Transvaginal Ultrasound Consent Form

October 8, 2019

Ultrasound is a modality used for investigating different disorders and planning treatment. Ultrasound consists of waves that pass through the body without having harmful effects, resulting in a detailed image of the soft tissues. It is a diagnostic procedure, but it can be used as an adjunct to treatment, called therapeutic ultrasonography. An ultrasound is usually performed by a radiologist; however, gynecologists may also perform it if needed.

Ultrasound is a safe imaging modality that can be used to identify disorders in pregnant women. There are different types of ultrasound techniques, and different probes are used for them, one of which is transvaginal ultrasound. It is a minimally invasive method of ultrasound.

Why is Transvaginal Ultrasound Needed?

Abdominal ultrasound detects disorders of organs like the liver, kidneys, stomach, intestine, pancreas, and spleen. Pelvic ultrasound is used to identify the urinary bladder, uterus, fallopian tubes, cervix, prostate, and ovaries. Rectal ultrasound is also used to see an image of the above-mentioned pelvic organs.

Transvaginal ultrasound TVS (through the vagina) is mostly required to identify disorders related to the uterus, fallopian tubes, and ovaries in detail. Ovaries are deep-seated, and imaging is poor in pelvic ultrasound. It is called transvaginal because the ultrasound probe is inserted through the vagina up to the cervix, waves pass through the walls of the vagina, and an image is obtained showing the organs of the pelvis.

After taking informed consent, the patient is asked to lie down, and their feet are held up in stirrups. Then the transducer is covered with lubricant and/or latex and introduced into the vagina. The procedure does not last long and is not painful. It is avoided in young females to avoid damaging the tissues. It has become common practice these days to identify polycystic ovarian syndrome.

Transvaginal Ultrasound Consent Form:

Before any kind of intervention, it is essential to obtain informed consent, especially if it involves the private parts of the patient. Some patients are hesitant and may require counseling regarding the procedure, the limitations of other techniques, and the importance of transvaginal ultrasound.

Counseling of the husband or mother of the patient may be required as well, as in some sects this kind of procedure may be prohibited. In cases like these, alternate methods may be adopted, like abdominal or pelvic scans.

Patient’s biodata: name, husband’s or father’s name, age, sex, hospital/clinic registration number, address, contact number, and identity card number.
A brief history of the patient’s current and past illness and clinical examination findings.
Description of the procedure, its indication, method, and duration.
Privacy and confidentiality agreement.
Consent about the level of exposure required for the ultrasound.
Repeat the scan and follow up if needed.
Complications related to the procedure, both during and after the ultrasound for example infection, allergy, pain, etc.
Name of the doctor performing the ultrasound.
Name and signature of the patient.
Next to a kin person with a contact number in case of any emergency.