Services

QUFW Services

We offer routine first trimester and nuchal translucency screening, morphology and growth scans, multiple pregnancy assessment as well as gynaecological imaging and assessment. QUFW also have experienced sonographers who use the latest ultrasound equipment and routinely scan using 3D and 4D for fetal assessment.

Pregnancy

Early Pregnancy Scanning

Dating

We perform early scans to assess the correct due dates for the pregnancy and to assess the wellbeing of the baby if there is any bleeding or pain. The earliest we can see a fetal heart beat is at 6 weeks.

Ectopic pregnancy

The detection of a pregnancy which is not located within the uterine cavity is important for the appropriate management of the pregnancy.

We can assess the location such as :

  • Tubal ectopic
  • Cervical
  • Caesarean section scar
  • Pregnancy of unknown location
Miscarriage

Unfortunately, 25% of pregnancies can miscarry. The correct diagnosis of whether the pregnancy is on going or not is helpful for your management.

Multiple pregnancy

The type of twinning – fraternal versus identical (dichorionic or monochorionic) is best determined in the first trimester. We are then able to determine the frequency of your monitoring for the pregnancy as you are high risk.

Early morphology

We can detect some of the major anomalies such as:

  • Brain-anencephaly
  • Abdominal wall defects
  • Limb defects
  • Some major heart anomalies
  • Bladder outlet obstruction

Diagnosis of these structural problems are limited by the size and gestation of the baby as well as by technical scanning restrictions.

Combined First Trimester Screening Or Nuchal Translucency Scan (11-14 weeks)

The nuchal translucency (NT) screening test is a non-invasive screening test to determine how likely your unborn baby will have a chromosomal abnormality, such as Down syndrome. The test combines the mother’s age related risk, a blood test determining the levels of hormones secreted by the placenta (free βhCG & PAPP-A), the length of the baby from head to bottom (crown to rump length or CRL) and the nuchal translucency measured on ultrasound. The CRL must be between 45 and 84 mm for the testing to be performed, that is, about 11 to 14 weeks pregnant. The nuchal translucency is a measurement of fluid behind the baby’s neck that is present in all babies during the first trimester of pregnancy. An increased NT measurement has an association with chromosome abnormalities but can also be associated with structural abnormalities e.g. heart. The fetus can have normal chromosomes even with an increased NT. The combined first trimester screening test (age + nuchal translucency + bloods) has a 90% accuracy for predicting your risk for Down Syndrome and some other chromosomal abnormalities.

Chromosomal Abnormalities

Each of our cells has 46 chromosomes; 23 chromosomes come from the sperm and 23 from the egg. The most common chromosomal abnormality is Down syndrome (Trisomy 21) which occurs when a baby receives an extra chromosome 21. Some other less common chromosomal abnormalities are Trisomy 18 and 13, which also involve an extra chromosome 18 or 13 respectively. None of these conditions can be detected on ultrasound alone and it is important to know that the nuchal scan is just a screening test. The diagnostic test for chromosomal abnormalities is a chorionic villus sampling (CVS) or amniocentesis.

Preparation

You are required to have a blood test (βhCG & PAPP-A) at least 3 working days prior to your scan. Your Doctor will need to refer you for this test. It is recommended to empty your bladder 1 hour prior to your scan, then drink 2 glasses of water and then do not empty your bladder. You are welcome to bring your family members or a close friend to your scan. Children are welcome but can sometimes get bored so it is helpful if another adult is available to help look after them.

Please bring with you:

  • A referral from your Doctor
  • Previous scans such as early pregnancy dating scans (if performed elsewhere)
  • Information on any hereditary conditions
What to expect

Allow 1-1.5 hours for your appointment. The examination is performed by one of our highly trained obstetric Sonographers using state of the art ultrasound equipment. The scan includes an examination of the baby’s early anatomy, however not all structural abnormalities can be determined at this stage. We will also measure the length of the baby (crown rump length) to confirm the due date. Other anatomy that will be looked at include your ovaries, uterus and your cervix.

Transvaginal Scanning

Occasionally, a transvaginal scan is required to get the images needed to complete the examination. Transvaginal ultrasounds are performed with discretion at QUFW and are perfectly safe during pregnancy.

