Julie Rawlins Diagnostic Ultrasonographer T/A Inside Image Ultrasound

06/08/2025

Ultrasound of the Uterus : Endometrium

Endometrial thickness is a commonly measured parameter on routine gynaecological ultrasound and MRI. The appearance, as well as the thickness of the endometrium, will depend on whether the patient is of reproductive age or postmenopausal and, if of reproductive age, at what point in the menstrual cycle they are examined.

Radiographic features
Ultrasound
The endometrium should be measured in the long axis or sagittal plane, ideally on transvaginal scanning, with the entirety of the endometrial lining through to the endocervical canal in view 10. The measurement is of the thickest echogenic area from one basal endometrial interface across the endometrial canal to the other basal surface. Care should be taken not to include hypoechoic myometrium or intrauterine fluid in this measurement.

The normal endometrium changes in appearance as well as in thickness throughout the menstrual cycle:

in the menstrual and early proliferative phase it is a thin, brightly echogenic stripe comprising of the basal layer; minimal fluid can be appreciated endovaginally within the endometrium in the menstrual phase
in the late proliferative phase it develops a trilaminar appearance: outer echogenic basal layer, middle hypoechoic functional layer, and an inner echogenic stripe at the central interface
in the secretory phase it is at its thickest, up to 16 mm 10, and becomes uniformly echogenic, as the functional layer becomes oedematous and isoechoic to the basal layer; there is through transmission and posterior acoustic enhancement noted
The postmenopausal endometrium should be smooth and homogeneous.

Normal range of endometrial thickness

The designation of normal limits of endometrial thickness rests on determining at which thickness the risk of endometrial carcinoma is significantly increased.

Whilst quantitative assessment is important, endometrial morphology and the presence of risk factors for endometrial malignancy should also be taken into account when deciding whether or not endometrial sampling is indicated.

Premenopausal

In premenopausal patients, there is significant variation at different stages of the menstrual cycle.

during menstruation: 2-4 mm 1,4
early proliferative phase (day 6-14): 5-7 mm
late proliferative / preovulatory phase: up to 11 mm
secretory phase: 7-16 mm
following dilatation and curettage or spontaneous abortion:

25/06/2025

UTERINE FIBROIDS

Uterine leiomyomas, also known as uterine fibroids, are benign tumors of myometrial origin and are the most common solid benign uterine neoplasms. They are a common incidental finding on imaging and rarely cause diagnostic dilemma.

Fibroids may have a number of locations within or external to the uterus:

-intrauterine

-intramural leiomyoma: most common, centered within the myometrium

-subserosal leiomyoma: projecting outwards from the uterus; may be pedunculated and predominantly extrauterine, simulating an adnexal mass

-submucosal leiomyoma: least common (10-15%), projecting into the uterine cavity

-extrauterine

-broad ligament leiomyoma

-cervical leiomyoma

-parasitic leiomyoma

-diffuse uterine leiomyomatosis

Ultrasound is used to diagnose the presence and monitor the growth of fibroids:

-uncomplicated leiomyomas are usually hypoechoic, but can be isoechoic, or even hyperechoic compared to normal myometrium

-calcification is seen as echogenic foci with shadowing

-cystic areas of necrosis or degeneration may be seen

-Venetian blind artifact may be seen but edge shadowing +/- dense posterior shadowing from calcification is also typically seen

09/01/2025

POLYCYSTIC OVARIAN SYNDROME: PCOS

Polycystic ovaries (PCO) or polycystic ovarian morphology (PCOM) is an imaging descriptor of a particular type of change in ovarian morphology. A proportion of women with polycystic ovaries will have polycystic ovarian syndrome (PCOS), which in turn requires additional clinical, as well as biochemical, criteria; otherwise, polycystic ovaries can be considered a normal variant.

Epidemiology
Polycystic ovaries may be seen in ~20% of women of reproductive age 1,4.

