Women’s Surgeries

Scroll below for some of the Women’s Surgeries provided to our patients. To book an appointment to see female doctor and gynecologist Dr. Kashyap about a surgical issue, please call our office at 702-983-2010 or click on a Book Appointment link.

Dilation & Curettage

What is dilation and curettage?

Dilation and curettage (D&C) is a surgical procedure in which the cervix is opened (dilated) and a thin instrument is inserted into the uterus. This instrument is used to remove tissue from the inside of the uterus (curettage).

Why is a dilation and curettage done?

D&C is used to diagnose and treat many conditions that affect the uterus, such as abnormal bleeding. A D&C also may be done after a miscarriage. A sample of tissue from inside the uterus can be viewed under a microscope to tell whether any cells are abnormal. A D&C may be done with other procedures, such as hysteroscopy, in which a thin, lighted telescope is used to view the inside of the uterus.

Where is a dilation and curettage done?

A D&C can be done in a health care professional’s office, a surgery center, or a hospital.

What happens during the procedure?

During the procedure, you will lie on your back and your legs will be placed in stirrups. A speculum will be inserted into your vagina. The cervix will be held in place with a special instrument.

Usually, only a small amount of dilation is needed (less than one-half inch in diameter).

Tissue lining the uterus will be removed, either with an instrument called a curette or with suction. In most cases, the tissue will be sent to a laboratory for examination.

What are the risks of dilation and curettage?

Complications include bleeding, infection, or perforation of the uterus (when the tip of an instrument passes through the wall of the uterus). Problems related to the anesthesia used also can occur. These complications are rare.

In rare cases, after a D&C has been performed after a miscarriage, bands of scar tissue, or adhesions, may form inside the uterus. This is called Asherman syndrome. These adhesions may cause infertility and changes in menstrual flow. Asherman syndrome often can be treated successfully with surgery.

What should I expect after the surgery?

After the procedure, you probably will be able to go home within a few hours. You will need someone to take you home. You should be able to resume most of your regular activities in 1 or 2 days. Pain after a D&C usually is mild. You may have spotting or light bleeding.

Is there anything I should watch out for or not do right after my dilation and curettage?

You should contact your health care professional if you have any of the following:

• Heavy bleeding from the vagina
• Fever
• Pain in the abdomen
• Foul-smelling discharge from the vagina

After a D&C, a new lining will build up in the uterus. Your next menstrual period may not occur at the regular time. It may be early or late.

Until your cervix returns to its normal size, bacteria from the vagina can enter the uterus and cause infection. It is important not to put anything into your vagina after the procedure. Ask your health care professional when you can have sex or use tampons again.

Hysteroscopy

What is hysteroscopy?

Hysteroscopy is used to diagnose or treat problems of the uterus. A hysteroscope is a thin, lighted telescope-like device. It is inserted through your vagina into your uterus. The hysteroscope transmits the image of your uterus onto a screen. Other instruments are used along with the hysteroscope for treatment.

Why is hysteroscopy done?

One of the most common uses for hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal bleeding can mean that a woman’s menstrual periods are heavier or longer than usual or occur less or more frequently than normal. Bleeding between menstrual periods also is abnormal. In some cases, abnormal bleeding may be caused by benign (not cancer) growths in the uterus, such as fibroids or polyps.

Hysteroscopy also is used in the following situations:

• Remove adhesions that may occur because of infection or from past surgery
• Diagnose the cause of repeated miscarriage when a woman has more than two miscarriages in a row
• Locate an intrauterine device (IUD)
• Perform sterilization, in which the hysteroscope is used to place small implants into a woman’s fallopian tubes as a permanent form of birth control

How is hysteroscopy performed?

Before the procedure begins, you may be given a medication to help you relax, or a general or local anesthetic may be used to block the pain. If you have general anesthesia, you will not be awake during the procedure.