3D/4D Scanning

The majority of the scan is completed in normal 2D (greyscale) as this offers the best resolution for detecting abnormalities. We will also try to obtain some nice pictures in 3D/4D of your baby, but this is very dependent on the baby’s position, the amount of amniotic fluid and maternal issues like abdominal scarring and mother’s size.

Results

A highly trained Sonographer or Doctor will discuss the results with you. In relation to the computer program that we use to calculate the risk, a risk of less than 1:300 implies that the baby has a low chance of having a chromosomal abnormality such as Down syndrome. If the risk calculated is greater than 1:300 (e.g. 1:50) it is implied that there is an increased risk that the baby has a chromosomal abnormality and further testing options (CVS/ amniocentesis/NIPT) will be discussed with you. The decision whether to proceed to further testing or not is yours. You will receive a copy of the report and a copy will also be sent to your referring Doctor.

Frequently Asked Questions (FAQ)

Why am I having this scan?

You have been referred for this scan to screen for chromosomal and structural abnormalities in the baby. This test is offered to mothers wanting to have a risk assessment performed.

Can ultrasound harm my baby?

There have been no proven harmful effects of using ultrasound during pregnancy.

Can I find out the sex of my baby?

It is not usually possible to determine the baby’s gender at this early stage although we sometimes are able to get an indication. The gender may be more accurately determined at the 18-20 week morphology scan.

What if I have a high risk result?

Not all babies that have a high risk result have Down syndrome but the result may help you decide if you wish to investigate further with a diagnostic test such as CVS or Amniocentesis or further screening with NIPT. There is a small risk of miscarriage with diagnostic tests such as CVS or Amniocentesis.

Morphology Scans

The morphology or 18-20 week scan is performed to assess structure and development of the baby, the position of the placenta, the growth of the baby, the amount of amniotic fluid surrounding the baby.

We examine all the major organs. Whilst this scan may detect many major structural problems, not all anomalies are able to be detected.

Images may be restricted by fetal position, or technical ultrasound factors such as distance from the probe to the baby or the size of the mother. If adequate images are not obtained, the patient may need to be rebooked for a later scan.

Growth Scans

Your doctor may refer you for a scan in the second half of pregnancy to

  • Assess the fetal growth
  • Assess placental function by looking at the blood flow
  • Check the position of the placenta
  • Review fetal structures
  • Assess the amount of amniotic fluid around the baby

Assessment of estimated fetal weight can be made but this can vary +/-10-15%Sometimes the baby maybe in a good position for images but at other times it may be very uncooperative

Multiple Pregnancies

Multiple pregnancies make up about 1.8% of all pregnancies. They occur more frequently with increasing age of the mother as well as with the use of IVF and ovulation induction. Whilst the majority of multiple pregnancies have a good outcome, there are increased rates of complications both for the mother and babies with the commonest complication being premature delivery.

There are 2 types of twins. The most common are seen when 2 eggs are released at the same time and are fertilised. These are known as non identical or fraternal twins. All of these twins will have 2 placentas and the pregnancy will be known as a Dichorionic Diamniotic twin pregnancy.

The other less common type of twins are where a single fertilised egg splits into 2 several days after conception. These are identical twins. If the split occurs very early, some will form 2 placentas and be dichorionic. Most will split after 2 days and form one placenta- a monochorionic twin pregnancy. These twins share their placenta and there are blood vessels that will connect the 2 twins circulation. In most cases 2 healthy twins will be delivered but there is a higher chance of complications developing as a result of the vascular anastomoses on the placenta such as Twin Twin transfusion syndrome. Because of the higher risk of complications and because there are potential treatments available for conditions such as Twin Twin, we recommend more frequent surveillance.

In uncomplicated Dichorionic twins we normally recommend regular growth scans about every 4 weeks from 18 weeks.

In Monochorionic twins we normally would recommend scans about every 2-3 weeks from 16 weeks looking for evidence of Twin Twin transfusion syndrome and other potential complications.

