Posted on September 14th, 2017 by wombwithaviewblog.com

What is the Yolk Sac?

In this post, I’ll explain the yolk sac, its role in your pregnancy, what you should expect to see, and when we can expect to see it. Additionally, I’ll share an email I received from an anxious mama regarding an image her doctor gave to her. She didn’t see a yolk sac and was concerned one may not be there.

anxious mama: I recently received an ultrasound at 7 weeks 5 days. My doctor said everything looked great, and we were able to see its little heartbeat. When I got home and looked at the photo a little closer, I couldn’t find a yolk sac. Would you mind looking at it and letting me know if you can see a yolk sac or anything else you may notice? Thank you so much. This is my first pregnancy after having a miscarriage and I am slightly protective. 🙂

***

In short, if there’s an embryo, a yolk sac must exist! I didn’t see a yolk sac in her image, either. That said, it may be positioned on either side of the embryo, in which case you may not be able to see it in your particular image.

What’s the Role of the Yolk Sac?

The job of the yolk sac provides nutrients for the embryo until the placenta develops. No yolk sac, no baby. Your baby cannot develop without it! So, if your doctor said all looks good and you see a heartbeat, there has to be a yolk sac in there somewhere.

When Can We See a Yolk Sac?

The yolk sac is typically seen somewhere after 5 Weeks gestational age, before we ever see an embryo at Week 6. We normally continue to see the yolk sac every week until somewhere around Week 12 or so, maintaining its same appearance. As we near the end of the 1st Trimester, however, we are less concerned about identifying the yolk sac. As long as Baby is growing appropriately, documenting it is not as important as it is in early pregnancy.

What Will You Expect to See on Ultrasound?

A yolk sac looks like a tiny white circle. Most often, you will see your embryo cuddling up against it. Below is an image of an embryo at 9 Weeks and a great image of the yolk sac right up against Baby’s bottom.

 

9 Weeks, 9 Weeks pregnant, pregnancy Week 9, yolk sac

Embryo – 9 Weeks

However, sometimes we are not able to obtain the yolk sac in the same image with the best view of your embryo or fetus. Check out the image of the twins’ yolk sacs below.

Yolk Sac, twins

Twins’ Yolk Sacs – Week 6

Here you can see an image below of the same scan with just the embryos shown.

6w6d Dichorionic/Diamniotic Twins, 6 Weeks pregnant, 6 Weeks, 6 Week Twins

Twins – Week 6

I will also add here that I understand how frightening and what an anxious time it is for women to try again for Baby after a pregnancy loss. No matter how early someone miscarries, it’s still a loss and emotionally draining.

When a miscarriage happens very early in one’s pregnancy, we call it nature’s way of taking care of something which was not developing properly. From a human, spiritual, or emotional viewpoint, I like to think that Baby decided he or she needed a little more time! I always say our babies come to us when they are ready, not always when we are ready for them. They have to be ready for this great big world, too!

As providers, we don’t take special pains to give you an image of the yolk sac. It’s just not as doggone cute as your Little Sprout! 🙂

You can email me at wombviewerblog@gmail.com
with your questions or images, too.

 

 

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Posted on September 7th, 2017 by wombwithaviewblog.com

Babies do not actually breathe in utero. They do, however, practice breathing movements.

But what are fetal breathing movements?

Fetal breathing movements is a phrase we use when we see your baby’s diaphragm involuntarily move back and forth intermittently. Now for Diaphragm 101 in case you didn’t already know! The diaphragm is essentially a sheath of muscle that separate our chest from our abdomen.

Also, it plays a key role in respiration as soon as breathing air is a necessity. When we want to take in a deep breath, our diaphragm pushes our abdominal organs down to make room for our lungs to expand and fill with air. Incredible, right? See the image below for a cross section of Baby’s belly. The diaphragm is the faint gray line between the three arrows.

fetal breathing movements, fetal diaphragm

Very often patients notice that my probe is fixed in one spot as I watch the diaphragm move. Naturally, they want to know what I’m doing and what they see moving on the monitor. When I respond that I’m watching fetal breathing movements, they usually reply with, “I didn’t know babies can breathe in there!”

And then I explain that Baby’s lungs are the last organs to mature, so a fetus cannot actually use their lungs until they’re born. Moreover, because they are surrounded by fluid, babies cannot take the fluid into their lungs. What typically follows is a sheepish, “Oh, of course. Don’t I feel dumb!” No way. Who would know if you didn’t study a fetus for a career?!

When can you see the breathing movements?

