ABSTRACT
Transvaginal sonography is a later addition to the diagnostic techniques available for the evaluation of the female pelvis and can overcome many of the limitations of traditional transabdominal scanning. Transvaginal sonography involves the placement of the probe within the vagina. This is uncomfortable for most women especially in this part of the world where ethical issues are now a challenge. This may reduce the practicability of transvaginal sonography. There is also reluctance in adopting this technique as a routine ultrasound investigation in our locality. The purpose of this study was to assess women’s views of transvaginal sonography; to assess the acceptability to women of transvaginal ultrasound scans; and to investigate any correlation between their educational background and their perception of the procedure. The sample size used in this study was 86 women. A convenience sampling technique was used in the study. The study utilized questionnaire as a source of data collection. Results showed that a greater percentage of the women studied have favourable views of transvaginal sonography; majority of women accept transvaginal sonography and would undergo the procedure again if it was recommended by their doctor; and that women’s perception of transvaginal sonography is not dependent on their educational background. The findings suggest that ultrasound practitioners should be educated on the advantages of transvaginal sonography so they could equip themselves and refer eligible patients for the procedure, thereby improving its practicability; more sonographers (especially females) should be trained in the use of the transvaginal probe.
LIST OT TABLES
Table 1: Distribution of age, marital status and educational background of the respondents.
Table 2: Responses on reason for undergoing scan.
Table 3: Response of women regarding prior knowledge and experience of the scan.
Table 4: Women’s response on information provided before the scan.
Table 5: Women’s views of transvaginal sonography.
Table 6: Preference of female sonographers over male.
Table 7: Response regarding acceptability of transvaginal sonography.
Table 8: Correlation of educational background and perception of pain, comfort, embarrassment and stress.
LIST OF FIGURES
Fig.1: Female Pelvic Anatomy
TABLE OF CONTENTS
Title page-----------i
Dedication---------ii
Approval page--------iii
Certification---------iv
Acknowledgement--------v
List to tables--------vi
List of figures--------vii
Abstract - - - -----viii
Table of contents - - - - - - - - ix
CHAPTER ONE: INTRODUCTION
1.1 Background of Study-------1
1.2 Statement of Problem-------2
1.3 Purpose of Study-------4
1.4 Significance of Study-------4
1.5 Scope of Study--------5
1.6 Operational Definition of Terms-----5
CHAPTER TWO: LITERATURE REVIEW
2.1Literature Review-------7
2.1.1 Women’s Views of Transvaginal Sonography--7
2.1.2Women’s Acceptability of Transvaginal Sonography-8
2.2Theoretical Basis of Research-----16
2.2.1Anatomy of Female Pelvic Area----16
2.2.2Anatomy of the Female Pelvis in Transvaginal Sonography17
2.2.3Piezoelectric Transducers-----20
2.2.4Examination technique------22
2.2.5Precautionary measures------23
2.2.6Applications of transvaginal sonography---24
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Research Design-------26
3.2 Sample Population and Sample Size----26
3.3 Sampling Technique-------27
3.4 Instrument for Data Collection-----27
3.5 Method of Data Collection------28
3.6 Methods of Data Analysis------28
CHAPTER FOUR: RESULTS
4.1 Data Presentation-------29
CHAPTER FIVE: DISCUSSION, CONCLUSION, AND RECOMMENDATIONS
5.1 Discussion and Implications of Results----35
5.1.1 Background Characteristics of the Respondents--35
5.1.2 Objective 1 (Women’s views of transvaginal sonography)-35
5.1.3 Objective 2 (Acceptability to women of
transvaginal ultrasound scans)-------36
5.1.4 Objective 3 (Correlation of educational background
and perception of TVS)------37
5.2 Conclusion--------37
5.3 Recommendations-------38
5.4 Limitations of the Study------39
5.5 Areas of Further Research------39
References
Appendix 1
Appendix 2
INTRODUCTION
Perception means ability to understand, see, believe and feel something. The main source of human attitude lies in the perceptions, awareness and life experiences of the individual. This strengthens the long-standing emphasis on using reason and facts as the basis for voluntary and purposeful change of behaviour in oneself or in the other. If we discover the perceptions operating in a community, the next task is to establish their relative effect in the population under study1.
Transvaginal sonography is a later addition to the diagnostic techniques available for the evaluation of the female pelvis. To date, it’s most frequent use has been in the evaluation of ovulation2 and in oocyte recovery in infertile patients3. Transvaginal sonography is performed with a high frequency transducer placed in the vagina where it is in close anatomic proximity to pelvic structures. The procedure overcomes difficulties in imaging obese patients, those with a large amount of bowel gas, and those with inadequate bladder filling.
Transabdominal sonography conventionally has been one of the best methods for evaluating the female pelvis. However, the necessity of traversing the abdominal wall and subcutaneous tissues causes degradation of image quality. Transvaginal sonography is a relatively new technique in pelvic imaging and can overcome many of the limitations of traditional transabdominal scanning2. The transvaginal transducer accurately assesses early embryos, ectopic pregnancies, and incomplete abortions4. It is especially useful in the work-up of the infertile patient and the monitoring of follicle development in these patients2, 5. Transvaginal sonography recently was used for transvaginal cyst aspirations6 and in fetal cephalocentesis for severe hydrocephalus7.
Transvaginal sonography provided more information than transabdominal sonography in most cases. However, the transvaginal technique is limited in some circumstances because of the smaller field of view of transvaginal probe. Transvaginal sonograms may be limited in patients with large myomatous uteri or large pedunculated fibroids, because it is difficult to image the entire uterus, and in the evaluation of cephalad or laterally displaced ovaries, because the pelvic structures are out of the focal zone of the transducer. In addition, because of the limited view, a global view of the pelvis cannot be obtained as it can be with transabdominal imaging.
It is unusual for the patients to experience discomfort, but this does occur and may be a limitation for this procedure in some cases. Patients with pelvic inflammatory disease or laterally located ovaries (requiring more manipulation of the transducer) are uncomfortable. Because elderly patients are uncomfortable with this technique, the transvaginal examination is seldom performed in these patients.
Over the last decade, there has been increasing use of transvaginal ultrasound in a wide range of gynaecological and obstetric contexts. Transvaginal ultrasound is an invasive investigation and there are a number of reasons for hypothesizing that it may be a difficult procedure for some women. For example, research has shown that a significant minority of women find vaginal examinations distressing8 and that, for some women, vaginal examinations may trigger post-traumatic stress symptoms9. There have been anecdotal reports that some women have found transvaginal scans very distressing10, and there have been some medico legal cases involving transvaginal scans11. This suggests that there is a need for research on women’s experiences of the procedure, examining both its acceptability to women and the relative effects of their perceptions.