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Case Study #7
A pregnant (5 mo.) woman is reporting pain and an enlargement in her lower right quadrant comes to seek advice on different ways of imaging the area without endangering her baby. What do you explain and advise?
I would also ask questions as to whether or not she is suffering from any other symptoms. Ordering blood and urine work on her is also an excellent idea. In Amanda’s case study she suggested the pelvic ultrasound. I would take it even a bit further. It is called a “transvaginal ultrasound”.
I would explain to her the benefits and/or risks of using this remarkable device. The ultrasound has been around since the 1950s and is considered safe and non-invasive. However, a transvaginal ultrasound is. (3) Transvaginal ultrasound is a method of imaging the genital tract in women. The ultrasound machine sends out high-frequency sound waves, which bounce off body structures to create a picture. With the transvaginal technique, the ultrasound transducer (a hand-held probe) is inserted directly into the vagina and is, therefore, closer to pelvic structures than with the conventional transabdominal technique (with the probe on the skin of the abdomen), providing superior image quality. This test can be used during pregnancy.
A transvaginal ultrasound takes it a bit further than a regular pelvic ultrasound. In this way, it rules out things like ectopic pregnancy, ovarian cysts, fibroid tumors and other abdominal/pelvic diseases like PID (pelvic inflammatory disease).
The transvaginal ultrasound is even better than the pelvic ultrasound. Doing her ultrasound this way will better pick up any potential problems too small enough for the pelvic ultrasound to catch. I would prefer it this way myself.
Ovarian cysts occur when there is a lot of fluid swelling inside the ovary. However, they usually will dissolve on their own. If an ovarian cyst does not dissolve after the next 1-2 menstrual cycles, the doctor would usually try to monitor their activity. If it enlarges, the doctor may suggest removal of the cyst(s). (1)
Fibroid tumors are usually benign (non-cancerous) tumors found, most often, in the uterus of women in their 30's and 40's, although they occasionally develop on other organs which contain smooth muscle cells. Fibroid tumors are solid tumors, which are made of fibrous tissue, hence the name 'fibroid' tumor. Most often fibroids occur as multiple tumor masses, which are slow-growing and often cause no symptoms. The size of fibroids varies immensely among women and some are so small that a microscope is required to see them.
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An ectopic pregnancy is when a pregnancy occurs in the fallopian tubes instead of the uterus. However, when this diagnosis is made, sometimes it can cause the fallopian tube to rupture. When this occurs, it requires the removal of the fetus, fallopian tube and ovary involved. (1)
PID occurs when disease-causing organisms migrate upward from the urethra and cervix into the upper genital tract. Many different organisms can cause PID, but most cases are associated with gonorrhea and genital chlamydial infections, two very common STDs. Scientists have found that bacteria normally present in small numbers in the vagina and cervix also may play a role. (2)
After reviewing the test results, the blood and urine were normal. Unfortunately, the ultrasound showed an ectopic pregnancy. Needless tosay, it is necessary to bring this pregnancy to an end and remove the affected fallopian tube before it ruptures and the patient hemorrhages.
1. Rosenthal M.D., M. Sara. The Gynecological Sourcebook. New York:
2. Pelvic Inflammatory Disease. National Institute of Allergy and Infection Disease. July 1998
3. Transducer Ultrasounds. A service of the U.S. National Library of Medicine and National Institutes of Health