After technological advances allowed for the adaptation of B-mode ultrasonography equipment for use in pig facilities, ultrasonography quickly established itself as an ideal diagnostic aid for determining pregnancy status in pigs. In recent years, B-mode ultrasonography has found increased application in its use for monitoring ovarian activity and in estimating time of ovulation in pigs. B-mode ultrasonography is also valuable in providing a detailed assessment of the sow's ovaries and uterus to determine if pathological conditions exist, which could be contributing to poor individual or herd reproductive performance. In its most recent application in pigs, the gilt genital tract has been characterized peripubertally by ultrasonography in order to detect onset of puberty. The purpose of this review is to provide an update on the current status of B-mode ultrasonography in pig reproduction, and how this technology can be of value when used in pig production medicine.