Transvaginal Ultrasound Consent Form

Introduction:

Ultrasound is a modality used for investigating different disorders for planning treatment. Ultrasound consists of waves that pass through the body without 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 performed usually by a Radiologist; however, gynecologists may also perform it if needed.

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

Why is Trans Vaginal Ultrasound Needed?

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

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Transvaginal ultrasound TVS (through the vagina) is mostly required to identify disorders related to 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 the image is obtained showing organs of the pelvis.

After taking informed consent, the patient is asked to lie down and feet are held up in stirrups. Then the transducer is covered with lubricant and/ or latex covering 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 a common practice these days in identifying the polycystic ovarian syndrome.

Trans Vaginal Ultrasound Consent Form:

Before any kind of intervention, it is essential to take informed consent especially if it involves the private parts of patient. Some patients are hesitant and may require to be counseled regarding the procedure, limitations of other techniques and the importance of trans vaginal 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 name/ 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 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 kin person with a contact number in case of any emergency.
Transvaginal Ultrasound Consent Form

Simi Karton

Dr. Simi Karton is a regular contributor to National Science Quarterly and an enthusiastic Lakers fan. She recently collaborated on a manuscript with friends and colleagues. Dr. Simi Karton, entitled Parkinsons and the Genetic Response to Eastern Medicine, in which she and Dr. Inshal presented research compiled during a summer spent in United States. She currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health related information stuff at an easy approach. The information has been collected from different sources at one place.

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