I’ve personally noticed fetal breathing movements as early as 14 Weeks, but we expect to witness them routinely from 32 Weeks. We also refer to them as respirations. These fetal breathing movements are part of the criteria to determine fetal well-being as a part of a BPP or Biophysical Profile.

Sometimes, we don’t see these movements when we expect to see them when performing a BPP. It’s often not a cause for concern. We do not expect to see continuous breathing movements while Baby lives in the warm comfort of his temporary home. Until they make their grand entrance and need to take their very first real breath, it’s only practice!

Just one more of the cool aspects of scanning your baby. 🙂 We all learn something new every day, right?

If you have a video of your baby practicing respirations on ultrasound,
I’d love to attach it to this post!
Just email it to wombviewerblog@gmail.com.

 

 

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Posted on September 4th, 2017 by wombwithaviewblog.com

Pregnancy Labor Isn’t Loved By All

Don’t worry that you’re all alone in this boat. Pregnancy labor and delivery isn’t fun for every mother. Some conquer it like Wonder Woman while others vow to never go down that road again. It’s all personal and relative, and no feelings are wrong or right…just your own! 🙂

I ran into a patient of mine who recently delivered her first baby. She couldn’t wait to show her off. “She’s finally here!” She was so sweet and told me how much she loved having me as her sonographer every week. I love it! And, of course, her baby was absolutely beautiful.

She took a minute to vent about her L&D experience, of which she was NOT a fan. She said, “Nobody told me what it was REALLY going to be like. I’m never doing this again!” I laughed and expressed I was not a fan of mine, either, but that it’s different for everyone. Some people actually call it easy or loved the experience. I guess this is why some beloved souls do the pregnancy thing over and over! Well, that and they must either have really good babies or the patience of a saint. God bless the fruitful mothers, but my personal limit was two.

Moreover, they’re incredibly expensive! After diapers, extra-curricular activities, cars, insurance, and college, it all adds up to a luxury house in the end. But I digress…I love motherhood, love my kids, and I wouldn’t trade them for a thing in this world. Change that. Between the ages of two and four, I did consider either

selling my younger daughter on the black market or duct tape for her mouth. Alas, I opted for the duct tape, and (what do ya know?!) she became a hard-working, compassionate, and loving young woman.

You can read her blog post here!

pregnancy labor

We seriously have no idea where she puts all the food she consumes…

 

And for those of you who don’t know me, said daughter would be laughing hysterically at this last comment. She can attest to the lack of duct tape for discipline…though it would have been effective. If what goes around comes around, I have no doubt she’ll need it for her own kids one day!

We go through pregnancy for ourselves, our spouses, and to create that family unit for ourselves. It’s the love we put in and the love we get back that makes it worthwhile. And when our kids are bad, we stick them in a corner because we sure can’t shove them back where they came from.

I sometimes say I’ve made my contribution to Mother Earth with my twice-inhabited uterus. For my patient and many like her, it’s one and done! So many of my 3rd Tri patients begin to express anxiety at the thought of labor. It’s understandable. Every labor can be entirely different from your prior experiences, and we always fear the unknown. My advice to them?

Nature has a unique way of preparing us to take on the unknowns of labor ~
the complete exhaustion of pregnancy!

Well, that and finally seeing our babies in living color:)

3D fetal face, pregnancy labor

Happy and healthy labor and delivery, Everyone!

You can email your ultrasound and L&D stories to wombviewerblog@gmail.com!

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Posted on August 28th, 2017 by wombwithaviewblog.com

Keeping Baby’s Name Secret

 

Is this a parent’s right? You bet it is. An anxious and anticipating grandma though you may be, you don’t have to like it. But a couple’s decision to withhold such prized personal information is theirs and theirs alone. Your presence wasn’t necessary to make this baby; your two-cents isn’t necessary, either.

Some of my patients have gotten fired up about this topic and rightly so. In the routine of scanning a few weekly “regulars,” the natural flow of conversation usually turns to all the beloved options in the baby-name hat. These patients often declare “mums the word” and take off on a tirade, venting about fights between sides or an overbearing mother. After such heated debate, parents simply decide to remain tight-lipped. Who can blame them?

We know how it is. Names run deep in some families, and parents find themselves caught in the middle when traditional expectations rank lofty on both sides. Some opinionated family members don’t mind chiming in or expressing discontent with a name or its spelling. But why should parents concern themselves with hurt feelings because the middle name of Uncle Joseph remains in every generation for a century? Of course, parents would love to share their joy, but not at the risk of negative feedback.

Can We Really Blame Parents?