Monochorionic Twins

Most twins (80%) are dichorionic where each twin has its own placenta. In these twin pregnancies each twins circulations are separate and they both just happen to share the same uterus at the same time.

Monochorionic twins are identical twins that share a single placenta. Whilst in most cases both twins would have an equal share, each pregnancy is unique and in some there is a marked imbalance in the amount of placenta that supplies each twin and this can result in disturbances and discordance in twin growth. All monochorionic twins have vascular anastomoses that connect each twin’s circulation to the other. This allows the flow of blood from one to the other and usually back again. This relationship results in a significantly higher rate of complications in this type of pregnancy as there are often disturbances to the flow to one or both twins.

Twin Twin Transfusion syndrome TTTS

Twin Twin Transfusion Syndrome (TTTS) is the commonest major complication of monochorionic pregnancies. Most twins have their own separate placenta and they are known as Dichorionic twins. About 20% of all twins share a single placenta and these are known as Monochorionic twins. Monochorionic twins will have their own share of the placenta and there are usually multiple blood vessels that connect one twins circulation to the other twin’s. These connections lie on the surface of the shared placenta. This allows blood from one twin to circulate to the other’, and this sharing of blood is usually balanced. Most monochorionic twins have their own amniotic sac.

In about 10% of monochorionic twins, the connections between them are unbalanced. This results in a transfusion of blood from one twin (the donor) to the other twin (the recipient). This typically develops in mid pregnancy (from 16-28w). Both twins will respond to this chronic transfusion differently. The donor twin tries to compensate for the loss of blood volume by decreasing its urine output. As most of the amniotic fluid around the baby is urine produced by the baby, this compensation results in a significant decrease in the amount of fluid seen around this twin. The amnion is seen to wrap around this twin and in the more serious cases there is no fluid seen around the donor twin which now appears to be stuck.

The twin that receives the blood transfusion is known as the recipient twin. It responds to the increased blood volume by significantly increasing its urine output, resulting in excessive amounts of amniotic fluid forming, known as polyhydramnios. The mother may notice a very rapid increase in her abdominal size over the course of a few weeks. If left untreated, the polyhydramnios can increase so much that the mothers uterus can expand to well beyond full term size. This can and usually results in delivery of the twins from either preterm labour, premature rupture of the membranes, or loss of either one or both twins in utero. As TTTS usually develops midpregnancy, very few if any of these twins would survive if this condition is untreated.

Other effects of the transfusion process for the recipient twin is that this twin’s heart can enlarge trying to cope with the extra blood volume, and ultimately its ability to pump may fail, resulting in heart failure which can lead to fetal hydrops (heart failure or equivalent to congestive cardiac failure (CCF) in an adult).

Due to the TTTS process and the consequences of the transfusion for both twins, the worst case scenario is that one or both of the twins may die without warning. If one monochorionic twin dies, the other may also die as a consequence, or may suffer from major brain damage from the transfusion process. It may be possible to detect changes in the surviving twins brain by ultrasound assessment and fetal MRI but these changes may take several weeks to develop and not all babies with brain damage can be identified in utero.

The severity of TTTS at presentation can be staged from 1 to 5 and this guides treatment options. Some twins may present with very early Stage 1 TTTS and they may be observed to see if this resolves spontaneously. Any progression or more severe forms of TTTS (stage 2 to 4) usually will be treated.

Treatment for TTTS

20 years ago, we did not understand the condition of TTTS. As this condition usually develops about midpregnancy and there was no treatment available at the time, up to 95% of these babies were lost.

We can sometimes see polyhydramnios and oligohydramnios developing around both twins but the severity may not constitute a diagnosis for TTTS. These twins will be observed closely to see if TTTS develops. Mild forms of stage 1 TTTS may be observed to see if it stabilises or resolves.

Amnioreduction was the mainstay of management for TTTS a decade ago. Amnioreduction is where an amniocentesis needle is inserted into the recipient twins amniotic sac and large amounts of amniotic fluid are drained. It was not uncommon to drain 2-3 litres of amniotic fluid at a time. The fluid would usually re-accumulate and the procedure would need to be repeated a week or two later. This treatment resulted in about 50-60% of babies surviving. However the average gestation of delivery for these twins was about 28 weeks, and the surviving twins often had major complications in NICU. Up to 25% of the surviving twins developed long term neurodevelopmental handicaps such as cerebral palsy. It was because of these short and longer term outcomes that an intense effort was made to develop better treatments for this condition.

