Optimizing transperineal sonographic imaging of the cervix: the hip elevation technique

Although transperineal ultrasonography is a valuable technique for imaging the cervix in pregnancy, transperineal imaging can be compromised when bowel gas obscures the external portion of the cervix. To determine if a hip elevation technique could improve visualization of a partially obscured cervix, transperineal scanning was performed with the hips and buttocks elevated on a thick cushion in 23 patients with suboptimal routine transperineal views. The "hips up" maneuver was tolerated by all patients and improved cervical visualization in 19 of 23 cases. We conclude that the simple maneuver of elevating the patient's hips and buttocks on a thick cushion is a useful adjunctive technique to improve transperineal imaging of the cervix when routine transperineal views are compromised by adjacent bowel gas.