We sat down with QUFW’s Lyn Stephens to learn more about her role at QUFW’s Ipswich clinic, her passion for obstetric and gynaecology patient care, and more.
Lyn is the clinic coordinator at QUFW’s Ipswich rooms, where she manages the clinic’s operations and, most importantly, makes patients feel right at home.
Lyn’s inspiring story as a QUFW ‘lifer’ is a testament to both her commitment to patient care and the ‘people-first’ culture QUFW brings to its community.
Lyn’s career with QUFW began almost twenty years ago as one of its founding team members. She’s now the clinic coordinator of QUFW’s Ipswich rooms, where she manages patient appointments, stock control, and oversees the team.
However, where Lyn really shines is her passion for patient care.
“I love building rapport with our patients, especially the ones that come back,” she says.
Patient care is important to Lyn during the good times. However, she stresses its importance during times of uncertainty or adversity.
Lyn recalls an emotional story of a patient who had suffered multiple miscarriages and needed weekly scans for reassurance that her baby was OK.
“A lovely patient was coming for multiple ultrasounds, because she’d had about a dozen miscarriages and could not get her head around the fact that she was actually pregnant this time,” Lyn explains.
“She needed weekly reassurance that her baby was okay.”
Thankfully, the patient delivered a healthy baby boy, and she brought him into the clinic to meet Lyn and the team.
“It’s such a lovely ending to her story, which was worrying at times.”
“I don’t think there was a dry eye in the room.”
Such cases allow Lyn to connect deeply with patients, providing them not just medical support but also emotional comfort.
“Because the waiting room is quite small, you get to chat with them and talk about their journey,” she explains.
“It’s quite emotional sometimes.”
“And it’s lovely that you end up being quite good mates with them.”
This personal connection extends to Lyn’s rapport with her colleagues. She describes the workplace at Ipswich as having a supportive and friendly atmosphere, where she and her teammates love working together and often socialise outside of clinic hours.
“I love working with the team at Ipswich.”
“My colleagues, all of the girls, are great.”
“We have a close relationship here.”
Lyn’s Origin Story
Lyn’s professional journey is a wonderful narrative of transition and growth within the healthcare sector, beginning unexpectedly from her days as a café owner.
Her entry into the medical field was sparked by a fortuitous connection with a colleague of QUFW co-owner Assoc. Prof Rob. Cincotta, who frequented Lyn’s coffee shop in Wickham Terrace.
After selling her café and searching for a new opportunity, Lyn was offered a position as a secretary for Assoc. Prof Rob. Cincotta, who, at the time, was about to establish his own obstetric practice.
And so, in 2005, Lyn began her career with Rob’s practice on the same day the business commenced, marking the beginning of what would become a two-decade-long tenure.
“The day that the business started in 2005 is the day that I started with the company,” Lyn explains.
This period was significant for both Lyn’s career and the expansion of the practice. Initially located in Spring Hill, close to her former coffee shop, QUFW eventually outgrew its original premises.
After nine years, it relocated to Little Edward Street to accommodate further growth.
In 2022, Lyn transitioned to a management role in the newly established Ipswich rooms. The new location not only meant a shorter commute but also represented significant growth in Lyn’s career.
“Here was our challenge to build up our new practice and make it as successful as the other QUFW locations,” she reflects.
On Industry Developments
When reflecting on industry changes, Lyn instead explores what has remained consistent at QUFW.
“One thing that hasn’t changed in almost 20 years is the level of care for our patients,” she says.
“That has always been the same from day one and I am proud to be part of a company that will always explain, offer guidance and give reassurance to our patients.”
Lyn also explains how advancements in technology have reshaped the clinic’s operations for the better, particularly via an app called “Tricefy,” which allows sonographers to send ultrasound images directly to patients’ mobile phones in real-time.
Reports are also sent to patients’ phones, streamlining the communication process and ensuring that patients receive information quickly and efficiently.
“Patients are getting their images straight away, and then once the report is done, that’s sent to their phone as well,” she explains.
Lyn also points out that traditional paper-based systems, such as patient referrals and medical records, have been replaced by digital alternatives.
Documents are now scanned and stored electronically, significantly reducing the need for physical storage. This shift has also facilitated better data management practices, including improved cybersecurity measures to protect sensitive patient information.
“The programs that we use now are far more efficient,” she explains.
“We now have in-built SMS messaging, custom task templates, more efficient banking reports and the fact that it is cloud based means we can access it from anywhere.”
Career Challenges
Throughout her extensive career at QUFW, Lyn has encountered numerous challenges, the most significant being the moments when she has had to support patients through devastating news, such as miscarriages or the detection of abnormalities during pregnancy scans.
These experiences are the most difficult aspects of her job, requiring a delicate balance of empathy and professionalism.
“That would have to be the most challenging part, trying to help patients when they’ve just received that really bad news.”
“During this time, it helps to have the support of people who care, and who listen to and empathise with them.”
While Lyn helps patients process their bad news, she must also help them understand the next steps in their clinical journey. This often includes explaining procedural details and associated costs, a task made harder by the patients’ emotional distress.
