From the Guidelines
Transvaginal ultrasound is the recommended type of ultrasound for diagnosing ovarian cysts and early pregnancy, as it provides superior image resolution and can clearly show the size, location, and characteristics of the cyst or gestational sac. This approach is supported by recent studies, including one published in 2023 in the American Journal of Obstetrics and Gynecology 1, which highlights the importance of ultrasound in the workup of adnexal masses in pregnancy. The use of transvaginal ultrasound allows for better visualization of ovarian structures and early gestational sacs, enabling healthcare providers to distinguish between functional cysts, endometriomas, or potentially concerning masses.
In pregnancy assessment, transvaginal ultrasound can detect a pregnancy as early as 4-5 weeks gestation, visualize the yolk sac, fetal pole, and cardiac activity earlier than transabdominal approaches 1. For patients beyond the first trimester or those uncomfortable with transvaginal ultrasound, transabdominal ultrasound becomes more appropriate and can provide adequate imaging. A full bladder is typically required for transabdominal ultrasound but should be empty for transvaginal examination for optimal imaging.
Some key points to consider when using ultrasound for diagnosing ovarian cysts and pregnancy include:
- The accuracy of ultrasound in characterizing adnexal masses, with a pooled sensitivity of 64% and specificity of 88% in diagnosing malignant masses in pregnancy 1
- The importance of considering the clinical situation and patient comfort level when choosing between transvaginal and transabdominal ultrasound
- The use of ultrasound-based scoring systems, such as the Sassone and Lerner systems, to help differentiate between benign and malignant masses 1
- The potential benefits of laparoscopic surgery over open surgery for adnexal masses in pregnancy, including shorter hospital length of stay and less postoperative pain 1
Overall, the use of transvaginal ultrasound as the primary diagnostic tool for ovarian cysts and early pregnancy is supported by recent evidence and can help improve patient outcomes by providing accurate and timely diagnoses.
From the Research
Ultrasound Recommendations for Diagnosing Ovarian Cyst and Pregnancy
- Transvaginal sonography is recommended for diagnosing ovarian cysts and pregnancy, as it plays an important role in the detection of ovarian cysts and the diagnosis of malignancy 2.
- Transvaginal ultrasound is also useful in diagnosing ovarian ectopic pregnancy, with findings such as a hyperechoic ring denoting the presence of a gestational sac 3.
- Transabdominal ultrasound may be used in some cases, but transvaginal ultrasound is generally more accurate and reliable 4.
- The use of transvaginal ultrasound-guided aspiration of benign ovarian cysts has been shown to be a simple, safe, and effective procedure 5.
- In cases of pregnancy complicated with an adnexal mass, the second trimester is the preferable time of action when operation is demanded, and transvaginal sonography can be used to diagnose and monitor the condition 2.
Key Findings
- Transvaginal sonography is the preferred method for diagnosing ovarian cysts and pregnancy.
- Transabdominal ultrasound may be used in some cases, but is generally less accurate and reliable than transvaginal ultrasound.
- Transvaginal ultrasound-guided aspiration of benign ovarian cysts is a safe and effective procedure.
- The second trimester is the preferable time of action when operation is demanded in cases of pregnancy complicated with an adnexal mass.