Hysteroscopy can be done in a health care professional’s office or at the hospital. It will be scheduled when you are not having your menstrual period. To make the procedure easier, your health care professional may dilate (open) your cervix before your hysteroscopy. You may be given medication that is inserted into the cervix, or special dilators may be used. A speculum is first inserted into the vagina. The hysteroscope is then inserted and gently moved through the cervix into your uterus. Carbon dioxide gas or a fluid, such as saline (salt water), will be put through the hysteroscope into your uterus to expand it. The gas or fluid helps your health care professional see the lining more clearly. The amount of fluid used is carefully checked throughout the procedure. Your health care professional can view the lining of your uterus and the openings of the fallopian tubes by looking through the hysteroscope. If a biopsy or other procedure is done, small tools will be passed through the hysteroscope.

What should I expect during recovery?

You should be able to go home shortly after the procedure. If you had general anesthesia, you may need to wait until its effects have worn off.

It is normal to have some mild cramping or a little bloody discharge for a few days after the procedure. You may be given medication to help ease the pain. If you have a fever, chills, or heavy bleeding, call your health care professional right away.

What are the risks of hysteroscopy?

Hysteroscopy is a very safe procedure. However, there is a small risk of problems. The uterus or cervix can be punctured by the hysteroscope, bleeding may occur, or excess fluid may build up in your system. In very rare cases, hysteroscopy can cause life-threatening problems.

Endometrial Ablation

What is endometrial ablation?

Endometrial ablation destroys a thin layer of the lining of the uterus. Menstrual bleeding does not stop but is reduced to normal or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be needed.

Why is endometrial ablation done?

Endometrial ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding are treated first with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation may be used.

Who should not have endometrial ablation?

Endometrial ablation should not be done in women past menopause. It is not recommended for women with certain medical conditions, including the following:

• Disorders of the uterus or endometrium
• Endometrial hyperplasia
• Cancer of the uterus
• Recent pregnancy
• Current or recent infection of the uterus

Can I still get pregnant after having endometrial ablation?

Pregnancy is not likely after ablation, but it can happen. If it does, the risks of miscarriage and other problems are greatly increased. If a woman still wants to become pregnant, she should not have this procedure. Women who have endometrial ablation should use birth control until after menopause. Sterilization may be a good option to prevent pregnancy after ablation.
A woman who has had ablation still has all her reproductive organs. Routine cervical cancer screening and pelvic exams are still needed.

What techniques are used to perform endometrial ablation?

The following methods are those most commonly used to perform endometrial ablation:

• Radiofrequency—A probe is inserted into the uterus through the cervix. The tip of the probe expands into a mesh-like device that sends radiofrequency energy into the lining. The energy and heat destroy the endometrial tissue, while suction is applied to remove it.
• Freezing—A thin probe is inserted into the uterus. The tip of the probe freezes the uterine lining. Ultrasound is used to help guide the procedure.
• Heated fluid—Fluid is inserted into the uterus through a hysteroscope, a slender, light-transmitting device. The fluid is heated and stays in the uterus for about 10 minutes. The heat destroys the lining.
• Heated balloon—A balloon is placed in the uterus with a hysteroscope.
• Heated fluid is put into the balloon. The balloon expands until its edges touch the uterine lining. The heat destroys the endometrium.
• Microwave energy—A special probe is inserted into the uterus through the cervix. The probe applies microwave energy to the uterine lining, which destroys it.
• Electrosurgery—Electrosurgery is done with a resectoscope. A resectoscope is a slender telescopic device that is inserted into the uterus. It has an electrical wire loop, roller-ball, or spiked-ball tip that destroys the uterine lining. This method usually is done in an operating room with general anesthesia. It is not as frequently used as the other methods.

What should I expect after the procedure?

Some minor side effects are common after endometrial ablation:

• Cramping, like menstrual cramps, for 1–2 days
• Thin, watery discharge mixed with blood, which can last a few weeks. The discharge may be heavy for 2–3 days after the procedure.
• Frequent urination for 24 hours
• Nausea

What are the risks associated with endometrial ablation?

