cervical ultrasound

Ultrasound of the cervix is a method that is one of the most informative methods that allow identifying the main causes of the development of pathology not only of the female genital organs, but also of the pelvic organs. Ultrasound is performed to diagnose pregnancy and to monitor the condition of the fetus. In addition, ultrasound is the "gold standard" for diagnosing both benign and background diseases, as well as malignant tumors of the female genital organs at an early stage of development. Due to the ability of ultrasound rays to penetrate tissues of varying density, today it is possible not only to diagnose pathology of the cervix, body of the uterus and appendages, but also to conduct differential diagnostics of various neoplasms by establishing their size and exact localization. Good separation ability of ultrasound waves allows this diagnostic method to be widely used in gynecology.

Indications and technique for ultrasound examination of the cervix

Ultrasound examination of the cervix is an additional diagnostic method that is used only as prescribed by a doctor to clarify the diagnosis or conduct differential diagnostics. Therefore, it is important to consider each individual case and decide on this method of examination, especially since its information content is very high, along with low harm. Before the appointment, the doctor must explain the technique and the main points of this examination.

Preparation for ultrasound examination of the cervix has no distinctive features, except for the difference in the technique. On the eve of the examination, it is necessary to carry out basic hygiene procedures, which are no different from daily toilet. As a rule, for better visualization, with different examination techniques, it is necessary to empty the gallbladder - this facilitates the free passage of waves. This must be done immediately before the examination itself. These are the main elements of preparation, which are very simple, if this examination is accompanied by additional manipulations, then there may be other methods of preparation, which the doctor will inform individually.

Indications for ultrasound examination of the cervix are conditions that require additional examination to clarify the diagnosis. As for ultrasound examination of the cervix, the indications are as follows:

• Leucorrhoea is a vaginal discharge that can be a consequence of an inflammatory process of both the cervix and the uterus with appendages, including.
• Bloody vaginal discharge can be the result of many processes - ectopic pregnancy, ruptured uterine pregnancy, endometriosis, cervical erosion, cervical polyp, premature placental abruption, placenta previa and many other pathological conditions.
• Pain in the lower abdomen with the clinical picture of an “acute abdomen” may occur with a ruptured tube during an ectopic pregnancy, ovarian apoplexy, torsion of the ovarian cyst pedicle, or necrosis of a myomatous node.
• Enlargement of the uterus in volume and size if uterine fibroids are suspected to clarify the size and determine treatment tactics.
• Disruption of the normal ovariomenstrual cycle to determine the presence of a follicle, its size, egg, and functional activity of the endometrium.
• If malignant neoplasms are suspected, to clarify the location, size, and extent of spread to adjacent organs.
• During pregnancy, to confirm the presence of a fertilized egg and to clarify its location, as well as a mandatory screening method for diagnosing the condition of the fetus and its development.

These are the main indications for which it is necessary to conduct an ultrasound of the cervix and uterus, and depending on the goal, the technique is determined. There are two main techniques for conducting ultrasound - transvaginal and transabdominal. Transabdominal ultrasound is performed on pregnant women to assess the condition of the fetus, measure its size, measure the amount of amniotic fluid, and also for functional diagnostics of its main systems. This method is convenient for pregnant women in the second half, since good conductivity of ultrasound waves through a dense enlarged uterus.

Transvaginal ultrasound is performed for all other conditions that require examination. In this case, a condom is put on the transvaginal sensor and inserted into the vagina to prevent infection, which allows visualization of all uterine structures, as well as the ovaries and tubes. With this technique, it is possible to see the ectopic space.

This type of diagnostics allows us to identify all structural changes in the uterus, ovaries, periuterine space and adjacent organs.

Ultrasound of the cervix during pregnancy

Ultrasound diagnostics during pregnancy is a mandatory method of examination and is carried out at least three times in each trimester. The first ultrasound is carried out between the 9th and 11th week and allows to establish the number of fertilized eggs in the uterus, their location, the level of placentation, as well as the condition of the uterus. At this stage, it is possible to see the pathology of fetal development - chromosomal mutations, and in case of suspicion of the development of congenital anomalies, it is possible to refer for invasive examination methods. The technique is transvaginal.

The next ultrasound is performed in the second trimester and here an important element is a special examination – cervicometry. This method consists of an ultrasound examination of the cervix with measurement of its size.

The interpretation of the results of ultrasound examination of the cervix during pregnancy is that the standard indicators of the length of the cervix are 35-45 millimeters, and the size of the cervical orifice is no more than 5 millimeters. Up to the thirtieth week of pregnancy, the length of the cervix should be at least 35 millimeters. Then, during the next ultrasound in the third trimester at 34-36 weeks, the length of the cervix decreases, as it prepares for childbirth. In this case, its length is approximately 34-36 millimeters, but can be 30. This is considered a standard indicator. If the length of the cervix is less than 35 millimeters, then a diagnosis of isthmic-cervical insufficiency is made. This condition is characterized by possible complications in the form of premature pregnancy, premature discharge of amniotic fluid, umbilical cord entanglement. In case of timely establishment of this diagnosis, surgical treatment is carried out in the form of application of an obstetric pessary - this is a suture on the cervix, which reduces the cervical os and lengthens the cervix. Before childbirth, such a suture is removed. Therefore, it is very important to conduct an ultrasound of the cervix during pregnancy, especially in dynamics, since this allows you to monitor not only the condition of the fetus, but also the readiness of the birth canal and its condition. It should also be noted that in women who had isthmic-cervical insufficiency earlier during their first pregnancy, the method of ultrasound cervicometry is mandatory to monitor the condition of the cervix.