She describes the complexity of delivering practical information—such as detailing the costs of necessary follow-up procedures like Chorionic Villus Sampling (CVS) or amniocentesis—at a time when patients are least receptive to such details.
“So the doctor and the sonographers do a great job at handling the clinical side of things,” she explains.
“And then I just have to be as gentle and as kind as possible in the next five minutes that they’re in the rooms, and then carefully explain to them the details of what will happen next”.
This delicate balancing act of empathy and efficiency exemplifies an important ‘human’ element in healthcare, making Lyn a cherished member of the QUFW team.
Personal Passions
Beyond her professional life, Lyn discusses how she recharges and maintains her well-being. With nearly ten grandchildren, family is a central part of her life.
Her hobbies include cake decorating—a skill she lovingly applies to making birthday cakes for her grandchildren—cooking, gardening, and maintaining an active lifestyle through regular gym visits.
“I do enjoy cake icing. I have just finished a Taylor Swift cake for my 7-year-old,,” she says with a chuckle.
“And with ‘approaching’ 10 grandchildren I am getting lots of practice.”
Lyn pauses to reflect on her love for camping.
“My husband Peter and I enjoy camping, we have been to some amazing locations in Australia and have lots of plans to venture to many more locations together in the future.”
“I also enjoy cooking, so I get to experiment on lots of recipes when we are out camping as well as at home.”
As we wrap up our chat, it’s obvious why Lyn is such a valued member of the QUFW team. Her story highlights the essential human connection at the heart of healthcare, an important value that, through the dedication of team members like Lyn, QUFW brings to every one of its patients.
—
November 2024
Content Disclaimer
The information provided on this website is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen.
The content on this website is not intended to be a comprehensive source of information on any particular topic and should not be relied upon as such. The authors and publishers of this website are not liable for any damages or injury resulting from the use or misuse of the information provided on this website.
We sat down with QUFW’s Dr. Carol Portmann to learn more about her journey as an obstetrics and gynaecology specialist, her commitment to helping women get the best pregnancy outcomes, her thoughts on medical technology, and more.
Dr. Carol Portmann is a Queensland-trained doctor, obstetrician, and maternal fetal medicine specialist with more than 20 years’ experience.
Engaging in conversation with Dr. Carol Portmann is as interesting as it is inspiring.
Whether it’s hearing about her lifelong interest in obstetrics and gynaecology, the way she masterfully combines empathy with medical advice, or her passion for cooking and travel, Dr. Portmann’s skill as a conversationalist leaves nothing to the imagination as to how, and why, she has achieved so much in her career.
“From the earliest time that I can remember, I always felt that I was going to go somewhere in healthcare, as a doctor, nurse, or one of those roles,” she says.
“I was lucky enough to get into med school, which I did locally here in Queensland.”
Dr. Portmann was attracted to obstetrics early in her career. For the most part, she was drawn to the natural positives of pregnancy and childbirth.
“In this space, there are generally happy endings, and it’s all about making that happen safely.”
“It’s about guiding a natural process,” she explains.
Dr. Portmann pursued a Diploma of Obstetrics in New South Wales, which solidified her interest in the field. Upon completion of this qualification, she returned to Queensland to take up a position at the Mater Mothers Hospital in Brisbane.
Here, her career was greatly influenced by the late Professor Fung Yee Chan.
“During my time at the Mater, I went to many meetings where Professor Fung Yee Chan would show ultrasound pictures of babies with various sorts of conditions,” she explains.
“And I looked up at that screen and was fascinated by what she was doing.”
“I had this strong motivation to learn obstetric ultrasound and how to identify babies with problems.”
Dr. Portmann’s pursuit of this field took her overseas to University College London, in the United Kingdom, where she completed a master’s degree in prenatal genetics and fetal medicine.
Her research, which focused on blood clotting disorders and their implications on pregnancy, advanced her expertise in specialised areas of maternal and fetal health.
“I got a chance to spend time processing blood tests and interviewing people with adverse pregnancy outcomes and putting it all together for a master’s research project.”
“It was fascinating,” she explains.
Upon returning to Australia, Dr. Portmann continued her work in Brisbane. She played a pivotal role in developing the Maternal Fetal Medicine (MFM) department at the Royal Brisbane and Women’s Hospital, and later joined the QUFW team where she practises today.
Reflecting on positivity, but also realism
Dr. Portmann describes her work as, for the most part, joyous. The majority of the pregnancies she sees result in positive outcomes.
However, she also comments on the statistical realism that not all pregnancies unfold as planned, and the importance of delivering advice with empathy when complications arise.
“There’s a lot involved in a complicated high-risk pregnancy, which is what maternal fetal medicine is all about,” she says.
“It’s trying to get the best outcome using your medical skills, but also trying to provide positive and emotional support.”
Early in a complicated pregnancy, she might discuss potential complications. However, through vigilant care and management, she often sees these pregnancies result in the birth of healthy babies, surpassing initial expectations.
“Sometimes, early on, you’ll see things where you’ve got to talk to someone about possibilities.”
“However, you also support them through the process with the view to doing the best you can for a good outcome,” she explains.
