Gynecological ultrasound becomes the standard examination for many abdominal and pelvic issues, which is often offered in reproductive healthcare practice. Although the need for clearer definition is apparent towards the sonographers, for many women it is a daunting prospect that could lead them to refuse this examination when the advantages are not communicated clear.
Communication is not an exciting point for many, borne by the limited understanding regarding the subject when interpreting the findings. However, just like any experienced sonographers knows when they go wrong, they damage the therapeutic relationship with their patients and perhaps relationships along with other colleagues. Frequently, patients get to the gynecological ultrasound ward without any concept of what does the examination comprises, and the potential findings.
Preparation of the patient is the time where the sonographer can start rapport with a patient that will be the building blocks for any potential diagnosis. It has to occur in a very beginning, but is of remarkable importance to begin to organize the way for any news to be obtained. In an assisted reproduction field, gynecological ultrasound is frequently accustomed to support a “one stop shop” model of care. This could produce difficulties in case of an unpredicted finding.
Not every news given throughout gynecological ultrasound appointment can be harmful ones, but sonographers cannot be fully aware about of what is going to be positive or negative news for a patient. A non-viable pregnancy is not good news for every woman, whilst a proper diagnosis of suspected cancer is not always bad news for a patient that has been attending medical institutions for a while neglected or diagnosis made.
Giving potential diagnoses could be demanding, specifically for the unskilled sonographer. Patients given the same news can react in several ways.
Unpredicted Pregnancy Loss
Gynecological ultrasound during pregnancy is a common assessment tool employed for both planned and unplanned pregnancies. The news that the pregnancy is non-viable could be devastating to some woman or perhaps a couple, even if the pregnancy is undesirable. This can be surprising, but feelings of guilt about not wishing to carry on with the pregnancy can happen during the time of the scan or indeed, a long time later. Miscarriage, especially even without the any signs, is really a shock when available on gynecological ultrasound. It might be in a routine antenatal scan, and also the woman’s partner can also be present and their feelings will have to be considered. It is advisable to possess a check scan done by another sonographer once easy to get his/her second opinion. News of the failing pregnancy could be devastating too. The woman may need an additional scan, either by another sonographer immediately or afterwards to verify any findings. This provides the woman and her family time to be prepared for diagnosing before management choices are discussed together with her.
The sonographer in a pregnancy maintenance clinic checking to organize for any potential termination might find an unsuccessful or failing pregnancy. Within this circumstance, the woman might have terrible feelings of guilt, thinking she might have caused this by not wanting to follow the pregnancy. This paradox can haunt the woman for several years afterwards. It is important to be honest and open as this might have happened whatever her wishes. Restricting emotional morbidity all around the potential termination of the pregnancy with honest reassurance is crucial as depression and problems with anxiety are typical are termination of pregnancy.
Ovaries that contains several cysts are a common physiological finding. This should not be wrongly identified with a diagnosis of PCOS. The normality of cysts on ovaries can be challenging to share to women who frequently do not have any knowledge that the function of ovaries just to produce cysts throughout a monthly cycle, and often these cysts do not resolve for several weeks.
Some cysts on ovaries are abnormal and have readily recognizable gynecological ultrasound characteristics. Included in this are:
Hemorrhagic – these corpus luteum cysts have bled internally and can resolve over several days,
Infective – tubo-ovarian collections of pus or fluid in chronic pelvic inflammatory disease. This might require further management, either antibiotics, if acute, or surgery/further analysis and referral to a gynecologist,
Dermoid – typically, that contains fat, hair and from time to time teeth. They are able to become large and often require surgery,
Endometriomas – may cause discomfort, especially around the time of the monthly period and can result in pelvic adhesions, ovulatory disorder and subfertility,
Cystadenomas – typically, fluid full of low-level echoes. These may become large.
Other benign and malignant adnexal masses are not readily recognizable and wish further types of assessment. Caused by these further tests will settle if the mass ought to be known a gynecological oncology service.
The finding of the adnexal mass could be frightening for the woman and her family. It might be apparent that the cysts are malignant, but oftentimes, the character from the mass is unclear. It is often hard to acquire a fine balance of communicating the emergency of further referral without causing panic, which is demanding for patient and sonographer. Information ought to be honest, although not so blunt regarding cause panic and deter the woman from taking on a choice of specialist referral. Time taken using the woman here is vital, but can be challenging to attain in the middle of a busy appointment list.
Communication and the early development of a therapeutic relationship are essential skills. The latter includes a profound impact on the patient’s response, ability to handle the data given and compliance with any treatments presented.