3. TYPESOFIUD’S Aah, If only they were all Copper T’s…

4. IUD location/position Malposition Perforation Congenital uterine anomalies Septum/Endometrium Fundal contour

6.  High frame rate 1 focal zone only (at level of endometrium) Scan in fundamental  Include the fundus  Keep the sound as perpendicular to the IUD as possible  Sweep Rt – Lt  True sagittal to the endometrium  Complete sweep Begin & end outside the uterus  Steady speed with no up/down movements

7. Press the 3D/4D button Press the touch screen 3D The image below is the end result of pressing those buttons

8. Creating a coronal plane: Highlight the top plane (red edges all around) by selecting it. Push this plane towards the endometrium.

9. Creating a coronal plane: Highlight the top plane (red edges all around) by selecting it. Push this plane towards the endometrium. If the top plane is not parallel to the endometrium, then adjustments have to be made. Find the single yellow edge at the fundal end of the top plane. Click and drag this edge until aligned with the endometrium.

10. Creating a coronal plane: Highlight the top plane (red edges all around) by selecting it. Push this plane towards the endometrium. If the top plane is not parallel to the endometrium, then adjustments have to be made. Find the single yellow edge at the fundal end of the top plane. Click and drag this edge until aligned with the endometrium. 4. Click on the side plane (red edges all around) pull it out in order to expose the entire coronal plane.

11. Now you should have a coronal image of the endometrium. Rotate the image. Rt Lt Fund Cvx

12. Make fist outside the box with Left Button Rotate using trackball

13. ROTATE Left Button SPIN/TURN Right Button

14. SELECT/SET Right Button

15. ROTATE Left Button SPIN/TURN Right Button

16. SELECT/SET Right Button

17. Select “Render” on the touch screen, and add annotations (Rt, Lt, Cor Uterus) Rt Lt Cor Uterus

18. Coronal image in plane with endometrium (and IUD) Coronal image immediately posterior to the IUD demonstrating the IUD shadow

19. Additional coronal image in plane with the IUD (rather than the endometrium). demonstrate “arms” of the IUD perforating the myometrium attitional sweeps may be required for demonstrating abnormally positioned IUD’s (cervix, adnexa)

20. Coronal images of the endometrium must demonstrate:  Extent of the septum  Fundal Contour (Note: transabdominal empty bladder images of the fundal contour are often better than reconstructed transvaginal images)

21. A retroverted uterus will produce an upside down coronal reconstruction. Rt Cor Uterus Lt Do not invert the image to make it fundus up.

23.  Fundal contour should be rounded Any indentation should be <1cm Arcuate Uterus <1.5cm = Arcuate >1.5cm = Septate  Prominent “dip” in the fundal endometrium

24. SEPTATE UTERUS Fundal contour should be rounded Any indentation should be <1cm Partial (Subseptate): septum ends above the internal os. Complete: septum extends to the internal os or lower.

25. Bicornuate Uterus Fundal contour should be indented (heart shaped). Indentation should be >1cm Partial: septum ends above the internal os. Complete: septum extends to the internal os or lower.

26. Uterine Didelphys Fundal contour should be indented (heart shaped). Indentation should be >1cm Two hemi-uteruses and two cervices. Widely divergent uterine horns. Full sized uterine horns.

27. Oops… Cookie anyone?