“And then as you guide this person through, with their tiny little baby, you get to the end and this little baby is born happier and healthier than you thought they might be, which is fantastic.”
The two sides to technology
Dr. Portmann also explains how developments in imaging technology have dramatically enhanced the ability to identify at-risk pregnancies. This progression has enabled better management of pregnancy complications, and has improved outcomes for both mothers and their babies.
However, for Dr. Portmann, technology can be a double-edged sword. While it brings enhanced capabilities for early diagnosis, it also introduces new challenges, such as the potential for increased patient anxiety over findings that might have uncertain implications.
“Of course, the downside to cutting-edge technology is that we are now finding things that we don’t necessarily know what their significance is.”
“So there’s always a downside to the technology when we identify things that could be an issue, but we don’t really know.”
“Technology is great, but it has the potential to create more anxiety.”
Dr. Portmann also emphasises the limitations of ultrasound imaging. She stresses that while ultrasound is a powerful tool for assessing fetal health, it does not reveal everything and should not be expected to predict all potential issues.
“You’re not going to see everything on an ultrasound about a baby’s wellbeing,” she says.
“And that also includes gynaecology ultrasound.” “You’re not going to identify everything. Not all forms of endometriosis or early reproductive cancers can be excluded.”
On adverse outcomes
Dr. Portmann touches on the ethical dilemmas encountered when potential adverse pregnancy outcomes are found. She discusses the delicate process of counselling parents through decisions about pregnancy continuation, or even termination, in cases where prognoses are uncertain. These situations demand a high degree of sensitivity and ethical consideration, as some choices are profoundly personal and impactful.
She also prioritises starting consultations positively but remaining committed to honesty, especially when the findings are serious. Her approach makes sure that patients are not only well-informed but also supported throughout their journey.
“If I see something that is definitive and serious, I will say what it means and the potential significance and what we need to do.”
“It’s about being honest when we have definitive information, but then when we see something that has some significance but is not necessarily severe, I will begin with positivity and say, look, we found something, but it doesn’t necessarily mean anything bad.”
“I’ll then explain that we need to do further work to just monitor or identify any additional issues.”
The benefits of NIPT
Dr. Portmann explains how non-invasive prenatal testing (NIPT) has been a positive step forward for both the patient and the medical practitioner. NIPT allows for more accurate and sensitive detection of potential issues in fetuses, reducing the need for more invasive procedures like amniocentesis.
“NIPT allows us to identify the babies at risk of problems with greater sensitivity and accuracy, without having to rely on invasive procedures that could put mother and baby at risk,” she says.
This advancement, coupled with improved genetic screening, enables the detection of conditions like cystic fibrosis beyond what ultrasound can reveal, enhancing prenatal care and parental preparedness.
Inspiring the next generation
Dr. Portmann plays a significant role in training the next generation of fetal maternal doctors. And surprisingly, the mentoring advice she has for medical students and young doctors is non-medical.
She stresses the importance of retaining humanity and empathy, reminding medical practitioners that both they and their patients are people first, a perspective that enriches the patient-doctor relationship and enhances care quality.
“Don’t make everything about science,” she says.
“They are people, you’re a person, your patient is a person.”
“Make sure that you retain your humanity on your journey in the medical field.”
On her role at QUFW
Dr. Portmann doesn’t hide her passion for QUFW. Her message to patients and referring general practitioners is clear: the service provided at QUFW is more than just diagnostics; it’s about comprehensive care and support. And it’s about the bigger picture.
This philosophy is central to Dr. Portmann’s practice, and is indicative of her broader approach to healthcare, which prioritises patient wellbeing and informed, supportive care.
“The service that we provide at QUFW is all about counselling, alongside imaging.”
“We don’t just send you away with your scan, and something that you might not know about.”
“We make sure that you’re informed if something is different to usual.”
“And at QUFW we have very, very experienced sonographers and doctors to assist if anything is happening, and to reassure you when we feel that everything is great,” she says.
Career and personal life reflections
Reflecting on her own career, Dr. Portmann acknowledges moments of personal challenge, particularly regarding work-life balance. She candidly shares that there were times when she allowed work to overshadow her personal life, leading to stress and burnout.
This experience taught her the value of taking time for oneself and maintaining connections with family, insights she wishes she had embraced earlier in her career.
Her interests in cooking and travel highlight her approach to maintaining a well-rounded life, which helps her manage the stresses associated with her career.
“I like cooking books. I like cooking classes. I like cooking shows,” she beams.
When quizzed on a particular cuisine, Dr. Portmann demonstrates an ambition for cooking that clearly competes with her passion for women’s health.
“I’ll try anything and everything,” she says with a smile.
Dr. Portmann’s career is a testament to the relationship between medical practice and the timeless values of compassion and ethical integrity. Her dedication to advancing her field while providing empathetic, informed care to her patients highlights her role not just as a medical professional but as a foundation of support for families during one of the most significant times of their lives.
As Dr. Portmann continues her work, her influence extends beyond immediate clinical outcomes. She shapes the practices and attitudes of the future medical cohort through her advocacy, teachings, and exemplary model of care.
