WOMEN’S PERCEPTION OF TRANSVAGINAL SONOGRAPHY AT IMAGE DIAGNOSTICS, PORTHARCOURT

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

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.

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

• 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

2.1     Literature Review –        –        –        –        –        –        –        7

2.1.1  Women’s Views of Transvaginal Sonography    –        –        7

2.1.2  Women’s Acceptability of Transvaginal Sonography   –        8

2.2     Theoretical Basis of Research –        –        –        –        –        16

2.2.1  Anatomy of Female Pelvic Area       –        –        –        –        16

2.2.2  Anatomy of the Female Pelvis in Transvaginal Sonography   17

2.2.3  Piezoelectric Transducers        –        –        –        –        –        20

2.2.4  Examination technique  –        –        –        –        –        –        22

2.2.5  Precautionary measures –        –        –        –        –        –        23

2.2.6  Applications 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

CHAPTER ONE

INTRODUCTION

• Background of Study

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 patients^{2, 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.

1.2 Statement of Problem

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 challenge¹². This could reduce the practicability of transvaginal sonography.

There is reluctance in adopting this technique as a routine ultrasound investigation in our locality. The reasons for this are yet to be determined.

1.3 Purpose of Study

The purpose of this study is to assess women’s perception of transvaginal sonography in Image Diagnostics Port Harcourt.

• Specific Objectives

1. To assess women’s views of transvaginal sonography.
2. To assess the acceptability to women of transvaginal ultrasound scans.
3. To investigate any correlation between their educational background and their perception of the procedure.

1.4 Significance of Study

1. This study will give the sonographer insight to women’s perception on transvaginal scans which may improve his technique in carrying out such scans.
2. This study might act as a reference in the future when referring women for transvaginal sonography.
3. This study will guide the sonographer towards improved patient comfort during transvaginal scans.

1.5 Scope of Study

This study will be carried out on patients who have undergone transvaginal scans in Image Diagnostics Port Harcourt. The research is intended to be for a period of 3 months in year 2012.

1.6 Operational Definition of Terms

1. Perception: Perception means ability to understand, see, believe and feel something¹⁴.
2. Transvaginal sonography: This is a type of pelvic ultrasound. It is used to look at a woman’s reproductive organs, including the uterus, ovaries, cervix, and vagina. Transvaginal means across or through the vagina.
3. Transabdominal sonography: This is a means of abdominal scan across the abdomen.
4. Acceptability: The approval of something by most people in a society.
5. Gynaecology: The medical specialty concerned with diseases of the female genital tract, as well as endocrinology and reproductive physiology of the female.
6. Patient care: This is the mannerism and means of administering attention to patients in a healthcare facility.
7. Transducer: A device designed to convert energy from one form to another used in diagnostic ultrasound.
8. Obstetrics: The specialty of medicine concerned with the care ad examination of women during pregnancy, parturition, and the puerperium.
9. View: A personal opinion and attitude about or towards something.
10. Experience: The knowledge and skill gained from doing something for a period of time.

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