Radiographic features
Ultrasound
Transvaginal ultrasound is considered the gold standard in the diagnosis of polycystic ovarian morphology (although not in adolescents 18). Features can affect either one (unilateral polycystic o***y) or both ovaries.

Features include:

increased follicle number per o***y (FNPO): ≥20

background ovarian enlargement (volume greater than 10 mL) excluding dominant follicle >10 mm or corpus luteum 7

10 antral follicles of 2-9 mm or more per slice (FNPS): ≥10

individual follicles are generally similar in size and measure 2-9 mm in diameter 7

peripheral distribution of follicles; this can give a "string of pearls" appearance

central stromal brightness +/- prominence (increased ovarian stromal area to total ovarian area (S/A) ratio 17)

Only one o***y fitting these criteria is sufficient to define PCOM. If there is evidence of a dominant follicle (>10 mm) or a corpus luteum, the scan should be repeated during the next cycle

01/09/2024

15/08/2024

Gender View scans

Ultrasound Gender Scan
This is probably the most common way that parents discover the s*x of their baby.There is normally a 100% accuracy gender prediction rate when over 16 weeks. This is usually a good timeline if you want to announce your baby’s gender to your friends and family or splash out on the blue or pink!
The s*x of the fetus becomes clearer to the sonographer as the baby gets bigger. If you have the patience to wait till 20 weeks, it is very clear to determine your baby’s gender at this stage.

To book your gender view scan contact :
Julie Rawlins- Diagnostic Ultrasonographer
Practice number 0390040517119
Tel: 0317654670
Cell: 0823217233
Heritage House Office Park: Vertebrae Wellness Vertebrae Chiropractic and Wellness Centre
20 Old Main Road
Hillcrest
KZN
julie@insideimage.co.za

Baby Imaging, 4 D scans, Prenatal Scans, Diagnostic Obstetric and Gynaecology Scans Abdominal Scans

07/08/2024

PELVIC ULTRASOUND

How often should a woman have a pelvic ultrasound?

It is recommend to have a routine gynaecological checkup with routine ultrasound pelvic screening every 1- 2 years.

**Book your screening pelvic ultrasound today-Julie Rawlins Diagnostic Ultrasonographer Tel: 0317654670 Hillcrest KZN / 0823217233**

Pelvic sonography is a screening tool and an important diagnostic modality for various gynecological and obstetric pathologies. Patients with abnormal uterine bleeding (AUB), postmenopausal bleeding, abdominal distension, palpable pelvic mass, abdominal pain, pelvic pain, infertility, recurrent pregnancy loss, and signs of infection should be evaluated by pelvic sonography.

Abnormal Uterine Bleeding

Heavy menstrual bleeding is one of the common presentations of structural uterine pathologies like leiomyoma, adenomyosis, and endometrial polyp detected by pelvic sonography. Patients with endometrial hyperplasia and carcinoma present with heavy menstrual and postmenopausal bleeding and require ultrasound screening. Intermenstrual bleeding is frequently associated with an endocervical polyp, carcinoma cervix, estrogen-secreting ovarian tumors, and intrauterine devices.
The most common presentation of endometrial carcinoma and hyperplasia in postmenopausal females is postmenopausal bleeding. Screening such females with pelvic sonography followed by endometrial sampling is highly recommended. Senile vaginitis, urethritis, and endocervical polyp are frequent causes of postmenopausal bleeding.

Abdominal Mass and Pelvic Mass

Ascites and ovarian malignancy frequently present primarily with complaints of increased abdominal girth, abdominal distension, and/or palpable pelvic mass. Large subserosal broad ligament leiomyoma, multiple uterine leiomyomas, adenomyosis with more than 12-week pregnant uterine size, molar pregnancy, rudimentary horn ectopic pregnancy, hematometra, pyometra, choriocarcinoma, ovarian and tubo ovarian mass present as pelvic mass frequently extending up to abdominal cavity. All these mentioned pelvic pathologies can be screened by pelvic sonography.