Her legacy is one of compassion, innovation, and a commitment to improving the lives of women and their families through excellence in maternal fetal medicine, even if things don’t quite go as planned.
—
August 2024
Content Disclaimer
The information provided on this website is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen.
The content on this website is not intended to be a comprehensive source of information on any particular topic and should not be relied upon as such. The authors and publishers of this website are not liable for any damages or injury resulting from the use or misuse of the information provided on this website.
Endometriosis is a common inflammatory condition that occurs when tissue similar to the endometrium (the lining of the uterus) grows in other locations around the body. In many cases, endometriosis causes discomfort, pain, and, occasionally, fertility issues. Endometriosis may affect up to one in seven women.
Despite it being a common condition, endometriosis can be challenging to diagnose due to the variability of its symptoms and their similarity to other conditions. In some women, endometriosis may be present with no symptoms at all.
Endometriosis is a common condition where ‘endometrium’, a type of tissue similar to the inside lining of the uterus, grows in other areas of the body.
Endometriosis is most commonly found around the female reproductive system, including the exterior of the uterus, fallopian tubes, ovaries and other organs within the pelvis.
The physiological effect of endometriosis include:
The presence of endometrial glands and stroma – these are called endometrial implants and usually occur outside of the uterus.
These endometrial implants are considered to be estrogen dependent which can respond to hormonal fluctuations with proliferatory and secretory activity.
Metabolic activity may include the release of cytokines and prostaglandins which can lead to chronic inflammatory response
Characterised by neovascularisation and fibrosis
Fibrosis and adhesions may lead to the physical alteration of the pelvic anatomy
Endometrium continues to behave as it normally would as if it was inside the uterus—it bleeds with each menstrual cycle. However, because it is unable to leave the body, like a normal menstrual cycle, it leads to inflammation and pain.
There are three types of endometriosis:
Superficial Endometriosis (SE): This form of endometriosis involves the growth of endometrial-like tissue on the surface of pelvic organs and structures. These superficial implants are less than 5 mm in depth.
Ovarian Endometriosis (Endometriomas): Endometriomas are cysts filled with dark, reddish-brown blood that form on the ovaries as a result of endometriosis. They can vary in size and may cause the ovaries to adhere to the fallopian tubes or the pelvic wall, leading to pain and affecting fertility.
Deep Infiltrating Endometriosis (DIE): DIE is considered the most severe form of endometriosis. It involves the infiltration of endometrial-like tissue more than 5 mm under the peritoneum, which is the lining of the abdominal cavity. DIE can be located in or around organs such as the bowel, bladder, and, less commonly, the ureters and lungs.
How common is endometriosis?
Recent Australian research suggests that endometriosis may affect as many as one in seven women. Despite its commonality, endometriosis is often underdiagnosed or diagnosed with a delay of up to nine years, sometimes due to the normalisation of menstrual pain or the variability of symptoms among affected individuals.
What are the causes of endometriosis?
There is no single known cause of endometriosis. However research suggest that these factors contribute to the risk of developing endometriosis:
Immune system disorders
Genetic predisposition
Hormonal imbalances
Environmental toxins
What are the symptoms of endometriosis?
Endometriosis presents differently in different people. Symptoms may include:
Pain around the pelvic area
Changes to menstrual frequency, duration, or heaviness
Pain going to the toilet
Infertility
Fatigue
Diarrhoea
Constipation
Bloating
Nausea
How is endometriosis diagnosed?
Your doctor may follow this process for diagnosing endometriosis:
Medical history and symptoms review: Your doctor will ask questions about your symptoms, including how severe they are and how long you’ve had them for. They may also ask about your family’s medical history.
An examination of the pelvic area: Your doctor may conduct a physical examination to check for cysts or scars, or any other physical indicators of endometriosis.
Ultrasound: A transvaginal ultrasound may be ordered to check for cysts associated with endometriosis (endometriomas) and assess the pelvis for evidence of superficial and deep endometriosis. Deep endometriosis may be detected during the ultrasound by specifically trained sonographers. Superficial endometriosis is more common, but not as easily diagnosed by ultrasound. The detection of superficial endometriosis is increasing with better technology and awareness of its subtle features.
Ultrasound video demonstrating the appearance of a normal ovary
Ultrasound image of an endometrioma in the left ovary
Magnetic Resonance Imaging (MRI): An MRI may be performed to check for endometriosis, or be used as an adjunct to a surgical procedure.
Laparoscopy: Still considered to be gold standard, this is a surgical procedure where a camera (laparoscope) is inserted into the pelvis.
Can endometriosis be cured?
There is no definitive cure for endometriosis but it is treatable. It is important to remember that sometimes endometriosis can recur after treatment.
What are the four surgical stages of endometriosis?
Endometriosis is classified into four surgical stages according to the extent, depth, location, and presence of scar tissue and endometriomas (cysts):
Stage I (Minimal): This is the mildest form of endometriosis, featuring light lesions only.
Stage II (Mild): Light lesions and shallow implants on the ovary and pelvic lining with minimal adhesions.
Stage III (Moderate): Deep implants, small cysts on one or both ovaries, and more extensive adhesions.
