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A gynaecological ultrasound examination can be performed transabdominally, transvaginally or, in exceptional cases, transrectally. Irrespective of the route of examination it is always important to optimise the image and to perform a systematic examination. There are two reasons to adopt a systematic scanning technique. First, it will ensure that a complete pelvic examination is performed. Second, if one always scans all the organs in the pelvis in a systematic way, he/she can build up a reference of what is normal, which increases confidence in detecting pelvic pathology. The uterus and ovaries are smaller in postmenopausal women than in women of fertile age. The endometrium has uniform ultrasound morphology because there are no cyclical hormonal changes. The ovaries contain no follicles but one or more inclusion cysts no larger than 10 mm are seen in healthy postmenopausal women.
Major improvement in the ultrasound assessment of early pregnancy came up with the introduction of transvaginal ultrasound at the end of 1980s. High-frequency transvaginal transducers improve the image quality to an extent that detailed description of the embryonic morphology became possible with in-depth anatomical studies of the brain compartments, the spine, the heart, the stomach, the midgut herniation and the limbs. There are three main characteristics that mark the early human conceptus: its small size, its rapidly changing anatomical appearance and its uniform development and constant growth. Embryologists use the Carnegie staging system to divide the human embryonic period into 23 developmental stages, commencing with fertilisation at stage 1, continuing into the fetal period with the onset of marrow formation in the humerus after stage 23, which takes place at 56-57 days post-ovulation, and the designation 'embryo' is replaced by 'fetus'.
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