Endometrial ablation has certain risks. There is a small risk of infection and bleeding. The device used may pass through the uterine wall or bowel. With some methods, there is a risk of burns to the vagina, vulva, and bowel. Rarely, the fluid used to expand your uterus during electrosurgery may be absorbed into your bloodstream. This condition can be serious. To prevent this problem, the amount of fluid used is carefully checked throughout the procedure.

LEEP

What is a loop electrosurgical excision procedure (LEEP) and why is it done?

If you have an abnormal cervical cancer screening result, your health care professional may suggest that you have a loop electrosurgical excision procedure (LEEP) as part of the evaluation or for treatment. LEEP is one way to remove abnormal cells from the cervix by using a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a thin layer of the cervix.

How is LEEP performed?

A LEEP should be done when you are not having your menstrual period to give a better view of the cervix. In most cases, LEEP is done in a health care professional’s office. The procedure only takes a few minutes.

During the procedure, you will lie on your back and place your legs in stirrups. The health care professional then will insert a speculum into your vagina in the same way as for a pelvic exam. Local anesthesia will be used to prevent pain. It is given through a needle attached to a syringe. You may feel a slight sting, then a dull ache or cramp. The loop is inserted into the vagina to the cervix. There are different sizes and shapes of loops that can be used. You may feel faint during the procedure. If you feel faint, tell your health care professional immediately.

After the procedure, a special paste may be applied to your cervix to stop any bleeding. Electrocautery also may be used to control bleeding. The tissue that is removed will be studied in a lab to confirm the diagnosis.

What are the risks of LEEP?

The most common risk in the first 3 weeks after a LEEP is heavy bleeding. If you have heavy bleeding, contact your health care professional. You may need to have more of the paste applied to the cervix to stop it.

LEEP has been associated with an increased risk of future pregnancy problems. Although most women have no problems, there is a small increase in the risk of premature births and having a low birth weight baby. In rare cases, the cervix is narrowed after the procedure. This narrowing may cause problems with menstruation.

What should I expect during recovery from LEEP?

After the procedure, you may have:

• a watery, pinkish discharge
• mild cramping
• a brownish-black discharge (from the paste used)

It will take a few weeks for your cervix to heal. While your cervix heals, you should not place anything in the vagina, such as tampons or douches. You should not have intercourse. Your health care professional will tell you when it is safe to do so.

You should contact your health care professional if you have any of the following problems:

• Heavy bleeding (more than your normal period)
• Bleeding with clots
• Severe abdominal pain

Will I need follow-up visits?

After the procedure, you will need to see your health care professional for follow-up visits. You will have cervical cancer screening to be sure that all of the abnormal cells are gone and that they have not returned. If you have another abnormal screening test result, you may need more treatment.

You can help protect the health of your cervix by following these guidelines:

• Have regular pelvic exams and cervical cancer screening.
• Stop smoking—smoking increases your risk of cancer of the cervix.
• Limit your number of sexual partners and use condoms to reduce your risk of sexually transmitted infections (STIs).

Hysterectomy

What is a hysterectomy?

Hysterectomy is surgery to remove the uterus. It is a very common type of surgery for women in the United States. Removing your uterus means that you can no longer become pregnant.

Why is hysterectomy done?

Hysterectomy is used to treat many women’s health conditions. Some of these conditions include the following:

• Uterine fibroids (this is the most common reason for hysterectomy)
• Endometriosis
• Pelvic support problems (such as uterine prolapse)
• Abnormal uterine bleeding
• Chronic pelvic pain
• Gynecologic cancer

Are there alternatives to hysterectomy?

Depending on your condition, you may want to try other options first that do not involve surgery or to “watch and wait” to see if your condition improves on its own. Some women wait to have a hysterectomy until after they have completed their families. If you choose another option besides hysterectomy, keep in mind that you may need additional treatment later.

What structures are removed during a hysterectomy?

There are different types of hysterectomy:

• Total hysterectomy—The entire uterus, including the cervix, is removed.
• Supracervical (also called subtotal or partial) hysterectomy—The upper part of the uterus is removed, but the cervix is left in place. This type of hysterectomy can only be performed laparoscopically or abdominally.
• Radical hysterectomy—This is a total hysterectomy that also includes removal of structures around the uterus. It may be recommended if cancer is diagnosed or suspected.