The standard treatment for TTTS today is fetoscopic laser ablation of the fetal blood vessels that connect the two circulations on the surface of the placenta. In this procedure, a fetoscope is inserted into the uterus through a tiny incision in the mother’s abdominal wall. This procedure is done with local anaesthetic and light sedation. The placenta is identified and the fetal vessels on its surface are examined. These vascular connections between the twins are then mapped. A laser fibre is then inserted down a channel in the fetoscope and the connections between the two twins are ablated. This stops blood flow from the donor to the recipient, and stops the TTTS process. The overall survival rate from this procedure is about 75%. The risks of fetal surgery include premature rupture of the membranes and preterm delivery or loss of one or both twins shortly after the laser. Maternal complications of this procedure are uncommon. The long term outcome of babies that have laser ablation shows a 12% incidence of neurodevelopmental disability. This incidence is lower than that which was seen after treatment with amnioreduction and may be due to brain injury occurring prior to treatment and also secondary to prematurity.

Amniocentesis & CVS

Chorionic villus sampling (CVS) and Amniocentesis (Amnio) are diagnostic tests available to detect chromosomal abnormalities such as Down Syndrome (Trisomy 21) in the unborn baby. These tests are commonly offered to patients who are considered to be at increased risk of chromosomal problems – if the first trimester nuchal translucency screen showed an increased risk, a previous baby had a chromosomal abnormality, the mother is over 35 years of age or they are simply concerned about chromosomal abnormalities.

CVS (11-14 weeks)

CVS can be performed between after 11-12 weeks. CVS involves inserting a fine needle through the maternal abdominal wall under ultrasound guidance into the uterus in order to obtain a small sample of the placenta (called chorionic villi). A small amount of local anaesthetic is used to numb the skin which does not affect the baby. The risk of miscarriage from a CVS is estimated at 1 in 100, and is slightly higher than for amniocentesis, but the advantage is that the results are available earlier. In around 2 – 3% of cases, the placenta may have mixed normal/abnormal cells (mosaicism) or other rarer abnormalities and an amniocentesis may be indicated to clarify the fetus’s condition.

Amniocentesis (16+ weeks)

Amniocentesis can be performed from 16 weeks onwards. The procedure involves inserting a fine needle through the maternal abdominal wall under ultrasound guidance into the uterus to the amniotic fluid surrounding the baby. A small sample of fluid is withdrawn (about 20mls) which is naturally replenished within 24 hours. The procedure carries a risk of miscarriage, estimated at around 1 in 200 to 300.

Preparation

It is recommended to empty your bladder 1 hour prior to the procedure, then drink 2 glasses of water and then do not empty your bladder.

Please bring with you:

  • A referral from your Doctor
  • Previous scans (if performed elsewhere)
  • Partner/friend/mum or dad for support and to drive you home after the procedure
What to expect

Allow 1-1.5 hours for your appointment. The procedure itself will only take approximately 10-15 mins. An ultrasound is done first to check the position of the baby and placenta. The Doctor will insert the fine needle under ultrasound guidance through the maternal abdominal wall. The sample will be taken with the assistance of the Sonographer. The sample will be checked and then the needle will be removed.

After the procedure

You will be taken to private room to sit and relax for 10-15 mins after the procedure and offered a tea or coffee. After the test a small amount of cramping can occur, which may be relieved with paracetamol. It is advisable to take it easy over the next 24-48 hours with no heavy lifting or strenuous exercise. Bed rest is not necessary and normal daily activities can be resumed after 48 hours. If you have any loss of blood or fluid from the vagina, or increasing discomfort you must contact your referring Doctor or Obstetrician or you should present to the nearest Emergency Department.