Stage IV (Severe): Large cysts on one or both ovaries, many deep implants, and thick adhesions. This stage may also involve implants on other organs outside of the pelvic cavity.
How can endometriosis be treated?
Treatment options vary depending on many factors, including the severity of symptoms, a desire for pregnancy, and previous treatment history. Your doctor will advise a treatment plan.
Treatments are mainly aimed at providing relief, reducing and ideally eradicating symptoms to improve your wellbeing. As described by QENDO, there are three main treatment plans that your doctor may recommend to you.
Drug therapy: used to manage endometriosis symptoms and minimise pain. This may include hormone therapies.
Surgery: used to remove the tissue from your body. This has a higher success than drug therapy and can usually be performed at the time of diagnosis. It is important the surgery is performed by a gynaecologist who is familiar with the latest treatment standards for endometriosis.
Alternative treatment: these can include herbal remedies, dietary change, acupuncture, reducing stress and exercise to reduce the pain. Endometriosis is not curable but IS treatable. But remember, sometimes endometriosis can recur after treatment.
Which parts of the body does endometriosis affect?
Endometriosis most commonly impacts the pelvic region. However it can also be found in other locations throughout the body, including but not limited to:
Peritoneum: This is the lining of the abdominal and pelvic cavity, and is the most common location for endometriosis.
Intestines and rectum This leads to symptoms such as painful bowel movements, gastrointestinal pain, and irritable bowel syndrome-like symptoms.
Ultrasound video of a deep infiltrating endometriosis bowel nodule
Bladder and urinary tract. This can cause urinary urgency, frequency, and pain during urination.
Ultrasound video of a deep infiltrating endometriosis bladder nodule
Diaphragm and lungs: Though rare, endometrial-like tissue can implant in the diaphragm and even the lungs, potentially leading to chest pain and difficulty breathing.
Additionally, endometriosis lesions have been found in even more distant sites, such as the skin, scars (from previous surgeries), and in very rare cases, the brain.
How does endometriosis affect pregnancy?
Endometriosis can influence pregnancy in different ways:
Fertility issues: Endometriosis can create fertility issues in some women. This happens when ovulation and the fertilisation of the egg is interrupted by the presence of endometrial tissue.
Increased risk of complications: Pregnant individuals with endometriosis may have a higher risk of certain complications, such as miscarriage, preterm labour, and placenta previa (where the placenta covers the cervix), compared to those without the condition.
Pain management: For some, pregnancy may lead to a temporary relief of endometriosis symptoms, as menstruation halts and hormonal changes can suppress the condition. However, for others, pregnancy may not alleviate pain, and managing pain without compromising the pregnancy can be challenging.
Obstetric outcomes: Studies suggest that endometriosis may be associated with increased risks of certain obstetric outcomes, including caesarean delivery and postpartum haemorrhage, though more research is needed to fully understand these relationships.
What support is available for people with endometriosis?
Here’s a list of support organisations:
QENDO – A peak organisation providing support to those affected by endometriosis, adenomyosis, PCOS, infertility or pelvic pain, by lobbying for national programs, better healthcare access, support, offering patients tools, services and programs to understand and take control of their health.
Endometriosis Australia – A national charity aiming to increase recognition of endometriosis, provide education programs, and support research.
CHARLI – a health tracking app that can help Australians take control of the diagnosis and management of endometriosis
Pelvic Pain Foundation of Australia – Offers information and support for those suffering from pelvic pain, including endometriosis.
Jean Hailes for Women’s Health – Provides comprehensive information on endometriosis and other women’s health issues, supporting women across Australia.
The Australian Pain Management Association – Offers resources and support for people dealing with pain, including endometriosis-related pain.
Healthdirect Australia – Government-funded service providing trusted health information and advice, including support and resources for endometriosis.
These organisations provide various forms of support, including information on diagnosis and treatment options, access to support networks and communities, and advocacy for better healthcare services for individuals with endometriosis.
The information provided on this website is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your obstetric doctor or other qualified provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen.
The content on this website is not intended to be a comprehensive source of information on any particular topic and should not be relied upon as such. The authors and publishers of this website are not liable for any damages or injury resulting from the use or misuse of the information provided on this website.
Despite endometriosis being a relatively common condition, it is challenging to identify and diagnose. For many years, laparoscopic surgery has been the “gold standard” procedure for definitively identifying endometriosis. However, the use of transvaginal ultrasound by experienced sonographers is emerging as a complementary diagnostic method due to its greater accessibility, lower cost and non surgical approach.
The growing use of TVUS as an endometriosis diagnosis and treatment planning tool also signifies a more important role for sonographers, and specialist practices like QUFW.
Endometriosis is a relatively common inflammatory condition in which cells similar to the endometrium (the lining of the uterus) grow in other locations around the body. While endometriosis is commonly found in and around the pelvis and reproductive organs, it can also grow in other parts of the body, including the bowel, bladder, and other organs.
Common symptoms of endometriosis include abnormal and heavy bleeding, chronic pelvic pain, dysmenorrhea (painful periods) and dyspareunia (pain during or after intercourse) , which can severely affect quality of life and may affect fertility.
