N.B. Transvaginal (TV) US equipment should be available in all Departments performing pelvic US
CLINICAL PROBLEM |
INVESTIGATION |
RECOMMENDATION |
COMMENT |
||
| Screening in pregnancy | I1 | US | Indicated | [C] | Screening US has not been shown to alter perinatal mortality, except where selective termination of pregnancy is applied in the presence of gross fetal abnormality. It does provide useful information about dating and multiple pregnancies. US is also of proven value in assessing placenta praevia and intra-uterine growth. In the specialist care of high risk pregnancies, Doppler US of the umbilical artery assists management. US is now commonly offered as a routine part of antenatal care in the UK, despite the scientific basis for its use remaining controversial. There is wide geographical variation in the number of antenatal US examinations performed. The optimal timing for a single US examination is 18-20 weeks of gestation. |
| Suspected pregnancy | I2 | US | Not indicated | [C] | Pregnancy testing most appropriate. US valuable where molar pregnancy suspected. |
| Suspected ectopic pregnancy | I3 | US | Indicated | [B] | After positive pregnancy test. TV US preferred. Colour flow Doppler increases sensitivity. |
| Possible non-viable pregnancy | I4 | US | Indicated | [C] | Repeat US after a week may be needed (especially when gestational sac <20 mm or crown rump length < 6 mm). Pregnancy test required. Where doubt exists about the viability of a pregnancy, delay in evacuation of the uterus is essential. |
| Suspected pelvic mass | I5 | US | Indicated | [C] | Combination of trans-abdominal and TV US often required. US should confirm a lesion's presence and determine likely organ of origin. See Cancer Section L. MRI is the best second line investigation, although CT still widely used. |
| Pelvic pain, including suspected pelvic inflammatory disease and suspected endometriosis | I6 | US | Indicated | [C] | Especially when clinical examination difficult or impossible. |
| MRI | Specialised investigation | [B] | Can be useful to localise the larger foci of endometriosis. | ||
| Lost IUCD | I7 | US | Indicated | [C] | |
| AXR | Not indicated | [C] | Unless IUCD is not seen in uterus on US. | ||
| Recurrent miscarriages | I8 | US | Indicated | [C] | Will show the major congenital and acquired problems. |
| MRI | Specialised investigation | [C] | Supplements US for uterine anatomy. Some centres still continue to use hysterosalpingography. | ||
| Infertility | I9 | US | Indicated | [C] | For follicle-tracking during treatment. For assessment of tubal patency. Some centres still continue to use hysterosalpingography. |
| Suspected cephalopelvic disproportion | I10 | XR Pelvimetry | Not indicated | [B] | The need for pelvimetry is increasingly being questioned. Local policy should be determined in agreement with obstetricians. Furthermore MRI or CT should be used wherever possible. |
| MRI or CT | Specialised investigation | [C] | MRI is best as it avoids x-irradiation. CT generally offers a lower dose than standard XR pelvimetry. | ||