Results

Two sets of results will be available; the short term result is usually available within 2-3 days which examines the 5 most common abnormal chromosomes including Down Syndrome. The long term result takes around 14 days and looks at all chromosomes in greater detail. One of our Doctors at QUFW or your referring Doctor will discuss the short term results with you over the phone within 2-3 days of you having the test. You will be asked if you would like to know the sex of your baby as this may also be determined from the chromosomes. The long term results will be discussed with you by your Doctor, over the phone with one of our Doctors or at your next appointment with us.

Frequently Asked Questions (FAQ)

Will it hurt?

Most women experience only a mild amount of discomfort during the procedure, similar to a blood test. Occasionally crampy period pain or mild pain radiating down the thighs or legs may be experienced and this is considered normal.

Can these tests harm my baby?

CVS and amniocentesis are carried out at QUFW by doctors who have many years’ experience in performing these tests. The only risk in performing these tests is the associated miscarriage risk of the procedure itself.

What is not detected by this test?

It is important to be aware that CVS and Amniocentesis cannot detect a physical abnormality such as spina bifida or a heart defect. Not all genetic problems can be detected by this test. Please discuss with us if there is a family history of a genetic problem.

What are the costs involved?

There is a Medicare rebate for these procedures, however there will be an out of pocket gap. The laboratory that analyses the sample will charge a separate fee, which you will receive in the mail.

NIPT at QUFW

Non Invasive Prenatal Testing (NIPT) is the most best screening test now available for the detection of the most commonly encountered chromosomal anomalies such as Downs Syndrome (trisomy 21) and Edwards syndrome (trisomy 18). It can also detect Trisomy 13 as well as test for sex chromosomal anomalies. As part of this, the fetal sex can also be determined. NIPT is still considered to be a screening test rather than a diagnostic test (such as an amniocentesis or CVS) It can detect up to 99% of cases of Downs syndrome and very few women are given a high risk result. However, it cannot detect all cases of Downs syndrome and occasionally women may be given a high risk result when the baby is normal.

QUFW performs Non Invasive Prenatal Testing or screening (NIPT) in our rooms.

We offer a full comprehensive service for all patients including:

  • Ultrasound scan (Referral needed)
  • Pre Test consultation
  • Blood Collection
  • NIPT testing
  • Post test counselling
  • Any further invasive testing if required

We can offer NIPT with the following tests – Harmony and Panorama.

  • The NIPT is a sensitive screening test for the common chromosomal anomalies -Trisomies 21 (Down Syndrome), 18 and 13, as well as the common sex chromosomal aneuploidies.
  • Testing for microdeletions – 22q11.2 known as Di George syndrome, Angelman syndrome, Prader-Willi syndrome, 1p36 deletion and Cri-Du-Chat syndrome are also available.
  • The cost of Harmony testing for Trisomies 21, 18 and 13 and sex chromosomes is $400
  • The cost of Panorama testing for Trisomies 21, 18 and 13 and sex chromosomes is $460
  • The cost of Panorama testing for Trisomies 21, 18 and 13 and sex chromosomes and 22q deletion is $590
  • The cost of Panorama testing for Trisomies 21, 18 and 13 and sex chromosomes and 22q and other microdeletions is $690

There is no medicare rebate for the NIPT test. There are medicare rebates for the ultrasound scan.

Patients will be charged for the ultrasound scan component accordingly.

  • Between 10-11 weeks – bulk billed dating scan for viability ( no additional out of pocket cost apart from NIPT)
  • 12 weeks and after – nuchal, anatomy and growth scans will be billed separately

This testing is available at our Brisbane, Southport and at John Flynn Hospital. Please contact our staff for any further questions or to make bookings.

Tertiary or Second Opinion Scans

You may have had an examination at another facility and the report suggest tertiary referral. This means that the doctors at the other facility feel that the findings of their examination require review and referral to an obstetrician who has subspecialised in the assessment of specific obstetric maternal or fetal medical conditions. Your own doctor, general practitioner or obstetrician, may also make that assessment themselves based on what the other company has reported.

Both of these situations are common reasons for referral to QUFW. Our doctors have been specifically trained for these situations, working in both the private and public health systems to offer our patients the best care.

gynaecology

At QUFW, we also specialize in routine and tertiary gynaecology ultrasound scanning. We have the only doctor in Queensland with the subspecialization in Obstetrics and Gynaecology Ultrasound and sonographers that have a special interest in this area.