Normative indicators of ultrasound of the cervix

The conclusion that the doctor gives after the ultrasound examination of the cervix has a lot of incomprehensible things. How can you understand if everything is okay with your health? To do this, you need to know the normal indicators that are determined during this examination.

The examination result is formed not only from the data of the cervix, but it is complex and the correct interpretation of the results is very important in making a diagnosis:

1. The body of the uterus – location, presence of deformations, bends.
2. Endometrium – structure, thickness, echogenicity, presence of additional structures in the form of a fertilized egg, polyp, etc.
3. The cervix – its length, structure, presence of cysts, polyps.
4. Right and left ovary - their sizes, presence of follicles and structure.
5. Ectopic space – the presence of fluid or additional structures in the form of a fertilized egg, hematoma.

As for the cervix, the standard indicators for ultrasound examination of the cervix are as follows:

• length not less than 35 and not more than 45 millimeters;
• the size of the cervical os is no more than 5 millimeters;
• free patency of the cervical canal - absence of additional echo signals, which may occur with an ectopic cervical pregnancy, localization in the cervical region of a submucous myomatous node or polyp.
• clear structure of the epithelial lining of the cervix and cervical canal without deformations;
• absence of “plus-tissue” and “minus-tissue” symptoms, which occurs when malignant tumors grow exophytically and endophytically, respectively.

It is also necessary to take into account the location of the cervix relative to adjacent organs. After surgical interventions on the cervix for, for example, dysplasia, there may be cicatricial changes, which must be taken into account by carefully collecting anamnesis, since a false diagnosis can be made.

Pathological changes in the cervix according to ultrasound results

There are many cervical pathologies that can only be diagnosed using ultrasound data. Therefore, ultrasound is the "gold standard" for diagnosing pathologies of the female reproductive system. It is important to suspect a certain pathology during a routine examination in order to conduct additional research methods and exclude or confirm the suspected diagnosis.

1. Cervical erosion is a fairly common pathology that occurs in every third woman of any age. This pathology is related to background diseases and is associated with a possible risk of developing oncological pathology in the future. Therefore, it is important to establish a diagnosis and conduct treatment in a timely manner. First of all, it is necessary to distinguish between pseudo-erosion and true erosion of the cervix. Pseudo-erosion is a defect of the mucous membrane of the cervix, which is most often found in girls under 25 years of age and is physiological. It occurs due to the action of hormones and does not require treatment, but only observation. Erosion is a true defect of the mucous membrane, which can occur as a result of trauma, the action of microorganisms, and therefore requires treatment. Such pathology can be detected during a routine examination of a woman in mirrors or during a colposcopy. Then the woman is sent for an ultrasound to exclude a malignant nature - then there will be no spread into the tissue. During ultrasound examination of the cervix, erosion has a characteristic appearance - a shallow superficial defect of the cervical covering without spreading deep into the tissue. Sometimes, erosion may not be visualized, which depends on the separation capacity of the device and the size of the defect.
2. Cervical cancer is a very dangerous pathology and requires the earliest possible diagnosis. Ultrasound allows you to accurately determine the localization of the pathological process, the degree of damage to neighboring organs, the state of regional lymph nodes. This allows you not only to establish a diagnosis, but also to classify the disease according to the stage, which is important for choosing treatment tactics.

Cervical cancer on ultrasound looks like "plus tissue" and has a fuzzy structure in the form of a heterogeneous echogenic formation with fuzzy contours, which fills the cavity of the cervical canal or is located on the cervix itself. This picture is observed with exophytic tumor growth. With endophytic growth of cervical cancer on ultrasound, heterogeneity of the structure of the cervix or cervical canal is observed in the form of a node with fuzzy boundaries and a blurred structure.

3. Cervical dysplasia is also a precancerous condition and requires timely diagnosis. This is a pathology in which epithelial metaplasia occurs, i.e. multilayered flat epithelium, which is normally located in the exocervix, appears in the transition zone or in the cervical canal. This structural disorder is a superficial defect and, unfortunately, has no manifestations on ultrasound. This pathology is detected and confirmed by cytological examination.
4. Cervical polyp is a very common pathology caused by infection and replication of the human papilloma virus in the cells of the cervix. This virus multiplies and contributes to the disruption of the normal structure of the epithelial cover, resulting in the formation of benign formations that look like cauliflower - polyps. These polyps look like "plus tissue" on ultrasound, but unlike malignant formations, they have clear boundaries and uniform density, do not spread or grow deep, and grow only exophytically. Thus, they look like an additional elongated formation with clear boundaries.
5. A cervical cyst is not a common occurrence, but it also occurs and requires diagnostics. A cyst is a non-proliferative benign formation that has thin walls and a uniform composition. On ultrasound, a cervical cyst looks like a clear, rounded formation that has a uniform composition inside in the form of liquid - which is clearly visible on the screen. It is necessary to carefully conduct a transvaginal examination if a cervical cyst is suspected, since a complication in the form of cyst injury is possible.
6. Carcinoma and adenocarcinoma are malignant tumors of the cervix that develop from epithelial glandular tissue. Often have exophytic growth and a heterogeneous structure. On ultrasound, it looks like an unclear formation with a significant depth of penetration into the thickness of the cervix, the sizes are different, the borders are heterogeneous. On ultrasound, it is difficult to distinguish between cancer and adenocarcinoma, since they have similar characteristics, one can only suspect a malignant nature, and an accurate diagnosis is established by the histological picture.

Ultrasound of the cervix is an informative diagnostic method that allows for the diagnosis of normal pregnancy, monitoring of the dynamics of the fetus, and also determining possible pathological processes not only in the cervix, but also in the pelvic organs. Timely diagnosis of benign, background, and malignant formations in the cervix allows for the avoidance of complications and timely treatment.