Overview of Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
Young girls and teenagers can have different health problems related to their reproductive system, which could be due to different causes such as birth defects, infections, growths, or health syndromes. Medical imaging is often necessary to make a correct diagnosis. The most common reasons for needing these images are because of pain in the pelvic area, a mass in the pelvic area, uncertainty about the external appearance of the genitals, no period starting by the correct age, and early onset of puberty.
Ultrasound—the use of sound waves to create images of the inside of the body—is usually the first and simplest imaging method used. It’s important for those specialized in reading these images, especially those who specialize in children’s health, to understand what normal ultrasound images look like, be familiar with the different health problems that can affect a girl’s reproductive system, and know how these conditions may appear on an ultrasound image. This article will focus on the technique of ultrasound, what normal ultrasound images look like, and how various conditions affecting girls’ reproductive systems can be interpreted on these images, including emergency cases.
Anatomy and Physiology of Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
The uterus is a body part in the middle of a woman’s pelvis, located between the bladder (where urine is stored) and rectum (where waste is eliminated). The uterus is positioned next to the pair of ovaries. The size of the uterus and ovaries changes across a woman’s life.
In newborn girls, the uterus is quite a decent size (about 3.5 cm in length and 1.4 cm in width) due to the effects of maternal hormones from the placenta. During early childhood, the uterus and ovaries don’t drastically change in size, maintaining a steady appearance until around age 7 or 8.
The uterus of newborn girls is prominent, with the cervix thicker than the upper part of the uterus, known as the fundus. In preteens, the uterus is tube-shaped and measures roughly 2.5 to 4 cm in length and less than 1 cm in thickness. Upon reaching puberty, the uterus grows larger, especially the upper part, and changes shape to look more like an adult uterus. At this stage, the uterus measures about 5 to 8 cm in length and 1.5 cm in width. The thickness of the lining of the uterus, known as the endometrium, differs depending on where a woman is in her menstrual cycle.
The ovaries, similar to the uterus, change in both appearance and size across a woman’s life. The changes are affected by maternal hormones during infancy and by hormones that stimulate the development of egg-containing follicles in the ovaries during puberty.
The rough ovarian sizes at different stages of life are as follows:
- In infancy: about 1 cm in size.
- Up to 2 years old: approximately 0.67 cm in size.
- Up to 6 years old: less than 1 cm.
- Up to 10 years old (prepubertal stage): the ovary grows a bit and measures about 1.2 to 2.3 cm.
- On the brink of the first menstruation (premenarchal stage): it grows to about 2 to 4 cm.
- During the first major growth spurt: The ovary reaches up to 8 cm as the follicles mature owing to the release of follicle-stimulating hormones.
- After menstruation starts (post menarchal): It can range from 2.5 cm to a sizable 20 cm.
Why do People Need Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
Your child might need a pelvic ultrasound for several reasons:
- If their genitalia is not clearly male or female (ambiguous genitalia)
- To check if they were born with any abnormalities or deformities
- When they are experiencing pain in the area between the hips (pelvic pain)
- If they haven’t started their period by the age of 15 (primary amenorrhea)
- If there’s an unusual swelling or lump in their pelvic region
- If they are bleeding before they reach the age girls usually start having periods (prepubertal bleeding)
- If they start showing signs of puberty very early (precocious puberty)
- When their periods are not regular (irregular menses)
- If they’re teenagers and might have a condition that causes their reproductive organs to become inflamed (pelvic inflammatory disease)
- If they’re teenage girls and there’s a chance they might have an ectopic pregnancy, which is when the fertilized egg grows outside the uterus instead of inside.
When a Person Should Avoid Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
That essentially means there are no specific health conditions or circumstances that would prevent someone from having an ultrasound scan.
Equipment used for Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
An ultrasound machine, along with a special piece of equipment called a transducer, are both essential for the procedure. Additionally, a special gel is applied on the skin which helps the ultrasound waves travel smoothly between the skin and the transducer.
For teenagers, a certain type of transducer, known as a curved or convex array transducer, operating at 3 to 5 MHz is used for the transabdominal ultrasound. However, for small children and infants, a different type, the linear 5 to 9 MHz abdominal transducer, is employed for the same kind of ultrasound. For more detailed ultrasounds of the area around the tailbone in newborns and infants, they use a linear transducer.
If needed, the ultrasound technician uses a 12 MHz linear transducer to examine various nearby details like the bowel, fat, muscles, and lymph nodes close to the pelvic organs. Doctors typically don’t perform transvaginal sonography, an ultrasound involving placement of a long, high-frequency ‘wand’ shaped transducer into the vagina, in children. But in sexually active teenagers, it can be done along with the transabdominal sonography for a more comprehensive view of the pelvic area, including the inner layer of the uterus.
For extra details about blood flow in the ovaries, uterus, and possibly any observed problem areas, color Doppler mode is useful. Spectral Doppler is particularly important for recording wave patterns from any vascular issues; for instance, it is crucial in diagnosing conditions like ovarian twisting.
Who is needed to perform Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation?