After all, they receive all kinds of unsolicited advice regarding everything from colic to college. Parents pore themselves over volumes of baby names, picking apart thousands of meanings one by one. Let’s not forget spelling, pronunciation, what it says to the world, and how his or her initials might read in all the ways. The effort can prove exhaustive, only to have to double down in defense.

Choose a popular name, and she’ll share it with five other Ashlyn’s in her Pre-K class. Choose an obscure one, and she might curse you forever. Ysatis. Beautiful, French — and she’s doomed to repeating herself to every teacher, classmate, mom, camp leader, and doctor’s office for the rest of her life. I can’t speak for other countries, but this certainly rings true in the U.S., at least (where most folks don’t even try beyond Kimberly or Susan). It’s not my experience, just my observation. By the way, it’s EE-suh-tees. She was a patient whose name I researched in advance, sending her into shock when I pronounced it correctly! Oh, it’s the little things in life, right? We owe it to our patients to make an effort.

On the contrary, maybe Mom dreamed her whole life of naming her little boy Darrin. Dad made a solemn vow to Grandpa Isaac on his death bed. But with Kelley for a surname, see the dilemma? No one wants her son to be a DIK. Names are a big deal. When parents finally agree, they don’t need someone to point out it also belongs to a murdering dictator or family nemesis. Don’t parents worry about enough?

The baby-name backlash can be fierce. And parents reserve the right to exercise caution if they gauge potential ill-effects from the fam! The real argument is why anyone argues over entitlement at all for what should only be considered a joyous occasion. And who really cares after the chubby-cheeked, long-awaited addition finally makes his or her grand entrance? When Baby’s health and preparing for the little prince’s or princess’ arrival becomes all-consuming for parents, only the same should matter to everyone else. The chosen name bestowed on your grandchild marks only the beginning of the millions of decisions parents must make on behalf of their children — don’t let your secret name become NagaliciousPITA, or Insufferable B. Those don’t look good on anyone!

So, comment if you have an opinion or experience with this subject at wombviewerblog@gmail.com.

To share or not to share…that is the question!

 

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Posted on August 25th, 2017 by wombwithaviewblog.com

What’s the purpose of ultrasound gel?

ultrasound gel

Ah…that amazing blue stuff…sometimes shockingly cold, oftentimes warm like a comfy blanket (if they’re nice and keep it in a warmer!). If you’ve ever had a sonogram, you know it’s pretty messy, and Moms usually hate it!

The best I’ve used for most of my career, pictured above, is made by Parker Laboratories and provides the perfect viscosity. In other words, it doesn’t run down the side of your belly when we squirt it. Ultrasound gel is made up mostly of water, gets everywhere, and feels tacky until it dries. However, no one can have an ultrasound without it!

Why do we use it?

The role of gel is two-fold. Most importantly, it’s acoustic transmission gel. This means it helps to conduct the sound waves. No gel, no view! Ultrasound cannot travel through air or gas. Without the gel, there exists a bit of air between the probe and skin which produces no image on the monitor!

Second, it allows the probe to move smoothly over Mom’s belly. Some wonder why we use so much. If we used it sparingly, it dries out. The probe won’t glide over your kin, and the dried gel forms little balls of stickiness. Gross. Better to use a bunch and extra tissue to wipe it off after! Usually, it dries like a fine powder on your skin.

I performed this little experiment one time for a patient who asked, much to her amazement. It’s really cool, actually…touch the probe to the skin with no gel and all you see is black. Add a little gel and Voila’! Baby.

So, there you go. Another lesson in Ultrasound 101.

Have a great day and a healthy pregnancy 🙂

Email me at wombviewerblog@gmail.com with your questions!

 

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Posted on August 15th, 2017 by wombwithaviewblog.com

6 Week Ultrasound – Twins!

 

Whether one baby or more, we have great expectations for your 6 week ultrasound! Not everyone can expect to have an ultrasound at this early gestational age. If you do, however, the first thing you can expect is a transvaginal ultrasound. Yep. Babies are just too tiny as you’ll see below, so we need the magnification and better resolution of the vaginal probe.

We expect to see some pretty amazing changes brewing! This post is dedicated to 6 Week babies x 2, aka twins!

Twins at 6 Weeks

If you have followed the twin pregnancy from Week 5, this post is a continuation. Did we see two babies? Two heartbeats? YES! Yay! This was a great milestone! This is a dichorionic pregnancy, meaning both babies came from two separate eggs. This particular pregnancy produced “fraternal” twins. This, of course, means these babies can either be the same sexes or one from each camp, Teams Pink and Blue. Woohoo – that would be a fun shopping trip!

