Pelvic Ultrasound (Female)

1. 1

   Ensure patient has a full bladder for transabdominal (TA) scan. Use curvilinear probe.

2. 2

   Sagittal uterus: probe suprapubic, marker toward head. Measure uterine length and AP diameter.

3. 3

   Transverse uterus: rotate 90°, sweep superior to inferior. Measure width at widest point.

4. 4

   Measure endometrial thickness in the sagittal plane — double layer, at the thickest point, excluding any fluid.

5. 5

   Locate right ovary (lateral to uterus, medial to iliac vessels). Measure in 3 planes. Assess follicles.

6. 6

   Locate left ovary similarly. Document any cysts — characterize as simple (anechoic, thin wall) or complex.

7. 7

   Check cul-de-sac for free fluid. If TA is suboptimal, proceed to transvaginal (empty bladder) for endometrium and ovaries.

• Uterus — sagittal (length & AP)
• Uterus — transverse (width)
• Endometrium measurement
• Right ovary (longitudinal + transverse)
• Left ovary (longitudinal + transverse)
• Cul-de-sac (free fluid)
• Transvaginal survey (if indicated)

• Uterine size and morphology
• Endometrial thickness
• Ovarian size and follicles
• Free fluid in cul-de-sac
• Adnexal masses

• Full bladder required for TA; empty bladder for TV
• Fibroids can distort uterine measurements
• Ovaries may be hidden behind bowel gas

For postmenopausal bleeding: endometrial thickness >4–5mm warrants biopsy. Use TV for superior resolution of endometrium.