What other organs besides the cervix and uterus may be removed during a total hysterectomy?

If needed, the ovaries and fallopian tubes may be removed if they are abnormal (for example, they are affected by endometriosis). This procedure is called salpingo-oophorectomy if both tubes and ovaries are removed; salpingectomy if just the fallopian tubes are removed; and oophorectomy if just the ovaries are removed. Your surgeon may not know whether the ovaries and fallopian tubes will be removed until the time of surgery. Women at risk of ovarian cancer or breast cancer can choose to have both ovaries removed even if these organs are healthy in order to reduce their risk of cancer. This is called a risk-reducing bilateral salpingo-oophorectomy.

Removing the fallopian tubes (but not the ovaries) at the time of hysterectomy also may be an option for women who do not have cancer. This procedure is called opportunistic salpingectomy. It may help prevent ovarian cancer. Talk with your surgeon about the possible benefits of removing your fallopian tubes at the time of your surgery.

What will happen if my ovaries are removed before I have gone through menopause?

You will experience immediate menopause signs and symptoms. You also may be at increased risk of osteoporosis. Hormone therapy can be given to relieve signs and symptoms of menopause and may help reduce the risk of osteoporosis. Hormone therapy can be started immediately after surgery. Other medications can be given to prevent osteoporosis if you are at high risk.

What are the different ways hysterectomy can be performed?

A hysterectomy can be done in different ways: through the vagina, through the abdomen, or with laparoscopy. The choice will depend on why you are having the surgery and other factors. Sometimes, the decision is made after the surgery begins and the surgeon is able to see whether other problems are present.

How is a vaginal hysterectomy done?

In a vaginal hysterectomy, the uterus is removed through the vagina. There is no abdominal incision. Not all women are able to have a vaginal hysterectomy. For example, women who have adhesions from previous surgery or who have a very large uterus may not be able to have this type of surgery.

What are the benefits and risks of vaginal hysterectomy?

Vaginal hysterectomy generally causes fewer complications than abdominal or laparoscopic hysterectomy. Healing time may be shorter than with abdominal surgery, with a faster return to normal activities. It is recommended as the first choice for hysterectomy when possible.

How is an abdominal hysterectomy done?

In an abdominal hysterectomy, the uterus is removed through an incision in your lower abdomen. The opening in your abdomen gives the surgeon a clear view of your pelvic organs.

What are the benefits and risks of abdominal hysterectomy?

Abdominal hysterectomy can be performed even if adhesions are present or if the uterus is very large. However, abdominal hysterectomy is associated with greater risk of complications, such as wound infection, bleeding, blood clots, and nerve and tissue damage, than vaginal or laparoscopic hysterectomy. It generally requires a longer hospital stay and a longer recovery time than vaginal or laparoscopic hysterectomy.

How is laparoscopic hysterectomy done?

Laparoscopic surgery requires only a few small (about one-half inch long) incisions in your abdomen. A laparoscope inserted through one of these incisions allows the surgeon to see the pelvic organs. Other surgical instruments are used to perform the surgery through separate small incisions. Your uterus can be removed in small pieces through the incisions, through a larger incision made in your abdomen, or through your vagina (which is called a laparoscopic vaginal hysterectomy).

A robot-assisted laparoscopic hysterectomy is performed with the help of a robotic machine controlled by the surgeon. In general, it has not been shown that robot-assisted laparoscopy results in a better outcome than laparoscopy performed without robotic assistance.

What are the benefits and risks of laparoscopic hysterectomy?

Compared with abdominal hysterectomy, laparoscopic surgery results in less pain, has a lower risk of infection, and requires a shorter hospital stay. You may be able to return to your normal activities sooner. There also are risks with laparoscopic surgery. It can take longer to perform compared with abdominal or vaginal surgery, especially if it is performed with a robot. Also, there is an increased risk of injury to the urinary tract and other organs with this type of surgery.

Is hysterectomy safe?

