Female Pelvic/Gynecologic Ultrasound ScanCoach™

Supine with a comfortably full bladder. The distended bladder acts as an acoustic window, displacing bowel gas and allowing visualization of the uterus and adnexa. Instruct the patient to drink 32 oz of water 1 hour before the exam and not to void.

Begin in the sagittal (longitudinal) plane just above the pubic symphysis, angled posteriorly toward the bladder. Sweep from right to left to survey the entire uterus. Then rotate 90° to the transverse (axial) plane and sweep from the fundus to the cervix. Tilt the transducer caudally to visualize the cervix and lower uterine segment.

Uterine size (length × AP × width; normal nulliparous: ~7 × 4 × 5 cm; multiparous: up to 9 × 5 × 6 cm); shape (pear-shaped, normal); orientation (anteverted, anteflexed, retroverted, retroflexed); myometrium (homogeneous, no masses); endometrium (thickness, echogenicity, regularity — measure in sagittal plane, double-layer thickness); cervix (length, nabothian cysts, polyps); IUD (location, if present).

Endometrial thickness measurement: measure the double-layer endometrial thickness (DLET) in the sagittal plane at the thickest point, excluding any fluid. Normal values: proliferative phase 4–8 mm; secretory phase 8–14 mm; postmenopausal <4 mm (without HRT) or <8 mm (with HRT). Postmenopausal bleeding with endometrium >4 mm warrants further evaluation.

Uterine anomalies (bicornuate, septate, unicornuate, didelphys) are best assessed with 3D ultrasound or MRI. On 2D TA, a fundal notch or two separate endometrial cavities may suggest a uterine anomaly. Refer for 3D ultrasound or MRI if a uterine anomaly is suspected.

An overfull bladder can compress the uterus and make it appear smaller or distorted. If the bladder is too full, ask the patient to partially void. An underfull bladder provides inadequate acoustic window — TVS is preferred when TA views are suboptimal.

When orienting during transvaginal imaging, begin with a transverse sweep. This provides a broader field of view and helps you quickly identify and align with uterine anatomy. Once the anatomy is clearly established, gently rotate the probe back into the longitudinal plane for detailed assessment.