A professional specially trained in ultrasound technology will carry out your ultrasound. They will capture both still and moving images during this process. These images will then be looked at by another type of doctor called a radiologist. Sometimes, the radiologist might do the ultrasound themselves if they need to get a clearer understanding of what’s going on in your body.
Preparing for Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
For a type of ultrasound scan called a transabdominal ultrasound, it’s important for your bladder to be full. The reason behind this is that the water in your bladder helps to push away any gas in your intestines. This allows the ultrasound waves to get a clear view of your pelvic organs, meaning the doctor can see them better.
So, before an ultrasound examination, you might be asked to drink lots of water and not use the bathroom. This helps to fill your bladder with fluid. In the case of young kids who can’t control their bladder, health professionals would use a bladder catheter. This small tube let’s them fill the bladder with fluid in a controlled way.
During the scan, you’ll be asked to lie on your back on a bed. Only your pelvis (the lower part of your belly) needs to be bare. The rest of your stomach will be covered with a cloth. Before a different kind of ultrasound, known as a transvaginal ultrasound, you’ll be asked to empty your bladder. You’ll also be asked to get into a position called the lithotomy position. This just means you’ll be lying on your back with your legs raised and bent.
How is Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation performed
For newborns and young children, ultrasound scans of the abdomen can provide good visualization of their pelvic structures. Another type of ultrasound, called a transperineal or translabial ultrasound, can be used when there’s a labial mass, a condition called hydrometrocolpos (fluid buildup in the uterus or vagina), anal atresia (absence of the anal opening), or malformation of the urinary and genital organs. In this procedure, the ultrasound probe is applied directly to the introitus (vaginal entrance) to show images of the vagina, uterus, and ovaries.
For transabdominal ultrasounds, the patients lie on their back while imaging is performed through a probe placed on the pelvis. The bladder filled with urine acts as an “acoustic window”, allowing better imaging. A similar approach called Transvaginal Sonogram (TVS) can be used in sexually active adolescents, by inserting a high-frequency probe into the vagina. This method is particularly good for detecting early pregnancy (in any location), or finding ovarian masses.
There are different images that a normal ultrasound can show:
Prepuberty: The uterus can be seen behind the bladder. It looks like a tube when seen from the side, and it generally maintains this shape until a few years before puberty. The lining of the uterus, called the endometrium, looks like a bright line on the scan. Sometimes, fluid may appear in the uterine cavity in a newborn due to hormones from the mother. The cervix (the lower part of the uterus) and the main body of the uterus are the same size in infancy. Prepubertal ovaries look like oval-shaped, less echoic (or darker) structures with small follicles appearing like little cysts. The ovaries are located on either side of the uterine opening on a side view. Also visible is the vaginal canal located below the cervix and in front of the rectum.
Postpuberty: The upper part of the uterus (the uterine fundus) is larger than the cervix and takes on a pear shape, increasing in volume at puberty. The thickness of the endometrial lining varies throughout the menstrual cycle, thickening around the time of ovulation and just before menstruation. The ovaries also become larger with the development of a mature egg in one of the ovaries.
There can also be some abnormal findings on an ultrasound. There may be congenital (present at birth) and non-congenital anomalies (conditions that develop after birth).
The congenital anomalies can be due to missing, underdeveloped, incorrectly fused structures, or defects in the resorption process during development. Conditions include agenesis, obstructive Müllerian anomalies, non-obstructed Müllerian anomalies, and Turner syndrome, an X chromosomal syndrome that affects girls.
Non-congenital issues include pelvic inflammatory disease (PID), which can lead to pyosalpinx (collection of pus in the fallopian tubes), pyometra (pus in the uterus), and a mass involving both the ovary and the fallopian tube (tubo-ovarian abscess). Another condition is an ectopic pregnancy, which can occur in girls and women with a history of sexually transmitted diseases (infections passed from one person to another during sexual intercourse), particularly if they’ve had an inflammation of the reproductive organs known as pelvic inflammatory disease (PID). Ovarian torsion is a painful condition that can occur when an ovary twists around its supporting structures, prompting an urgent need for treatment.
Possible Complications of Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation
It’s reassuring to know that there are no reported problems tied to undergoing an ultrasound exam. It’s a safe procedure.
What Else Should I Know About Sonography Pediatric Gynecology Assessment, Protocols, and Interpretation?
Ultrasound is a safe and easy-to-use imaging technique that can be carried out right by a patient’s bedside. It does not involve any radiation, making it widely available and easily portable. This makes ultrasound a critical tool, especially for initial evaluations of children’s health and gynecological conditions.
Most of the time, a firm diagnosis can be made using an ultrasound. When needed, it can also help pinpoint cases that require further detail from an MRI or CT scan. Radiologists specializing in children’s health (pediatric radiologists) should be well-versed in how female pelvic organs normally look on ultrasound images from infancy through to adolescence.
Knowing how various health problems affecting the pelvis appear on ultrasound is crucial for making the right diagnosis. For instance, it’s necessary to understand conditions like ovarian torsion (a serious condition where an ovary twists around the ligaments that support it) and how it appears in ultrasound images to save ovaries from damage.
In conclusion, ultrasound is a simple, trustworthy, and a vital first step in investigating health conditions in children and gynecological conditions.