Hysterectomy is one of the safest surgical procedures. As with any surgery, however, problems can occur:

• Fever and infection
• Heavy bleeding during or after surgery
• Injury to the urinary tract or nearby organs
• Blood clots in the leg that can travel to the lungs
• Breathing or heart problems related to anesthesia
• Death

Some problems related to the surgery may not show up until a few days, weeks, or even years after surgery. These problems include formation of a blood clot in the wound or bowel blockage. Complications are more common after an abdominal hysterectomy.

Are all women at the same risk of complications?

No, some women are at greater risk of complications than others. For example, if you have an underlying medical condition, you may be at greater risk of problems related to anesthesia.

Will I have to stay in the hospital after having a hysterectomy?

You may need to stay in the hospital for up to a few days after surgery. The length of your hospital stay will depend on the type of hysterectomy you had and how it was done. You will be urged to walk around as soon as possible after your surgery. Walking will help prevent blood clots in your legs. You also may receive medicine or other care to help prevent blood clots.

What should I expect after having a hysterectomy?

You can expect to have some pain for the first few days after the surgery. You will be given medication to relieve pain. You will have bleeding and discharge from your vagina for several weeks. Sanitary pads can be used after the surgery. Constipation is common after most hysterectomies. Some women have temporary problems with emptying the bladder after a hysterectomy. Other effects may be emotional. It is not uncommon to have an emotional response to hysterectomy. You may feel depressed that you are no longer able to bear children, or you may be relieved that your former symptoms are gone.

What are some important things I should know about recovery?

Follow your health care professional’s instructions. Be sure to get plenty of rest, but you also need to move around as often as you can. Take short walks and gradually increase the distance you walk every day. You should not lift heavy objects until your doctor says you can. Do not put anything in your vagina during the first 6 weeks. That includes douching, having sex, and using tampons.

After you recover, you should continue to see your health care professional for routine gynecologic exams and general health care. Depending on the reason for your hysterectomy, you still may need pelvic exams and cervical cancer screening.

Laproscopy

What is laparoscopy?

Laparoscopy is a way of doing surgery using small incisions (cuts). It is different from “open” surgery where the incision on the skin can be several inches long. Laparoscopic surgery sometimes is called “minimally invasive surgery.”

How is laparoscopic surgery done?

Laparoscopic surgery uses a special instrument called the laparoscope. The laparoscope is a long, slender device that is inserted into the abdomen through a small incision. It has a camera attached to it that allows the obstetrician–gynecologist (ob-gyn) to view the abdominal and pelvic organs on an electronic screen. If a problem needs to be fixed, other instruments can be used. These instruments usually are inserted through additional small incisions in the abdomen. They sometimes can be inserted through the same single incision made for the laparoscope. This type of laparoscopy is called “single-site” laparoscopy.

What are the benefits of laparoscopy?

Laparoscopy has many benefits. There is less pain after laparoscopic surgery than after open abdominal surgery, which involves larger incisions, longer hospital stays, and longer recovery times. Recovery from laparoscopic surgery generally is faster than recovery from open abdominal surgery. The smaller incisions that are used allow you to heal faster and have smaller scars. The risk of infection also is lower than with open surgery.

What are the risks associated with laparoscopy?

Laparoscopy can take longer to perform than open surgery. The longer time under anesthesia may increase the risk of complications. Sometimes complications do not appear right away but occur a few days to a few weeks after surgery. Problems that can occur with laparoscopy include the following:

• Bleeding or a hernia (a bulge caused by poor healing) at the incision sites
• Internal bleeding
• Infection
• Damage to a blood vessel or other organ, such as the stomach, bowel, bladder, or ureters

What surgeries can be done with laparoscopy?

Tubal sterilization is one example of a surgery that can be done using laparoscopy. Laparoscopy also is one of the ways that hysterectomy can be performed. In a laparoscopic hysterectomy, the uterus is detached from inside the body. It can be removed in pieces through small incisions in the abdomen or removed in one piece through the vagina.

What problems can laparoscopy be used to diagnose and treat?