Pelvic Pain and Dysmenorrhea

Endometriosis, pelvic inflammatory disease, ovarian torsion, tubo ovarian mass, adenomyosis, degenerating leiomyoma, ectopic pregnancy, and cystitis are common pathologies presenting with lower abdominal and pelvic pain having an ultrasound diagnosis.

Infertility, Amenorrhea, and Recurrent Pregnancy Loss

Structural uterine anomalies in the case of the unicornuate uterus, bicornuate uterus, septate uterus, didelphys uterus, and cervical incompetence are associated with causing infertility and recurrent pregnancy loss. In patients with amenorrhea in case of androgen insensitivity syndrome (AIS) and Mayer-Rokitansky-Kuster-Kuster-Hauser (MRKH) syndrome due to absent uterus; due to hypoplastic uterus in case of Turner syndrome; and in case of imperforate h***n with hematometra, ultrasound diagnosis is required. These patients also have infertility.

22/04/2024

Happy Earth Day 🌍🌱

11/04/2024

During pregnancy, a woman’s body undergoes many transformations in preparation for creating an environment ideal for the developing baby.

Having your body adjusted while pregnant can help:

- Promote a healthier, pain-free pregnancy
- Relieve back, neck and joint pain
- Establish pelvic balance and alignment
- Promote a shorter labour

Find a local chiropractor with a special interest in pregnancy by visiting www.chiropaeds.co.za

05/04/2024

Umbilical Cord:

The umbilical cord is a fetal organ that connects the placenta to the developing fetus and is a vital passage for nutrients, oxygen and waste products to and from the fetus.

Gross anatomy
The umbilical cord inserts into the center of the placental bulk and into the fetus at the umbilicus. Variations in insertion can occur. For example, eccentric insertion, marginal insertion and velamentous insertion may be seen 1. It measures 55-60 cm in length with a thickness of 2.0-2.5 cm 3. The normal cord has two arteries and one vein 2-3: paired umbilical arteries (branches of the internal iliac artery) carry deoxygenated blood from the fetus to the placenta
umbilical vein carries oxygenated blood from the placenta to the fetus

Related pathology:

- variation in cord insertion
- marginal cord insertion
- velamentous cord insertion
- variation in morphology
- forked umbilical cord
- long umbilical cord
- short umbilical cord
- umbilical cord knot
- false umbilical cord knot
- true umbilical cord knot
- umbilical cord entanglement
- straight umbilical cord
- umbilical cord thrombosis
- umbilical cord hematoma
- single umbilical artery
- umbilical cord cyst
- umbilical cord pseudocyst
- umbilical cord prolapse

19/03/2024

Fetal Heart Rate

A normal fetal heart rate (FHR) usually ranges from 120 to 160 beats per minute (bpm) in the in utero period. It is measurable sonographically from around 6 weeks and the normal range varies during gestation, increasing to around 170 bpm at 10 weeks and decreasing from then to around 130 bpm at term.

Evolution through gestation

Although the myocardium begins to contract rhythmically by 3 weeks after conception (from spontaneously depolarizing myocardial pacemaker cells in the embryonic heart) it is first visible on sonography around 6 weeks of gestation. The FHR is then usually around 100 to 120 beats per minute (bpm).

FHR then increases progressively over the subsequent 2-3 weeks becoming 7:

~110 bpm (mean) by 5-6 weeks
~170 bpm by 9-10 weeks
This is followed by a decrease in FHR becoming on average:

~150 bpm by 14 weeks
~140 bpm by 20 weeks
~130 bpm by term

Although in the healthy fetus the heart rate is usually regular, a beat-to-beat variation of approximately 5 to 15 beats per minute can be allowed.

13/03/2024

What is placental grading?

Placental grading (Grannum classification) refers to an ultrasound grading system of the placenta based on its maturity. This primarily affects the extent of calcifications.

Mismatched grades for gestational age are considered abnormal. Grading is however still based on visual appearance of the placenta.

The grading system is as follows:

grade 0: