#transverse vaginal septum

[dhddmods]

Some intersex flags! (Part 4)

And finally, part 4! This covers the last of the formerly-flagless intersex variations/traits. (Here are parts one, two, and three.)

Now all of the main (discovered) traits/variations have been covered!

All thats left are hyper-specific conditions that can cause intersex traits/variations (such as "hand-foot-genital syndrome"), and we aren't planning to make flags for those, as there are thousands of them.

Please read (and reblog) our intersex guide. It is so important to understand intersex people, their bodies, and their health!

All of these flags are based on the Zero-V (vaginal agenesis) and Micro-P (micropenis) flags by @thirdsexmanifesto.

Urethral Agenesis

The orange represents the urinary tract. The yellow circle crossed out represents incomplete or absent urethra.

Vaginal Hypoplasia

The black triangle is inspired by how demisexual/demiromantic flags are set up, as to imply that the vaginal entry is still present, but only partially.

Imperforate Hymen

The X over the circle is meant to represent the hymen blocking the entry.

Microperforate Hymen

The X over the circle is meant to represent the hymen blocking the entry. Unlike the imperforate hymen flag, the X doesn't cover the entire circle, which is meant to represent how the vagina is not fully covered.

Cribriform Hymen

The circle with the multiple Xs are meant to represent the small entrances in the hymen.

Septate Hymen

The circle with the slash through it is meant to represent the septate hymen stretched across the vaginal entrance, splitting the entrance in two.

Vaginal Septum

The symbol is a combination of the TVS, obstructed hemivagina, and LVS symbols. This flag is for those with any of those three variations.

Transverse Vaginal Septum (TVS)

The symbol is meant to represent the tissue running horizontally across the vaginal canal.

Obstructed Hemivagina

The symbol is meant to represent the hemivagina within the vaginal canal.

Longitudinal Vaginal Septum (LVS)

The symbol is meant to represent the tissue running vertically across the vaginal canal.

Labial Hypoplasia

The first flag is when both of the labia are absent. The second flag is when only one of the labia is absent.

Clitoral Hypoplasia

The little black triangle represents the small clitoris.

Clitoral Aplasia

The X over the triangle represents the lack of clitoris.

Penile Agenesis

The X over the triangle represents the lack of penis.

Congenital Buried Penis

The triangle under the line represents the penis buried beneath the skin.

Aposthia

The white wrapping around the end of the triangle with the X overtop it represents the lack of foreskin.

Microorchidism

The small circle with the minus symbol represents the microtestes. The large circle surrounding it represents the typical/average teste-size.

Cryptorchidism

The black line represents where the teste is expected to be. The black circle being within the grey, away from both the pink and the line, represents the teste being elsewhere within the body.

[drshefalibansalmadhav]

Pregnancy with Uterine Abnormalities

There’s nothing to hide that, yes, the risk of pregnancy complications increases with uterine abnormalities. Pregnancy offers an experience that brings both joy and challenges. For some women, uterine abnormalities may add extra trouble to the journey. These are generally problems with the structure of the uterus.

Uterine abnormalities are structural differences in the uterus, which may affect fertility in women and make pregnancy complicated. Yet, many women with these uterine conditions can have successful pregnancies under medical supervision. You might consult here the leading IVF specialist in Siliguri.

Let’s understand how these conditions can impact pregnancy.

Overview of What Uterine Abnormalities Are?

Uterine abnormalities mean congenital (present from birth) or acquired (developed later in life) issues with the structure or shape of the uterus (womb).

These anomalies can vary in type and severity, impacting how a woman’s uterus functions in general and especially during pregnancy. For IVF support, you can see the best IVF doctors in Siliguri. Here are some common types of uterine abnormalities include:

Septate Uterus. A uterine condition in which a septum (wall) divides the uterus partially or fully. It can increase the risk of miscarriage or premature labor in pregnant women.

