The Central and Posterior Compartments

Abstract

Translabial ultrasound has been utilized for prolapse quantification, not just for the anterior compartment, but in the assessment of central and posterior compartment as well.1, 2 The uterus itself may be difficult to identify because it is iso- to hypoechoic, similar to vaginal tissues. A specular (line-like) echo often indicates the leading edge of the cervix. At times, nabothian follicles help with identification of the cervix, but in postmenopausal women the uterus may be so small as to be virtually invisible on translabial imaging, even if there is significant descent. The same holds true for a retroverted uterus, especially if significant rectal contents or a rectocele shadow the area of interest, and a well-supported uterus may be outside the field of view, in particular if higher-frequency transducers are used. Needless to say, a full sonographic assessment of the uterus requires transvaginal scanning. Despite all those limitations, however, the cervix can often be located translabially (see Figure 5.1 for a second-degree uterine prolapse), and the same holds true for the apex of the vault after hysterectomy (see Figure 5.2).