GP Referral Guidelines for Female Pelvic Ultrasound
The purpose of this post is to provide referral guidelines for the examination of the female pelvis and reproductive system through the use of pelvic ultrasound. Having an understanding of such guidelines can aid the management of your female patients.
Effective communication is an important aspect of optimizing successful clinical outcomes and according to ICGP, more than 20% of GPs do not have direct access to diagnostic information obtained at ultrasound that is often located in a public system. It is often preferable that you, in your capacity as a patient’s GP, should receive such information in the first instance so that triaging and further referral (if necessary) can be rapidly coordinated.
What is a female pelvic ultrasound?
A female pelvic ultrasound is a gynecological scan that allows the uterus, cervix, endometrium, ovaries, and adnexa to be examined. If a patient reports that pain is being felt in the right iliac fossa, the appendix will also be examined. There are also cases where a large mass or fibroid may compress the ureter and cause hydronephrosis, making it important for the kidneys to be examined as well.
What is an optimal time to perform a female pelvic ultrasound?
The most optimal time to perform a gynecological ultrasound is during the early stages of the cycle, around day 5 to day 7, as this timeframe yields more accurate results in respect to viewing the endometrium and possible ovarian cysts. If a patient complains of acute pain, or abdominal swelling is noticeable, an ultrasound should be performed immediately.
Transabdominal vs Transvaginal female pelvic ultrasound?
Many pelvic ultrasounds are performed through a combination of transabdominal and transvaginal methods. Firstly, the patient is examined transabdominally with a full bladder to assess the adnexa. This approach provides a physical overview of the patient’s reproductive organs and is often enough when there is no pathology. However, it may be difficult to properly examine certain internal organs through transabdominal methods, which is when a transvaginal approach can be used. Most importantly, a combination of both approaches may decrease the chance of missing an adnexal mass or cyst that is located high within the pelvis, which could be missed if only a transvaginal is performed.
Possible Delays in Diagnosis:
When performing a pelvic ultrasound, large cystic structures should not be observed on healthy ovaries early on during the cycle. However, if an ultrasound is performed during the middle of the cycle, hormonal changes, which can lead to structural changes may make it difficult to determine whether a cystic structure is a true dominant follicle or a type of functional cyst.
For example, a patient may report left sided pain in the pelvis. An ultrasound that is performed during the middle of the cycle may demonstrate a left ovarian cystic structure measuring 3cm. This may represent a dominant follicle which is a part of the normal cycle or an abnormal structure that may represent a functional cyst. In such a case, the examination would have to be repeated after the next cycle has started and this could delay the diagnosis.
Several factors must be considered during the examination and having guidelines to follow can help GPs improve their ability to address clinical issues.
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