Gynecological ultrasound
Learning chapters: Uterus & adnexa
A systematic pelvic ultrasound examination starts with orientation. Where are the bladder, uterus and ovaries? How are the endometrium and uterine cavity displayed, and what can you see in the adnexa or pouch of Douglas? The tutorial moves from normal anatomy to an abnormal clinical case.
First, explore a normal uterus and unremarkable adnexa in a transabdominal view. Then follow a structured examination in a case suspicious for ectopic pregnancy. The accompanying chapters explain the terminology and show how individual observations contribute to a reasoned ultrasound report.
- Anteversion / anteflexion
- Endometrium
- Adnexa
- Pouch of Douglas
1:21Orient yourself: bladder, uterus and ovaries
Orient yourself: bladder, uterus and ovaries
The first case shows a normal uterus with unremarkable adnexa. In the transabdominal examination, the filled urinary bladder provides an anterior landmark. The live labels show the relationship between bladder, uterus and the ovaries on either side.
The adnexa include the ovaries and uterine tubes with their associated structures. Practise examining both sides systematically. An overview of normal pelvic anatomy helps you describe the exact location of an abnormal finding later in the examination.
Display the bladder and uterus together, then locate the right and left ovarian regions.
Check your understanding
Where is the filled bladder in relation to the uterus?
Show the explanation
In the transabdominal view shown, the bladder lies anterior to the uterus and provides an orientation landmark. The ovarian regions are then examined on either side of the uterus.
2:07Recognise anatomy without the labels
Recognise anatomy without the labels
In the examination mode demonstrated in the video, the learner must display a requested structure, freeze the image and mark the structure. This changes the task from recognising a colour overlay to actively finding your way around the ultrasound image.
Use the same principle when you learn sonography: examine a labelled plane, remove the visual help, find the structure again and explain its relationship to adjacent organs. Check your answer only after you have made your own identification.
Name a structure without the labels and then switch them on to check your answer.
Check your understanding
How can you check that you recognise a structure without its colour label?
Show the explanation
Hide the labels, find and name the structure yourself, and explain its relationship to adjacent organs. Only then switch the labels back on to check your identification.
2:31Uterine position: anteversion, anteflexion and measurements
Uterine position: anteversion, anteflexion and measurements
The abnormal case starts with a systematic assessment of the uterus. The video describes anteversion and anteflexion: these distinguish the inclination of the uterus relative to the vagina from the bend between its body and cervix. They describe orientation and do not automatically indicate pathology.
The uterus is then measured in three dimensions. Reliable measurements require the appropriate scan planes. Practise setting a clean longitudinal or transverse view before placing the measurement points, rather than measuring an oblique section simply because the organ is visible.
Locate the fundus, body and cervix and decide which scan plane you need for each uterine measurement.
Check your understanding
What is the difference between anteversion and anteflexion?
Show the explanation
Anteversion describes the inclination of the uterus relative to the vagina. Anteflexion describes the bend between the uterine body and cervix. Both terms describe orientation rather than automatically indicating pathology.
3:57Assess the endometrium and uterine cavity
Assess the endometrium and uterine cavity
The tutorial describes a thickened endometrium and measures its thickness. The endometrium is the lining of the uterus. Distinguish it from the surrounding myometrium and relate the measurement to a clearly identified scan plane.
The uterine cavity is then examined systematically. No intrauterine pregnancy is identified in the case shown. This absence alone does not prove ectopic pregnancy: it must be interpreted with the other ultrasound findings, clinical presentation and laboratory results.
Describe the appearance of the endometrium separately from the question of whether an intrauterine pregnancy is visible.
Check your understanding
Does the absence of a visible intrauterine pregnancy alone prove ectopic pregnancy?
Show the explanation
No. It is an ultrasound finding that must be interpreted with the other scan findings, clinical condition and laboratory results, together with the required further assessment.
4:23Examine the left adnexa and ring-shaped structure
Examine the left adnexa and ring-shaped structure
The examination extends to the left adnexal region. The video identifies an abnormal conglomerate between the left ovary and uterus. Closer inspection reveals a cystic finding with a small ring-shaped structure inside.
Describe the location, relationship to the ovary and internal appearance before drawing a conclusion. Can you find the abnormality again in adjacent sections? A precise description separates what the image actually shows from the diagnostic interpretation.
Locate the finding relative to the uterus and left ovary and describe its internal structure.
Check your understanding
What should you describe about the abnormality in the left adnexal region?
Show the explanation
Describe its position between the left ovary and uterus, its relationship to the ovary and its cystic appearance with a small ring-shaped structure. Check whether you can find it again in adjacent planes.
4:43Pouch of Douglas and suspicion of ectopic pregnancy
Pouch of Douglas and suspicion of ectopic pregnancy
The case summary combines a thickened endometrium, no visible intrauterine pregnancy, substantial fluid in the pouch of Douglas and an abnormal cystic finding between the left ovary and uterus. The pouch of Douglas lies behind the uterus and is an important location to assess for free fluid.
Together, these findings raise strong suspicion of an ectopic pregnancy in the left uterine tube in this case. An empty uterus or free fluid is not diagnostic on its own. Interpretation requires the overall clinical condition, laboratory findings and appropriately qualified further assessment.
List the observations first, then state the suspected diagnosis and explain which findings support it.
Check your understanding
Which combination of findings raises suspicion of ectopic pregnancy in this case?
Show the explanation
The case combines a thickened endometrium, no visible intrauterine pregnancy, fluid in the pouch of Douglas and the abnormal left adnexal finding. Individual signs are not conclusive alone; interpretation also requires clinical and laboratory information and further assessment.