Facts about endometriosis:
Recent Australian research suggests that endometriosis may affect as many as one in seven women.
On average, it takes 6.5 years to be diagnosed with endometriosis, during which patients may experience discomfort, pain, and other symptoms.
Endometriosis commonly presents in three different ways:
Superficial endometriosis (SE)
Ovarian endometriosis (endometriomas)
Deep infiltrating endometriosis (DIE)
According to Delsandes et al (2024), endometriosis may lead to further complications including:
Infertility
Bowel obstruction
Renal failure
Recurrent miscarriage
Depression
Higher rates of cancer
Autoimmune conditions
Cardiovascular disease
Endometriosis is a complex condition, which makes its diagnosis and treatment difficult.
A change in the way endometriosis is diagnosed
Laparoscopic surgery has traditionally been the preferred method of diagnosing endometriosis, which involves a surgical procedure to directly visualise and surgically excise lesions. Laparoscopy, like all operations, has potential risk, expense and recovery time.
However a medical imaging process called transvaginal ultrasound (TVUS) is being utilised more effectively by suitably trained sonographers as a method for diagnosing endometriosis.
QUFW Sonographers are skilled and experienced in this process.
What is transvaginal ultrasound (TVUS)?
Transvaginal ultrasound is a diagnostic imaging technique used primarily in gynaecology to obtain detailed images of the female reproductive organs, including the uterus, ovaries, and surrounding areas. This procedure involves the insertion of a small, wand-like device, called a transducer, into the vagina. The transducer emits sound waves that bounce off internal structures, creating echoes that are then converted into images on a monitor.
This method provides higher resolution images than a transabdominal pelvic ultrasound, allowing for more accurate assessment and diagnosis of conditions such as ovarian cysts, uterine fibroids, early stages of pregnancy, and now endometriosis.
The benefits of TVUS
It has been suggested that transvaginal ultrasound can be used as a first-line imaging method for assessing women with suspected endometriosis (Deslandes Et Al 2024). The assessment however, needs to be performed according to well standardised, established protocols. Transvaginal ultrasound is a noninvasive examination that is not only easily accessible, it is inexpensive but allows for preoperative planning in cases that require surgery.
Diagnostic features of endometriosis can be very subtle and it is important that the scan is performed by a skilled sonographer. At QUFW we believe that endometriosis assessment should be part of every routine gynaecological examination.
QUFW has continued interest in continued professional development for our sonographers and has collaborated with leading experts in the field to ensure that we are at the forefront of diagnostic imaging for our patients. Our sonographers have undergone advanced training in detecting endometriosis on ultrasound and follow the International Deep Endometriosis Analysis (IDEA)consensus. This is a four step systematic approach.
The International Deep Endometriosis Analysis (IDEA) consensus has outlined a four-step assessment approach, using TVUS, for the detection of endometriosis:
Assessment Step 1: Uterus and ovaries
Pathology detected:
Adenomyosis
3D coronal ultrasound image of a uterus demonstrating hyperechogenic myometrial islands commonly seen in adenomyosis.
Ultrasound image of an endometrioma in the left ovary
Assessment Step 2: Ovarian mobility and site-specific tenderness
Pathology detected:
Ovarian adhesions
Sites of tenderness which may indicate endometriosis
Assessment of mobility and tenderness of the right ovary by using “probe palpation” via a transvaginal transducer
Ultrasound video clip demonstrating “kissing ovaries”
Nodules of deep endometriosis within the posterior compartment
Ultrasound video of a deep infiltrating endometriosis bowel nodule
The growing importance of sonographers
The importance and relevance of transvaginal ultrasound in the detection of endometriosis places sonographers at the forefront of diagnosis.
This is due to:
The nuanced skills required to use ultrasound as a medical imaging modality: Sonographers not only use their advanced imaging skills to detect deep endometriosis, but also rely and utilise dynamic imaging to assess for mobility. Assessing mobility is a limitation of MRI in assessment of endometriosis.
Identification of subtle signs: Sonographers provide expertise in spotting the specific markers of endometriosis, which can be challenging to detect via other non-invasive means.
Patient comfort and communication: Sonographers play a key role in ensuring patient comfort during the procedure.
Collaborative care: Sonographers are vital in the multidisciplinary approach to managing endometriosis, working alongside doctors to tailor patient care.
Potential for future advancements
Emerging techniques and technological developments will continue to advance TVUS as a valuable method for diagnosing endometriosis. Some of these are:
SonoPODography
SonoPODography is an innovative ultrasound-based technique designed for the direct visualisation of superficial endometriosis. This procedure involves the infusion of saline into the pouch of Douglas (POD) via an intrauterine balloon catheter, creating an acoustic window that enhances the ultrasound beam’s ability to visualise the surrounding structures of the pelvis. This method allows for the assessment of the presence or absence of superficial endometriosis using pre-defined features.
Elastography
Elastography is a medical imaging technique that measures the elasticity or stiffness of soft tissue, to detect changes that may indicate disease. It’s often used alongside ultrasound or magnetic resonance imaging (MRI) to add important information about the mechanical properties of tissues. By applying slight pressure and analysing how tissue deforms in response, elastography can help in identifying lesions or abnormalities.
