POCUS Learning Modules

MODULE 9:  Gynecology US

Curriculum Location: Gynecology / Total Time: 1 hour

For this and all other modules, you are welcome and encouraged to take notes as helpful to you in your Ultrasound/POCUS for Family Medicine Evernote Notebook, found here. 

Learning Module Objectives:

  1. Understand a general approach to transabdominal and transvaginal ultrasound.

  2. Evaluate the endometrial lining to determine risk for endometrial cancer in a postmenopausal woman with abnormal uterine bleeding.

  3. Evaluate the uterus to confirm IUD placement.

Gynecologic US (Time: 30 minutes)

  1. Background Case:

    1. Introduction: Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding gynecology ultrasound.

    2. Case description: A 55 year old postmenopausal woman presents with complaint of vaginal bleeding. Her past medical history includes hypertension, Type 2 diabetes, and obesity (BMI 45). She has had a bilateral tubal ligation but no other gynecologic surgeries. She is a G3P3 with 3 previous vaginal deliveries. Last pap was 1 year ago and normal with negative high-risk HPV co-testing. No family history of endometrial cancer. No significant findings on physical exam, including normal external pelvis, vagina, cervix, uterus, and adnexa.

    3. Case Questions: Would POCUS be sufficient to evaluate this patient or is an endometrial biopsy indicated?

  2. Assignments:

    1. First, watch this video from SUSME on US of female pelvis (14m) to review the basics. (Here are the AIUM female pelvis US guidelines referenced at the end of the video.)

    2. Next, read this statement and review the images summarizing ultrasound for evaluating vaginal bleeding in the postmenopausal woman such as in the Background Case above:

      1. Overview: For a postmenopausal woman complaining of vaginal bleeding, with no additional risk factors for endometrial cancer, a transvaginal ultrasound (TVUS) to evaluate the uterus is sufficient to rule out endometrial cancer as the cause if the endometrial wall thickness is <5mm. (Premenopausal women older than 45 years, or premenopausal woman younger than 45 years with risk factors or failed management, are at higher risk for endometrial cancer and need endometrial biopsy. Biopsy is also indicated for postmenopausal women with risk factors.) TVUS demonstrating endometrial wall thickness of 4mm or less in a postmenopausal woman with no risk factors has a 99% NPV (negative predictive value); however, if bleeding is persistent, a biopsy is indicated.

      2. Read this Radiopaedia review and images (Figures 1-3) and this 30 second video from GCUS.

    3. POCUS can also be used to assess IUD placement. Please review these brief videos:

      1. IUD PLACEMENT (4.5 min) (https://www.youtube.com/watch?v=0e9Tmge0G2c)

      2. MIRENA (3 min) (https://www.youtube.com/watch?v=6bjIGwP8YOA)

      3. Optional longer video (good teaching): https://www.youtube.com/watch?v=9IG__pg1pQ8

Module QUIZ (Time: 5 minutes)

  • Congratulations on completing the module. Please click HERE to take your Module Quiz and provide Module feedback.