Laparoscopy may be used to look for the cause of chronic pelvic pain, infertility, or a pelvic mass. If a problem is found, it often can be treated during the same surgery. Laparoscopy also is used to diagnose and treat the following medical conditions:

• Endometriosis—If you have signs and symptoms of endometriosis and medications have not helped, a laparoscopy may be recommended. The laparoscope is used to see inside your pelvis. If endometriosis tissue is found, it often can be removed during the same procedure.
• Fibroids—Fibroids are growths that form inside the wall of the uterus or outside the uterus. Most fibroids are benign(not cancer), but a very small number are malignant (cancer). Fibroids can cause pain or heavy bleeding. Laparoscopy sometimes can be used to remove them.
• Ovarian cyst—Some women have cysts that develop on the ovaries. The cysts often go away without treatment. But if they do not, your ob-gyn may suggest that they be removed with laparoscopy.
• Ectopic pregnancy—Laparoscopy may be done to remove an ectopic pregnancy.
• Pelvic floor disorders—Laparoscopic surgery can be used to treat urinary incontinence and pelvic organ prolapse.
• Cancer—Some types of cancer can be removed using laparoscopy.

What kind of pain relief is used during laparoscopy?

Laparoscopy usually is performed with general anesthesia. This type of anesthesia puts you to sleep.

What happens during laparoscopy?

After you are given anesthesia, a small incision is made in or below your navel (belly button) or in another area of your abdomen. The laparoscope is inserted through this small incision. During the procedure, the abdomen is filled with a gas. Filling the abdomen with gas allows the pelvic reproductive organs to be seen more clearly.

The camera attached to the laparoscope shows the pelvic organs on a screen. Other small incisions may be made in the abdomen for surgical instruments. Another instrument, called a uterine manipulator, may be inserted through the vagina and cervix and into the uterus. This instrument is used to move the pelvic organs into view.

What happens after laparoscopy?

After the procedure, the instruments and most of the gas are removed. The small incisions are closed. You will be moved to the recovery room. You will feel sleepy for a few hours. You may have some nausea from the anesthesia.

If you had outpatient surgery, you will need to stay in the recovery room until you can stand up without help and empty your bladder. You must have someone drive you home. You usually can go home the same day. More complex procedures, such as laparoscopic hysterectomy, may require an overnight stay in the hospital.

What should I expect during recovery?

For a few days after the procedure, you may feel tired and have some discomfort. You may be sore around the incisions made in your abdomen and navel. The tube put in your throat to help you breathe during the surgery may give you a sore throat. Try throat lozenges or gargle with warm salt water. You may feel pain in your shoulder or back. This pain is from the small amount of gas used during the procedure that remains in your abdomen. It goes away on its own within a few hours or days. If pain and nausea do not go away after a few days or become worse, you should contact your ob-gyn.

How soon after laparoscopy can I resume my regular activities?

Your ob-gyn will let you know when you can get back to your normal activities. For minor procedures, it is often 1–2 days after the surgery. For more complex procedures, such as hysterectomy, it can take longer. You may be told to avoid heavy activity or exercise.

What signs or symptoms should I watch out for after laparoscopy?

Contact your ob-gyn right away if you have any of the following signs or symptoms:

• Fever
• Pain that is severe or gets worse
• Heavy vaginal bleeding
• Redness, swelling, or discharge from the incision
• Fainting
• Inability to empty your bladder

Ultrasound

What is ultrasound?

Ultrasound is energy in the form of sound waves. During an ultrasound exam, a transducer sends sound waves through the body. The sound waves come into contact with tissues, body fluids, and bones. The waves then bounce back, like echoes. The transducer receives these echoes, which are turned into images. The images can be viewed as pictures on a video screen.

How is ultrasound used in women’s health care?

Ultrasound is used to monitor pregnancy and to diagnose and monitor medical conditions that are not related to pregnancy.

How is ultrasound used during pregnancy?