Routine Gynaecology Ultrasound

At QUFW, we also specialise in tertiary gynaecology ultrasound scanning. We have doctors and sonographers that have a special interest in this area.

There are many different reasons you may need a gynaecology scan. This may include lower abdominal pain for investigation, ovarian cancer screening, postmenopausal bleeding, ovarian cysts, fibroid mapping, check contraception placement or check Essure device placement. We also perform gynaecology procedures such as saline infusion sonography.

Gynaecology ultrasound scans are used commonly in the fertility workup of a patient. Various reasons could be due to a low anti-Mullerian hormone level, low ovarian reserve, pretreatment base scan, follicle tracking, treatment monitoring and tubal patency testing such as HyCoSy.

Preparation

Transabdominal ultrasound scanning requires a full bladder and with the examination performed on the abdomen only. This gives a limited knowledge of potential pathology but is generally used for the adolescent age group, never been sexually active and the extreme age group. It is usually used as preliminary view looking for larger pathology that may not be seen transvaginally.

A transvaginal scan is when an ultrasound probe in the vagina is used to for the examination. The patient is allowed to empty their bladder. This enables the operator to not only gain information about the internal reproductive anatomy but also can be very helpful in the investigation for pain. The detail from a transvaginal scan is usually much better than transbadominal.

In general, it is best to scan Day 2-9 after the first day of your last period. If unsure please ask when you ring for an appointment. A gnyaecology scan can be performed during your period. You may wish to wear comfortable clothes as you will be required to undress your bottom half for the examination. You will be given a gown and privacy to change.

What to Bring

It is always beneficial to bring any previous scans, reports or test results with you to the appointment. If a procedure is being performed, having someone to accompany you to drive is good in case you experience discomfort.

Please bring your referral from your doctor.

Frequently Asked Questions

Does it hurt?

The scan itself is not painful. It maybe painful or uncomfortable because of the reason you are having the scan. You may experience some discomfort due to pressure from the probe.

Is it safe?

Transabdominal and transvaginal ultrasound scanning does not use radiation like routine Xrays.

HyCoSy

Introduction

HyCoSy is a specialised ultrasound procedure used to assess the inside of the uterus and the fallopian tubes. It involves inserting a solution of contrast material (called Exem Foam™) into the uterine cavity and observing the flow within the fallopian tubes.

HyCoSy is used to detect blockages of the fallopian tubes and abnormalities of the uterus.

You may be sent for a HyCoSy as part of your investigations for:

  • Fertility issues
  • Recurrent miscarriage
Preparation

The procedure needs to be performed between 3 to 9 days after the first day of your last menstrual period. If you have a very irregular cycle or infrequent periods it is advisable to contact us on day 1 of your period to make your booking.

Please empty your bladder 1 hour prior to your appointment and drink 1 glass of water. You will be asked to complete a pregnancy test before the procedure.

What to bring
  • Previous ultrasounds
  • Referral from your Doctor
  • You may wish to bring some pain relief such as paracetamol or naprogesic
What to expect

The examination will take approximately 1-1.5 hours, but most of this is time is used for setting up the equipment and performing the initial scan. The procedure itself will only take approximately 10-15 mins.

Initially, an abdominal scan will be done to assess the position of the uterus and ovaries. Then you will be asked to perform a pregnancy test and empty your bladder. If the pregnancy test is positive the procedure cannot be performed.

You will be given a gown to wear. The Doctor will explain the procedure to you. A transvaginal ultrasound will be performed prior to the HyCoSy procedure.

The Doctor will insert a speculum into the vagina and apply an antiseptic solution to the cervix. A fine tube (2mm) will be passed through the cervix and into the uterine cavity. The speculum will then be removed and the transvaginal probe will be inserted. The contrast material will be introduced into the uterus using the fine tube. You may feel a warm sensation and less frequently mild cramping similar to period pain. The Doctor will observe the solution pass through the uterine cavity and fallopian tubes on ultrasound. When the procedure is finished the tube and probe will be removed.