Bicornuate Uterus. A uterine condition in which the uterus is heart-shaped, with a deep indentation at the top. A bicornuate uterus can cause a higher risk of premature delivery or breech position (baby is born bottom first instead of head first.

Unicornuate Uterus. In this uterine condition, only one-half of the uterus develops, which causes a smaller space for the baby to grow and develop in the womb. It potentially increases the risk of prematurelabor.

Didelphys Uterus. This uterine condition means the uterus is divided into two separate cavities, which can increase the chance of recurrent miscarriages and premature births.

Arcuate Uterus. This uterine condition is a mild form of a bicornuate uteruswith a small indentation at the top. Basically, it is less severe but can still cause trouble in pregnancy.

Uterine Agenesis. About 10% of women with uterine abnormalities have uterine agenesis, in which the uterus does not form at all.

How Uterine Abnormalities Affect Pregnancy – Here’ What To Know

When a uterine abnormality is present, it increases the risk of pregnancy challahs. But, it doesn't necessarily mean a woman cannot conceive or carry a successful pregnancy (pregnancy to term). However, issues with the shape and structure of the uterus can affect embryo implantation, fetal growth, and the position of the baby.

Below arethe potential impacts of uterine abnormalities on pregnancy:

Increased Risk of Miscarriage

Issues with the shape and structure of the uterus, such as a septate uterus, can cause trouble in the proper implantation of the embryo. If so, there is a higher risk of first-trimester miscarriage.

Preterm Labor

Conditions (uterine abnormalities) such as a bicornuate or unicornuate uterus can lead to little space in the uterine cavity, which may increase the chance of preterm labor or even premature rupture of membranes in some cases.

Abnormal Fetal Position

Did you know a uterus with an unusual shape may cause a breech position pregnancy in which the baby settles into a breech (bottom-first) or transverse position? In this condition, there can be complications in vaginal delivery.

Intrauterine Growth Restriction (IUGR)

There are some uterine abnormalities that give a small amount of space for the baby to grow in the womb, leading to growth restrictions.

The good news is despite all these, many women with uterine abnormalities can carry out their successful pregnancies. Careful monitoring and specialized treatment by an OB-GYN is very important here. You might consult the best IVF specialist in Siliguri to conceive through IVF due to uterine conditions. IVF doctors are there to support you and provide you with compassionate care.

[ggirhravez]

ENDOMETRIOSIS

ENDOMETRIOSIS

Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient’s symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease. From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary.

Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis

The ultrasound:

uterus The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented

The ultrasound:

adnexa Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel.

Hydrosalpinx or hematosalpinx may be identified in endometriosis.

The ultrasound: site‐specific tenderness

SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet.

The ultrasound: Sliding sign

The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated.

Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus

The ultrasound: anterior and the posterior compartment

Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space. An independently moving bladder from the uterus represents a positive ‘sliding sign’.

The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon. Done by gently placing the TV probe in the posterior vaginal fornix

Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle).

Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle

[avez2001]

ENDOMETRIOSIS

ENDOMETRIOSIS

Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient’s symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease. From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary.

Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis The ultrasound: uterus The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented The ultrasound: adnexa Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel. Hydrosalpinx or hematosalpinx may be identified in endometriosis. The ultrasound: site‐specific tenderness SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet. The ultrasound: Sliding sign The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated. Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus The ultrasound: anterior and the posterior compartment Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space. An independently moving bladder from the uterus represents a positive ‘sliding sign’. The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon. Done by gently placing the TV probe in the posterior vaginal fornix Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle). Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle

[safeenaposts]

ENDOMETRIOSIS

ENDOMETRIOSIS

Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient's symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease. From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary. Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis The ultrasound: uterus   The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented

The ultrasound: adnexa

Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other  indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel.

Hydrosalpinx or hematosalpinx may be identified in endometriosis.

The ultrasound: site‐specific tenderness SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet.

The ultrasound: Sliding sign The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated.

Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus

The ultrasound: anterior and the posterior compartment Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space.  An independently moving bladder from the uterus represents a positive ‘sliding sign’. The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon.  Done by gently placing the TV probe in the posterior vaginal fornix

Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle).

Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle)

[hyvait2020]

ENDOMETRIOSIS

ENDOMETRIOSIS Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient's symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease. From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary. Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis The ultrasound: uterus  The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented

The ultrasound: adnexa

Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other  indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel.

Hydrosalpinx or hematosalpinx may be identified in endometriosis.

The ultrasound: site‐specific tenderness SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet.

The ultrasound: Sliding sign The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated.

Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus

The ultrasound: anterior and the posterior compartment Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space.  An independently moving bladder from the uterus represents a positive ‘sliding sign’. The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon.  Done by gently placing the TV probe in the posterior vaginal fornix

Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle).

Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle)

[innogenxpage]

ENDOMETRIOSIS

ENDOMETRIOSIS 

Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient's symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease. 

 From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary. 

Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis 

The ultrasound: uterus  

The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented 

 The ultrasound: adnexa 

 Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other 

 ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other  indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel. 

 Hydrosalpinx or hematosalpinx may be identified in endometriosis. 

 The ultrasound: site‐specific tenderness 

SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet. 

 The ultrasound: Sliding sign 

The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated. 

 Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus 

 The ultrasound: anterior and the posterior compartment

Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space.  An independently moving bladder from the uterus represents a positive ‘sliding sign’. 

 The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon.  Done by gently placing the TV probe in the posterior vaginal fornix 

 Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle). 

Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle) 

[irginia-blog]

What are the gynecological diseases that cause abdominal pain in women?

What are the reasons why women often have backache or abdominal pain? In fact, most of them are caused by gynecological diseases. What kind of gynecological disease does it cause a woman to have abdominal pain? The most common cause of chronic abdominal pain in gynecological diseases is chronic pelvic inflammatory disease. Some are due to acute pelvic inflammatory disease treatment is not thorough and become chronic; there is the beginning of chronic fatigue, often in sports or sexual life after acute attack; genital malignant tumors often present as a slow onset and

Exacerbate. If during the two menstruation periodic side abdominal pain should consider ovulation pain; periodic abdominal pain without menstruation seen in congenital genital tract malformation (such as imperforate hymen, transverse vaginal septum etc.) or postoperative uterine cavity, cervical adhesions; cervical erosion is serious or severe uterine prolapse can also lower abdomen to the waist pain, tenesmus and department of Radiology; unexplained abdominal pain, abdominal pain often patient consciousness obviously, and the doctor examination found no abnormalities, only in laparoscopic can prove a pelvic congestion syndrome.

[gynaecologypk]

Hematometra Treatment In Lahore, Causes and Symptoms

Hematometra Treatment In Lahore, Causes and Symptoms Hematometra is also known as hematometra that is a medical condition and involves the retention or collection of blood in the uterus part. It is very common and caused by the imperforate a transverse vaginal septum or hymen imperforation.We have Chinese Specialist For Hematometra Treatment.  >>>Live chat<>Live chat<>Live chat<>Live chat>>> for…

[ggirhravez]

ENDOMETRIOSIS

ENDOMETRIOSIS

Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient’s symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease. From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary.

Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis

The ultrasound:

uterus The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented

The ultrasound:

adnexa Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel.

Hydrosalpinx or hematosalpinx may be identified in endometriosis.

The ultrasound: site‐specific tenderness

SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet.

The ultrasound: Sliding sign

The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated.

Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus

The ultrasound: anterior and the posterior compartment

Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space. An independently moving bladder from the uterus represents a positive ‘sliding sign’.

The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon. Done by gently placing the TV probe in the posterior vaginal fornix

Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle).

Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle

[ggirhravez]

ENDOMETRIOSIS

ENDOMETRIOSIS

Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient's symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease.

From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary.

Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis

The ultrasound: uterus

 The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented

The ultrasound: adnexa

Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group

Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other

‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other  indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel.

