1. begin with a clear image
For example, you will need to be angled up slightly into the anterior fornix to see a uterus that is anteverted (your wrist will move down to the bed) and angled down slightly into the posterior fornix to a uterus that is retroverted (your wrist will move up away from the bed).
2. sagittal sweeps
Keep in mind that not all uteruses are exactly center in the midline, so a little angling to the side may be necessary to image the full length.
3. Assessing the endo
An EV scan is the best way to visualize these and they can often cause spotting and abnormal bleeding so I take the opportunity to check for a possible echogenic mass and color stalk in the endo which could confirm this.
4. transverse sweeps
Make note of how your hand is holding the transducer so you know that you have turned the right way. Sweep anteriorly and posteriorly through the uterus and cervix and image as needed.
5. be firm in the adnexa
You can press further and firmer into the adnexa than you can on the midline because the uterus is a firm muscle without much give, while the adnexa are soft and the contents for mobile.
So remember to pull out a bit and apply less pressure to the midline when you move from left to right across the pelvis.
Now you have a normalized view of the left adnexa that uses the angle of the head of the transducer to your advantage in seeing a bit further over more easily.
Remember when you are done assessing to turn off the reverse image to return to normal scanning.