Artificial Intelligence
Artificial Intelligence (AI) can enhance the diagnostic process of endometriosis via transvaginal ultrasound (TVUS) by enabling more accurate analysis of imaging data. AI algorithms can be trained to recognize specific patterns and markers indicative of endometriosis, which may not be easily discernible by the human eye. This can help in identifying the presence and extent of endometriosis with greater precision, supporting sonographers in making more informed decisions and potentially leading to earlier detection and treatment of the condition. However, don’t worry, AI won’t be replacing sonographers any time soon.
This advancement in imaging technology enhances diagnostic precision and also significantly improves the overall management of endometriosis. By offering a less invasive diagnostic option, TVUS minimises patient discomfort and anxiety, allowing for a smoother journey through endometriosis diagnosis and treatment.
Reference
Deslandes, A., Panuccio, C., Avery, J., Condous, G., Leonardi, M., Knox, S., Chen, H., Hull, M. 2024. Are sonographers the future ‘gold standard’ in the diagnosis of endometriosis? Sonography.https://doi.org/10.1002/sono.12402
The information provided on this website is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your obstetric doctor or other qualified provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen.
The content on this website is not intended to be a comprehensive source of information on any particular topic and should not be relied upon as such. The authors and publishers of this website are not liable for any damages or injury resulting from the use or misuse of the information provided on this website.
As you approach your upcoming ultrasound, it’s natural to have questions about what to expect, how to prepare, and what insights the procedure can provide about your baby’s health and development. Ultrasounds are an important part of prenatal care, offering you and your healthcare team valuable information about your pregnancy. This fact sheet is designed to demystify the process, addressing common concerns and queries you might have before your appointment.
Ultrasound imaging, also known as sonography, involves the use of a small device called a transducer which emits high-frequency sound waves that are above the range of human hearing. When the transducer is placed on your abdomen, it sends these sound waves into your body where they travel until they hit tissue boundaries, such as the fluid and tissues of your baby.
Different tissues reflect these sound waves back to the transducer at different rates. For instance, bones reflect more sound waves than soft tissues. The transducer picks up these reflected waves and sends them to the ultrasound machine, which processes the data to construct an image based on the time it took for the echoes to return and their strength. This image appears on the monitor, providing a real-time view of your baby’s shape, position, and movements. The process is safe for both mother and baby, as it uses sound waves instead of radiation.
Early dating assessment of an 8 week fetus by measurement of Crown-Rump Length (CRL)
Is ultrasound safe for the baby and me?
Yes, ultrasound is considered safe for both you and your baby. It uses sound waves, not radiation, to create images. Ultrasounds have been used in pregnancy for decades and extensive studies have shown no direct harm to patients or their unborn children from standard diagnostic ultrasound.
The sound waves are of low energy and the device is designed to be used for short periods of time to minimise any potential risk, even though no risks have been conclusively proven. Sonographers, doctors, and other health specialists who use ultrasound are trained to use the lowest power settings and the shortest exposure times possible while still obtaining the needed information. This is known as the ALARA principle (“As Low As Reasonably Achievable”)
It is recommended that ultrasound is still utilised for medically indicated reasons, however the emotional benefits of ultrasound in pregnancy is also well known and documented.
What can ultrasounds show about my baby’s health?
Ultrasounds can provide valuable information about your baby’s health and development throughout pregnancy. Here are some key aspects that ultrasounds can help assess:
Viability and Heartbeat: An early ultrasound can confirm the pregnancy is viable by detecting the baby’s heartbeat.
Growth and Development: Regular ultrasounds check if the baby is growing normally. Measurements of the baby’s head, abdomen, and limbs help estimate fetal weight and growth.
Anatomical Structures: During the 20 week morphology scan, the ultrasound can examine the baby’s brain, heart, kidneys, limbs, and other organs to ensure they are developing properly.
Amniotic Fluid Volume: The ultrasound checks the amount of amniotic fluid surrounding the baby, which is important for the baby’s movement and development.
Placenta Position: It assesses the position of the placenta, which is crucial for a safe delivery.
Birth Defects: Ultrasound can help in identifying certain physical abnormalities or potential genetic disorders. For instance, it can detect conditions like spina bifida or cleft lip.
Multiple Pregnancies: For twin or multiple pregnancies, ultrasounds determine the number of fetuses, their growth patterns, and their positions.
Overall Health: Ultrasound can help monitor the general health of the fetus, including heart rate and movement, which indicate the baby’s well-being.
Will the ultrasound be able to tell the sex of the baby?
Yes, an ultrasound can usually determine the sex of the baby, provided conditions are favourable, such as clear visibility of the relevant anatomy and the baby being in a suitable position. This is typically done during the second trimester ultrasound, around 20-22 weeks into the pregnancy. At this stage, the genitals are usually developed enough to be visibly distinguished on the ultrasound. There are medical conditions or genetic conditions where ambiguous genitalia may be seen. This is why, at QUFW, we document the gender of all babies. If you do not wish to know your baby’s gender, please let your sonographer know prior to your ultrasound.