Hydrosalpinx or hematosalpinx may be identified in endometriosis.

The ultrasound: site‐specific tenderness

SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet.

The ultrasound: Sliding sign

The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated.

Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus

The ultrasound: anterior and the posterior compartment

Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall,

When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space.  An independently moving bladder from the uterus represents a positive ‘sliding sign’.

The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon.  Done by gently placing the TV probe in the posterior vaginal fornix

Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle).

Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle)

[ggirhravez]

ENDOMETRIOSIS

ENDOMETRIOSIS

Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient’s symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease. From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary.

Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis 

The ultrasound:

 uterus The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented 

The ultrasound: 

adnexa Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel.

 Hydrosalpinx or hematosalpinx may be identified in endometriosis. 

The ultrasound: site‐specific tenderness

 SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet.

 The ultrasound: Sliding sign 

The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated. 

Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus 

The ultrasound: anterior and the posterior compartment 

Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space. An independently moving bladder from the uterus represents a positive ‘sliding sign’. 

The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon. Done by gently placing the TV probe in the posterior vaginal fornix 

Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle). 

Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle

[safeenaposts]

ENDOMETRIOSIS

ENDOMETRIOSIS

Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient's symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease.

From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary.

Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis The ultrasound: uterus   The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented

The ultrasound: adnexa

Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other  indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel.

Hydrosalpinx or hematosalpinx may be identified in endometriosis.

The ultrasound: site‐specific tenderness SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet.

The ultrasound: Sliding sign The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated.

Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus

The ultrasound: anterior and the posterior compartment Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space.  An independently moving bladder from the uterus represents a positive ‘sliding sign’. The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon.  Done by gently placing the TV probe in the posterior vaginal fornix

Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle).

Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle)

[ggirhravez]

ENDOMETRIOSIS

ENDOMETRIOSIS

Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient’s symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease. From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary.

Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis

The ultrasound:

uterus The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented

The ultrasound:

adnexa Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel.

Hydrosalpinx or hematosalpinx may be identified in endometriosis.

The ultrasound: site‐specific tenderness

SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet.

The ultrasound: Sliding sign

The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated.

Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus

The ultrasound: anterior and the posterior compartment

Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space. An independently moving bladder from the uterus represents a positive ‘sliding sign’.

The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon. Done by gently placing the TV probe in the posterior vaginal fornix

Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle).

Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle

[ggirhravez]

ENDOMETRIOSIS

ENDOMETRIOSIS

Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient’s symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease. From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary.

Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis

The ultrasound:

uterus The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented

The ultrasound:

adnexa Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel.

Hydrosalpinx or hematosalpinx may be identified in endometriosis.

The ultrasound: site‐specific tenderness

SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet.

The ultrasound: Sliding sign

The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated.

Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus

The ultrasound: anterior and the posterior compartment

Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space. An independently moving bladder from the uterus represents a positive ‘sliding sign’.

The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon. Done by gently placing the TV probe in the posterior vaginal fornix

Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle).

Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle

[avez2001]

