The function of the ureters is to carry urine from the
hilum of each kidney to the urinary bladder.
The function of the urinary bladder is to store urine
until the urge to void is felt.

SONOGRAPHIC APPEARANCE
The uterine myometrium is midgray or medium-level echoes with
even texture. The contour of the normal myometrium should appear
smooth. Occasionally round, anechoic venous structures may be
seen along the uterine periphery.
The endometrial cavity is a thin echogenic line that varies in
intensity and thickness depending on the menstrual phase and
patient age.
The vaginal walls are midgray or medium-level echoes with even
texture that is equal to the normal uterus. The vaginal canal is
echogenic.
The ovaries are midgray or medium-level echoes with even texture
that is equal to or more echogenic than the normal uterus. Uterine
follicles are seen as round or oval anechoic structures along the
ovarian periphery.

 The pelvic side wall musculature is midgray or

medium-level echoes with even texture that is less
echogenic than the normal uterus and ovaries.
The cul-de-sac or pouch of Douglas is a recessed
portion of the peritoneum posterior to the uterus
that is seen when it contains fluid or blood. It is
normal to see a small amount of anechoic free fluid
between the echogenic walls of the cul-de-sac and
the myometrium of the uterus.

SONOGRAPHIC APPEARANCE
The fallopian tubes are not normally seen.

The ureters are not normally seen.

The urinary bladder cavity is not seen if it is
collapsed; otherwise it appears anechoic.
The bladder wall appears as a smooth, thin
echogenic line. Distended bladder shape is
variable but transversely it may appear somewhat
squared.

Anteverted Uterus

The menses phase

The menses phase this phase, which
typically lasts from day 1 to day 5, is the time
when the lining of the uterus is actually shed
out through the vagina if pregnancy has not
occurred. Most women bleed for 3 to 5 days,
but a period lasting only 2 days to as many as
7 days is still considered normal.

The follicular phase

This phase typically takes place from days 6 to 14.
During this time, the level of the hormone
estrogen rises, which causes the lining of the
uterus (called the endometrium) to grow and
thicken. In addition, another hormonefolliclestimulating hormonecauses follicles in the
ovaries to grow. During days 10 to 14, only one of
the developing follicles will form a fully mature
egg (ovum).

Ovulation
Ovulation this phase occurs roughly at
about day 14 in a 28-day menstrual cycle. A
sudden increase in another hormone
luteinizing hormonecauses the ovary to
release its egg. This event is called ovulation.

The luteal phase

This phase lasts from about day 15 to day 28.
After the egg is released from the ovary it begins
to travel through the fallopian tubes to the
uterus. The level of the hormone progesterone
rises to help prepare the uterine lining for
pregnancy. If the egg becomes fertilized by a
sperm and attaches itself to the uterine wall, the
woman becomes pregnant. If pregnancy does not
occur, estrogen and progesterone levels drop and
the thickened lining of the uterus is shed during
the menstrual period.

NORMAL VARIANTS
Retroverted uterus:
The entire uterus is tilted posteriorly
Sonographic appearance is the same as that of
the normal uterus
Retroflexed uterus:
Only the uterine fundus and body are tilted
posteriorly.
Sonographic appearance is the same as that of
the normal uterus

Retroverted Uterus

NORMAL VARIANTS
Didelphia uterus:
Developmental variant causing two uterine bodies, two
cervices, and two vaginas.
Sonographic appearance is the same as that of the
normal uterus, cervix, and vagina.
Bicornuate uterus:
Developmental variant causing two uterine bodies
(divided) or two uterine horns (septated) with one
vagina and one or two cervices.
Sonographic appearance is the same as that of the
normal uterus, cervix, and vagina.

Didelphia uterus

Bicornuate uterus

PATIENT PREP
Full urinary bladder.
32 to 40 ounces of clear fluid should be ingested one
hour before the exam and finished within a 15 to 20
minute time period.
if for any reason the patient cannot have fluids,
sterile water can be used to fill the bladder through
a Foley catheter.

PATIENT POSITION
Supine.
TRANSDUCER
3.0 MHz or 3.5 MHz.
5.0 MHz for thin patients.

TRANSABDOMINAL FEMALE PEVLIS SCANNING

PROTOCOL
LONGITUDIANL IMAGES
Longitudinal image of the midline images of the pelvic cavity just
superior to the symphysis pubis
Longitudinal image of the right adnexa that may include part of
the uterus depending on its lie
Longitudinal image of the left adnexa that may include part of the
uterus depending on its lie
Longitudinal image of the right lateral wall of the bladder and
pelvic side wall
Longitudinal image to include left lateral wall of the bladder and
pelvic side wall
Long axis image of the uterus to include as much endometrial
cavity as possible with superior to inferior and anterior to posterior
measurement
Same image as above without calipers

TRANSABDOMINAL FEMALE PEVLIS

SCANNING PROTOCOL

TRANSVERSE IMAGES
Transverse image of the vagina
Transverse image of the cervix
Transverse image of the uterus body
Transverse image of the uterus fundus with right to
left measurement
Same image as above without calipers
RIGHT OVARY - LONGITUDINAL IMAGE
Long axis image of the right ovary with superior to
inferior and anterior to posterior measurement
Same image as above without calipers