Pelvic Protocol
Use same protocol for Transvaginal
Protocol
 Patient should have a full bladder for transabdominal & empty bladder for transvaginal
 If transvaginal examination order, do a brief survey of the pelvis with a transabdominal approach first
 Scan through the entire pelvis in both planes prior to storing any images:
 Begin in the transverse plane starting at the symphis pubis
 Scan upward through the fundus, evaluating the uterus and surroundings
 DO NOT ANGLE the probe while scanning up, your transducer should move up the body
 Return to the mid body of the uterus and turn into the sagittal plane
 Scan right to left and evaluate the uterus and surrounding structures
Structure
Scan Plane
Label
UT SAG ML
UT SAG ML
UT SAG ML ENDO
Uterus
Uterus
Sagittal
Transverse
UT SAG ML
ENDO
UT SAG RT
UT SAG RT
ADNEXA SAG RT
UT SAG LT
UT SAG LT
ADNEXA SAG LT
UT TX VAGINA
UT TX CX
UT TX BODY
UT TX BODY
UT TX FUNDUS
Sagittal
RO SAG
RO SAG
RO SAG
RT Ovary
Transverse
Sagittal
RO TX
RO TX
RO TX
LO SAG
LO SAG
LO SAG
LT Ovary
Transverse
LO TX
LO TX
LO TX






























HMP:\Protocols\OBGYN Protocols\Pelvis Protocol r14.docx
Landmarks Identified
Vaginal Canal (not included on endovaginal exam)
Uterus-cervix, body (with endometrium) and
fundus
Vaginal Canal (not included on endovaginal exam)
Uterus-cervix, body (with endometrium) and fundus
with AP and Length uterus measurement
Enlarge UT SAG ML image on endometrium in the
areas of the upper uterine body
Enlarge UT SAG ML image on endometrium in the
area of the upper uterine body
Measure AP diameter of endometrium
Uterine body and fundus just to the right of midline
Uterine body and fundus far right lateral
Lateral to the uterus in the right adnexa region
Uterine body and fundus just to the left of midline
Uterine body and fundus far left lateral
Lateral to the uterus in the left adnexa region
Vaginal Canal (not taken on endovaginal exam)
Uterine Cervix
Uterine mid-body
Uterine mid-body with width measurement
Uterine fundus (Scan completely out of uterus, then
scan back down toward the fundus)
Right ovary
Right ovary enlarged
Right ovary enlarged with AP and Length
measurements
Right ovary
Right ovary enlarged
Right ovary enlarged with width measurements
Left ovary
Left ovary enlarged
Left ovary enlarged with AP and Length
measurements
Left ovary
Left ovary enlarged
Left ovary enlarged with width measurements
Pelvic Protocol
Use same protocol for Transvaginal
Normal Measurements
Structure
Uterus
 Measurements
given are average
measurements
 Uterus will be
smaller for
premenarche
& postmenopausal
uterus
Endometrium
Area of
Interest
Length
Plane
AP dimension
or depth
Sagittal
Measureme
nt
6-8.5cm
nulliparous
8-10cm
multiparous
3cm
Width
Transverse
2-3cm
AP
Sagittal
4-8mm
Sagittal
 Only measure
echogenic area
 Do not include the
hypoechoic halo
Ovaries
 Size varies w/ age,
menstruation
phase &
menstrual status
6-10mm
7-14mm
Length
AP or depth
Width
Sagittal
Sagittal
Transverse
Less than
8mm
Less than 5
mm
2.5-5cm
1.5-3cm
.6-2.2cm
Comments



Includes Vaginal canal and Uterine-Fundus, Body and
Cervix
Be careful on transvaginal scanning the cervix must
be included or measurements will be off
Widest portion of the uterine body from the anterior
to posterior wall
Calipers should be placed perpendicular to length
Widest portion of the uterine body (level of cornua)













Early Proliferative-Days 5-7
Thin bright echogenic line
Late Proliferative-Days 10-14
3-line sign
Secretory-Days 15-28,
Thick echogenic stripe
Post Menopausal-Asymptomatic
Varies with hormone therapy
Post Menopausal-Symptomatic
Varies with hormone therapy
Measure longest axis
Calipers should be placed perpendicular to length
Measure from left to right in the mid portion


Tips





You may need to apply pressure to the pelvis with the transducer in order to see ovaries. If transducer pressure is not
working, pressure can be applied with your hand or by having the patient press down on themselves
Look for free fluid in the posterior cul-de-sac
Utilize 3D or 4D imaging to aid in pathology and endometrium shape details
Ovaries are located between the uterus and the iliac vessels
Pelvic muscles may mimic ovaries, evaluate structures in both planes prior to storing the image
Patient Information
 Document first day of the last normal menstruation cycle
 Document if postmenopausal patient is currently on hormone therapy
 Document all symptoms in detail—area of pain, length of pain or bleeding, amount of bleeding, etc.
 Document clinical history of pregnancies, surgeries, or previous pathologies
Pathology
 Gray scale sagittal and transverse images
 Gray scale sagittal and transverse images with 3 measurements (length, width and height)
 Color Doppler image document the presence of blood flow and Spectral Doppler image document type and
velocity of blood flow
HMP:\Protocols\OBGYN Protocols\Pelvis Protocol r14.docx