ENDOMETRIOSIS

ENDOMETRIOSIS Ultrasound is a reliable first‐line imaging modality for the assessment of patients with gynaecological concerns. In patients with suspected endometriosis, ultrasound serves three purposes. First, it is used to evaluate the aetiology of the patient's symptoms. Second, it has the potential to map the disease location. Lastly, it can ascertain the extent of disease. From a clinical perspective, these products of ultrasound may benefit patients by ensuring a thorough understanding of disease by both the patient, who needs to provide informed consent to treatment options, and the physician, who may adequately prepare for potentially advanced surgical procedures. In many cases, when deep endometriosis (DE) exists, physicians need to consider referral to an appropriate gynaecologic surgeon with advanced skill. The multidisciplinary input of other specialists such as colorectal or urologic surgeons or fertility specialist may also be necessary. Recently, the International Deep Endometriosis Analysis (IDEA) group published a systematic approach to sonographically evaluate the pelvis in patients with suspected endometriosis. This consensus statement was developed to standardise anatomical landmarks, nomenclature of disease and the components of an ultrasound seeking to identify DE. A four‐step system was introduced, including routine evaluation of the uterus and adnexa, evaluation of soft markers such as site‐specific tenderness (SST), assessment of the pouch of Douglas (POD) using the ‘sliding sign’ and, finally, assessing the presence of DE nodules compartmentally throughout the pelvis The ultrasound: uterus  The orientation (anteverted, retroverted or military) and dimensions in three orthogonal planes should be recorded. Patients with endometriosis have a high likelihood of concurrent adenomyosis and as such, signs of this should be sought. In addition, the ‘question mark sign’, signifying a fixed anteverted/retroflexed uterus with the fundus adhered posteriorly to the rectum and/or sigmoid colon can represent adenomyosis and/or endometriosis and should be documented The ultrasound: adnexa Includes evaluation of the ovaries and Fallopian tubes. The entire ovarian size should be measured in three orthogonal planes. Any abnormalities should be quantified, measured and documented. The sonographic characteristics of any ovarian abnormality should be described according to terminology published by the International Ovarian Tumor Analysis (IOTA) group Ovarian mobility can be judged by applying pressure to the ovaries using the TV probe. Non‐mobile ovaries are considered a ‘soft marker’ potentially signifying superficial pelvic endometriosis and/or DE. The mobility of the ovaries is assessed against the pelvic side wall laterally, uterus medially, uterosacral ligaments (USLs) inferiorly and each other ‘Kissing’ ovaries, an ultrasound diagnosis of ovaries fixed to each other  indirectly indicates intra‐abdominal adhesions and possibly underlying DE of the Fallopian tubes and/or bowel. Hydrosalpinx or hematosalpinx may be identified in endometriosis. The ultrasound: site‐specific tenderness SST-‘soft markers’- The key anatomic locations to assess in this component of the scan include the uterus, adnexa, USLs and POD. Currently, the IDEA group recommends a scoring system of 0 or 1; 0 for no pain and 1 for pain. However, this test is still limited in that no scoring system has been validated as yet. The ultrasound: Sliding sign The test is considered positive when the uterus and cervix move independently (i.e. slide) along the anterior rectum and sigmoid . Clinically and surgically, this is reassuring for a non‐obliterated POD. Conversely, if the uterus and cervix move in unison with the anterior rectum and sigmoid, the test is negative and the POD is thought to be obliterated. Schematic Drawing Demonstrating How to Elicit the ‘Sliding Sign’ in an Anteverted Uterus (a) and Retroverted Uterus The ultrasound: anterior and the posterior compartment Lesions may appear as hypoechoic linear or spherical lesions, with or without regular contours . The uterovesical region should be examined for tethering to the uterus (i.e. obliteration of the space). The concept of the ‘sliding sign’ can be applied here as well. The operator should hold the TV probe in the anterior fornix with one hand and the other hand should be placed over the suprapubic region. By balloting the uterus between the probe and hand, the operator can judge whether the posterior bladder slides freely over the anterior uterine wall, When the bladder and uterus move together, the operator should document a negative ‘sliding sign’, representing an obliterated space.  An independently moving bladder from the uterus represents a positive ‘sliding sign’. The posterior compartment sites include USLs, posterior vaginal fornix, rectovaginal septum (RVS), anterior rectum, anterior rectosigmoid junction and sigmoid colon.  Done by gently placing the TV probe in the posterior vaginal fornix Schematic and Ultrasound Images Demonstrating an Isolated RVS Nodule. Note the Hyperechoic Nature of the RVS (Red Star) and Adjacent Hypoechoic Layers of Vagina (Yellow Star) and Rectal Wall Muscularis (Green Circle). Schematic and Ultrasound Image Demonstrating the Location of Deep Endometriosis (DE) in the Right Uterosacral Ligament in Transverse View (Within Green Circle)