Ultrasound is used to view the fetus inside the uterus. It allows your obstetrician–gynecologist (ob-gyn) or other health care professional to check the fetus’s health and development, monitor your pregnancy, and detect many congenital anomalies. Ultrasound also is used during chorionic villus sampling and amniocentesis to help guide these procedures. There are three types of prenatal ultrasound exams: 1) standard, 2) limited, and 3) specialized.

What is a standard ultrasound exam?

A standard ultrasound exam checks the fetus’s physical development, screens for major congenital anomalies, and estimates gestational age. A standard ultrasound exam also can provide information about the following:

• The fetus’s position, movement, breathing, and heart rate
• An estimate of the fetus’s size and weight
• The amount of amniotic fluid in the uterus
• The location of the placenta
• The number of fetuses

If the fetus is in a good position, it may be possible to tell the sex.

What is a limited ultrasound exam?

A limited ultrasound exam is done to answer a specific question. For example, if you are in labor, a limited ultrasound exam may be done to check the fetus’s position in the uterus. If you have vaginal bleeding, ultrasound may be used to see if the fetus’s heart is still beating or if the placenta is too low.

What is a specialized ultrasound exam?

A specialized ultrasound exam is performed if a problem is suspected based on risk factors or other tests. For example, if there are signs that the fetus is not growing well, the fetus’s growth rate can be tracked throughout pregnancy with specialized ultrasound exams. Depending on what the suspected problem might be, specialized techniques may be used, such as Doppler ultrasonography and 3-D ultrasonography.

How many ultrasound exams will I have during my pregnancy?

You should have at least one standard exam during your pregnancy, which usually is performed at 18–22 weeks of pregnancy. Some women may have an ultrasound exam in the first trimester of pregnancy. A first-trimester ultrasound exam is not standard because it is too early to see many of the fetus’s limbs and organs in detail. An ultrasound exam done this early is used to do the following:

• Estimate gestational age
• Help screen for certain genetic disorders
• Count the number of fetuses
• Check the fetus’s heart rate
• Check for ectopic pregnancy

How is ultrasound used for health issues not related to pregnancy?

Ultrasound is used to create images of the pelvic organs to find or diagnose problems. Some of the ways in which ultrasound may be used include the following:

• Evaluate a mass in the pelvis (such as an ovarian cyst or a uterine fibroid)
• Look for possible causes of pelvic pain
• Look for causes of abnormal uterine bleeding or other menstrual problems
• Locate an intrauterine device (IUD)
• Diagnose reasons for infertility
• Monitor infertility treatments

In addition, ultrasound may be used to assess mammography findings that are unclear, help guide breast biopsyprocedures, and evaluate breast lumps.

How is an ultrasound exam performed?

During a pelvic ultrasound exam, the transducer is either moved across your abdomen (transabdominal ultrasound) or placed in your vagina (transvaginal ultrasound). The type of ultrasound exam you have depends on what types of images your ob-gyn or other health care professional needs and why the exam is being done.

What happens during a transabdominal ultrasound exam?

You will lie on a table with your abdomen exposed from the lower part of the ribs to the hips. A gel is applied to the surface of the abdomen. This improves contact of the transducer with the skin surface. The handheld transducer then is moved along the abdomen to make images. You may need to drink several glasses of water during the 2 hours before your exam. This will make your bladder full. A full bladder creates a “window” through which structures underneath the bladder or around it can be seen more clearly.

What happens during a transvaginal ultrasound exam?

You will be asked to change into a hospital gown or undress from the waist down. It is recommended that you empty your bladder before the test. You will lie on your back with your feet in stirrups, like for a pelvic exam. The transducer for this exam is shaped like a wand. It is covered with a latex sheath, like a condom, and lubricated before it is inserted into the vagina.

What are the risks of ultrasound exams?

Currently, there is no evidence that ultrasound is harmful to a developing fetus. No links have been found between ultrasound and birth defects, childhood cancer, or developmental problems later in life. However, it is possible that effects could be identified in the future. For this reason, it is recommended that ultrasound exams be performed only for medical reasons by qualified health care professionals. Casual use of ultrasound during pregnancy should be avoided.