First trimester bleeding occurs in up to 30% of all diagnosed pregnancies. Important causes of first trimester bleeding include spontaneous abortion, missed or threatened abortion, ectopic pregnancy, and gestational trophoblastic disease. One of the greatest dilemmas for clinicians is to accurately diagnose the cause of pain or bleeding, and specifically to determine if an ectopic pregnancy exists due to its grave consequences. Ectopic pregnancy occurs in almost two percent of all reported pregnancies in the United States and is the leading cause of pregnancy-related death in first trimester. When an early pregnant patient is identified who has bleeding or pain, it is crucial step to determine where the pregnancy is located. Ultrasound as a first line diagnostic tool offers an excellent opportunity for pregnancy localization. The use of the beta subunit of human chorionic gonadotropin (beta-hCG) quantification is a valuable adjunct to help determine the course and possible outcome of an early pregnancy. The goal should be to preserve the health and future reproductive capabilities of our patients.

REVIEW ARTICLE DSJUOG ULTRASOUNDTransabdominal gynecologic ultrasound combined with transvaginal scanning is a technique that was initially introduced in the early 1980's and quickly became a "musthave" procedure for gynecologists and emergency room physicians for assistance in diagnosing many gynecologic conditions. Rapid advances in the quality of the equipment, techniques used to obtain best images, and research designed to help physicians interpret their findings have contributed to ultrasound's quick rise in use and popularity. It is ubiquitous that ultrasound is the imaging modality of choice for gynecologic conditions.The advantages of ultrasound are numerous. It is fast, easy to obtain, has a high patient tolerance and is relatively inexpensive when compared to CT and MRI. Many physicians' offices have ultrasound machines that are more than sufficient to make common diagnoses thereby alleviating patient anxiety and physician concerns if an abnormality is found during a physical exam. Appropriate referrals and treatments can be initiated in a timely manner at minimum expense. The ability to use the transvaginal ultrasound as an extension of a pelvic exam is extremely useful, particularly when the source of pain is uncertain during bimanual exam or if a mass is found of uterine or ovarian origin. An obvious advantage, especially when compared to CT, is that no radiation exposure occurs. As will be discussed in more detail, pelvic ultrasound has been shown, in numerous studies, to have a high negative predictive value and offers excellent resolution of the uterus and adnexal structures, especially when compared to CT and MRI.There are disadvantages; however, that should be addressed. Even with routine use of transabdominal scanning which utilizes the acoustic window of a full bladder, the field of view is very limited, especially, compared to CT and MRI. Transvaginal sonography limits the field; however, it is effective in obtaining excellent resolution of the uterus, endometrium and adnexal structures. Ultrasound visualizes the bowel poorly and it is well-known that bowel gas corrupts the ultrasound signal allowing for potential "missed" masses not visible under the bowel. An additional drawback is that poor contrast occurs between dissimilar tissues (i.e. blood and fat) making it difficult to characterize certain ovarian masses accurately.Ultrasound characterizes gynecologic pathology extremely well. Fibroids, endometriomas, dermoids, masses that are suspicious for malignancy, uterine anomalies, IUD complications, ectopic pregnancies, and endometrial pathology (with the help of transvaginal saline infusion sonography) are diagnoses that are detected with high accuracy. The following will give illustrations of the clinical utility of diagnostic gynecologic ultrasound for specific clinical conditions. AbstractAlthough ultrasound is the primary imaging modality for most gynecologic diagnoses and conditions, knowledge of other diagnostic imaging procedures is important to gynecologists, emergency room physici...

Simple cysts of the ovary are quite common, with a prevalence of 5 to 17%. Advances in the technology of ultrasound and the increasing frequency of use of TVS has made it all the more important to have knowledge of the natural history of simple asymptomatic postmenopausal cysts. Previously, due to the paucity of data, postmenopausal women with asymptomatic simple cysts were managed much too aggressively. Current available data suggest a more conservative approach with serial ultrasounds, Doppler evaluation and CA-125 levels. Further studies are needed in order to have definitive guidelines for the gynecologic practitioner.

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Although ultrasound is the primary imaging modality for most gynecologic diagnoses and conditions, knowledge of other diagnostic imaging procedures is important to gynecologists, emergency room physicians and radiologists who care for women of all ages. Since the early 1960s when ultrasound was introduced for the use in obstetrics and gynecology, other imaging techniques have rapidly come into play due to the tremendous advances in computer technology and in the field of engineering. It behooves us to become familiar and knowledgeable about the differences in these imaging techniques in order to gather the most information in the shortest amount of time to care for patients in the most efficient and cost-effective way. This review is meant for the use of most practicing physicians that are exposed to common as well as uncommon gynecologic conditions; therefore the primary imaging modalities discussed in this paper are limited to ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Objectives Understanding of the strengths and limitations of ultrasound, MRI and CT Obtaining knowledge of when to apply the most appropriate imaging technique for a certain clinical situations