You will be given a sanitary pad as it is normal to expect some fluid leakage after the procedure. The Doctor will discuss the findings with you and you will be given a report.

Frequently Asked Questions (FAQ)

Will I require an anaesthetic?

No, anaesthetics are not required and therefore you will be awake for the procedure.

Is it safe?

HyCoSy does not require ionising radiation or a general anaesthetic and therefore is a safe test for investigating tubal blockages.

Will it hurt?

You may experience mild cramping during the procedure that is similar to period pain. This will usually resolve shortly after the procedure and pain relief can be used to alleviate these symptoms.

How is this test different to a transvaginal ultrasound?

The fallopian tubes are not seen on a regular transvaginal ultrasound. HyCoSy uses a contrast material to highlight the fallopian tubes and lining of the uterus. The contrast material is expensive, which is why the test is more expensive than a routine gynaecology transvaginal ultrasound.

Will I get money back from medicare?

There is a medicare rebate for this procedure.

Who should not have this test?

Anyone who might be pregnant or has an acute pelvic infection at the time of the procedure should not have this test.

Saline Infusion Sonography

Introduction

SIS is a specialised ultrasound procedure used to assess the inside of the uterus. It involves inserting a solution of saline (salt water) into the uterine cavity to better visualise the lining of the uterus and the cavity.

SIS is used to detect abnormalities of the lining of the uterus. It is performed in conjunction with a transvaginal ultrasound to assess the pelvis.

You may be sent for a SIS to investigate:

  • Fertility issues
  • Recurrent miscarriage
  • Bleeding issues such a postmenopausal bleeding or irregular bleeding
  • Fibroids
  • FPolyps
Preparation

The procedure needs to be performed between 3 to 9 days after the first day of your last menstrual period. If you have a very irregular cycle or infrequent periods it is advisable to contact us on day 1 of your period to make your booking.

Please empty your bladder 1 hour prior to your appointment and drink 1 glass of water. You may be asked to complete a pregnancy test in our rooms. If the test is positive the procedure cannot be performed.

What to bring
  • Previous ultrasounds
  • Referral from your Doctor
What to expect

The examination will take approximately 1-1.5 hours, but most of this is time is used for setting up the equipment and performing the initial scan. The procedure itself will only take approximately 10-15mins.

Initially, an abdominal scan will be done to assess the position of the uterus and ovaries. You will be given a gown to wear.

The Sonographer or Doctor will explain the procedure to you and discuss your relevant history. A transvaginal ultrasound will be performed prior to the SIS procedure.

The Doctor will insert a speculum into the vagina and apply an antiseptic solution to the cervix. A fine tube (2mm) will be passed through the cervix and into the uterine cavity. The speculum will then be removed and the transvaginal probe will be inserted. A solution of saline will be introduced into the uterus using the fine tube. You may feel a warm sensation and less frequently mild cramping similar to period pain. The Doctor will observe the solution pass through the uterine cavity and assess the lining of the uterus. When the procedure is finished the tube and probe will be removed.

You will be given a sanitary pad as it is normal to expect some fluid leakage after the procedure. The Doctor will discuss the findings with you and you will be given a report.

Frequently Asked Questions (FAQ)

Will I require an anaesthetic?

No, anaesthetics are not required and therefore you will be awake for the procedure.

Is it safe?

SIS does not require ionising radiation or a general anaesthetic and therefore is a safe test for investigating the lining of the uterus..

Will it hurt?

You may experience mild cramping during the procedure that is similar to period pain. This will usually resolve shortly after the procedure and paracetamol can be used to alleviate these symptoms.

How is this test different to a transvaginal ultrasound?

It can be difficult to clearly see the lining of the uterus in a regular transvaginal ultrasound. The saline solution better outlines the cavity in a SIS procedure.

How is this procedure different to a HyCoSy?

A HyCoSy is a similar procedure but uses a dye solution to assess the fallopian tubes instead of the uterine cavity.

Will I get money back from medicare?

There is a medicare rebate for this procedure.

Who should not have this test?

Anyone who might be pregnant or has an acute pelvic infection at the time of the procedure should not have this test.

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