However, the accuracy of determining the sex depends on factors like the position of the baby, the amount of amniotic fluid, the mother’s abdominal wall thickness, and the experience of the ultrasound technician. While the prediction is generally accurate, there is still a chance of error, so it’s not 100% guaranteed.
3D image of a 20-week fetus
What should I do to prepare for an ultrasound?
To prepare for an ultrasound, you can follow these steps to ensure the process is smooth and the images obtained are clear:
Follow Instructions on Drinking Water: For many ultrasounds in early pregnancy, you might be asked to have a full bladder, which helps improve the visibility of the uterus and the baby by pushing the bowel out of the way. Drink the amount of water recommended by your healthcare provider about an hour before the scan and try not to urinate until after the ultrasound. If you are feeling uncomfortable, it is important to discuss this with the QUFW team prior to your scan.
Wear Comfortable Clothing: Choose two-piece clothing that allows easy access to your abdomen. This makes it easier for the technician to apply the ultrasound transducer without discomfort. However, dresses are often more comfortable during pregnancy. We are also equipped with modesty sheets to cover you during the scan.
Know Your Medical History: Be prepared to provide your medical and obstetric history, as well as details of any previous pregnancies and ultrasounds, which can be important for comparative analysis.
Check Hospital or Clinic Protocols: Especially under current health guidelines, check if there are any specific protocols about bringing a support person. Some places might restrict visitors to reduce health risks.
Ask About the Procedure: If you have any concerns or questions about the ultrasound, don’t hesitate to ask your healthcare provider beforehand. Knowing what to expect can help ease any anxiety.
How long does an ultrasound take?
The duration of an ultrasound can vary depending on the type of scan and the specific objectives, but most routine ultrasounds during pregnancy typically take about 30 to 45 minutes.
Early ultrasounds might be quicker, often completed in about 15 minutes, as they are generally simpler and focus on confirming the pregnancy and checking basic measures like the presence of a heartbeat.
More detailed scans, like the 13 week early anatomy scan and the 20 week morphology anatomy scan, can take longer, sometimes up to 45 minutes, especially if the baby is not in an ideal position to see all the structures clearly or if there are multiple babies.
If the ultrasound is being conducted to address specific concerns or to monitor a particular condition, the duration might also vary based on what needs to be examined. We always recommend to be aware that you may be in the department for approximately 90 minutes.
Will I need a full bladder for the ultrasound?
Whether you need a full bladder for an ultrasound depends on how far along you are in your pregnancy:
Early Pregnancy: For ultrasounds done in the first trimester, especially those before 12 weeks, a full bladder is often required. The full bladder helps to lift the uterus up and out of the pelvis, providing a clearer view of the developing fetus. It is also known as an ‘acoustic window’, where we can look through the fluid within the bladder and see the uterus and pregnancy sitting behind the bladder.
Later Pregnancy: For ultrasounds performed in the second and third trimesters, a full bladder is usually not necessary. By this stage, the uterus is large enough to be easily visible without the need for a full bladder. We recommend to have a small amount of fluid within your bladder, but not to the point where you are feeling uncomfortable.
Does an ultrasound hurt?
No, an ultrasound does not hurt. It is a painless procedure. During the ultrasound, a handheld device called a transducer is used to send and receive sound waves. This transducer is moved over your abdomen with a gel that helps improve contact between the device and your skin. You might feel some pressure as the technician moves the transducer to get the best images, but this should not be painful. If you experience any discomfort during any type of ultrasound, you can communicate this to the sonographer who will try to make adjustments to ease your discomfort.
If you do experience discomfort or pain during the scan, please inform your sonographer at the time.
If you have a transvaginal ultrasound, where the transducer is inserted into the vagina for better imaging in early pregnancy, you might feel some discomfort, but it should not be painful. If you experience any discomfort during any type of ultrasound, you can communicate this to the sonographer who will try to make adjustments to ease your discomfort.
Can I get pictures or a video from the ultrasound?
At QUFW, we utilise the Tricefy app to send images or short video clips during your ultrasound. However, the quality of the images and video clips is dependent on the position of your baby and other factors such as placental position and maternal habitus that we cannot control. We will always endeavour to send some images through to your mobile phone, however sometimes the number and quality of the images may be not within your expectations prior to the scan.
Further reading
Take a look at these pages to learn more about the pregnancy ultrasound scans we provide:
If you have another question about your upcoming ultrasound at QUFW, please write them down and bring them to your scan. Your sonographer or doctor will discuss them with you.
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Content Disclaimer
The information provided on this website is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your obstetric doctor or other qualified provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen.
The content on this website is not intended to be a comprehensive source of information on any particular topic and should not be relied upon as such. The authors and publishers of this website are not liable for any damages or injury resulting from the use or misuse of the information provided on this website.
Engaging in conversation with Dr. Carol Portmann is as interesting as it is inspiring. 
Dr. Portmann also explains how developments in imaging technology have dramatically enhanced the ability to identify at-risk pregnancies. This progression has enabled better management of pregnancy complications, and has improved outcomes for both mothers and their babies.