The gestational sacs at the 6 week ultrasound were still discrepant from one another. We could not explain why the gestational sac of Baby A was smaller or why that of Baby B was larger. This finding still concerned us. However, the fact that we saw two strong heartbeats and two babies who measured essentially the same were both very reassuring! See the images below for measurements of the embryos.

 

6 Weeks, 6 Weeks pregnant, twins 6 Weeks

Baby A Embryo

You’ll note here that Baby A was measuring a whopping 3.5mm!

 

6 week ultrasound

Baby B Embryo

Baby B measured about the same at 3.4mm.

 

Now check out the heart rates!

6 Weeks, 6 Weeks pregnant, twins 6 Weeks, heartbeat 6 Weeks

Baby A Heart Rate

This is the heart rate for Baby A. Note that it measures just over 100bpm which is a great start!

 

6 Weeks, 6 Weeks pregnant, 6 Weeks twins, heartbeat

Baby B Heart Rate

Baby B’s heart rate was just a tad faster at 109bpm. Both heart rates were just what we want to see – strong, steady, and rhythmic.

If you want to follow these twins, this link combines Week 7 and Week 8. You will be impressed at how much bigger they look in only one week’s time!

~*~

Best wishes for healthy, and feel free to comment below!

~You can email me at wombviewerblog@gmail.com with your questions~

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Posted on August 13th, 2017 by wombwithaviewblog.com

Ectopic Pregnancy Explained

 

An unfortunate circumstance of pregnancy, especially a desired one, is the ectopic pregnancy. In this post, I’ll talk a little about what we look for with transvaginal imaging, and how they can sometimes be extraordinarily difficult to diagnose.

What’s An Ectopic Pregnancy?

An ectopic (pronounced ek-top’-ik) pregnancy is one that is displaced. This type of pregnancy is one that implants somewhere other than within the lining of the uterus – where it’s supposed to be. An ectopic frequently occurs within the tube, commonly referred to as a tubal pregnancy. I’ve also seen them within the adnexa, usually the area between the ovary and uterus. Very rarely, a pregnancy attaches abdominally. (Rare and bizarre!)

How Do We Know to Look for an Ectopic? Your low hCG Levels

One sign that leads us to look for an ectopic with ultrasound is a very low hCG level. Now, this alone is not alarming. It is, however, when combined with other factors. Your level of hCG should essentially double every two days in a normally-progressing pregnancy. If this isn’t happening, we become concerned that your pregnancy is not a good one.

LMP Dating Doesn’t Measure Up

Many women are unsure of their LMP. Maybe their periods are very irregular. However, if your periods are like clock-work and you are very sure of the first day of your last period, not seeing a pregnancy within the uterus at a time when we would expect to see one would worry us. For example, from about Week 5 on, we would expect to at least be able to confirm the presence of a gestational sac within the endometrium (lining of the uterus). See the image below for a super-early (~4 1/2 Weeks), normal intrauterine pregnancy:

ectopic pregnancy

If You Have Pain

If the above factors come into play and you also have pain, we increasingly become concerned for the possible presence of an ectopic. Too early in your pregnancy, even with an ectopic, you may not experience pain immediately. Even if you don’t, the other factors are enough to raise an eyebrow and spark the hunt. Typically, the pain occurs on the same side as the ectopic. You may be watched very carefully and followed with blood work and serial ultrasounds until we’ve either proven or disproven the ectopic. Physicians want these patients treated as soon as possible because they can pose a serious health risk for mom.

If We See Bleeding in the Pelvis

Another characteristic of an ectopic via ultrasound is the presence of free fluid or bleeding in the pelvis. A large collection of blood can be seen around the uterus and ovaries when the ectopic starts to bleed. We tend to raise both eyebrows when we see this and all the other factors mentioned above are part of the equation. The extra fluid tends to cause an increase in pain.

If We Find an Unexplained Mass in the Adnexa or Tube

Most of the time these pregnancies present as a mass somewhere outside of uterus, usually in the tube between the uterus and ovary. Either the pregnancy implanted in the tube on its journey to the uterus or it never made it to the tube at all. In these cases, the egg was released, but the “fingers” at the end of the tube failed to catch the little guy. Most often, these masses do not look like the typical normal pregnancy. The masses can be vague and difficult to see depending where in the pelvis they are located.

If You Have a History

Moreover, your doc may consider you at an increased risk of an ectopic if you present with all the above findings and a history. Your chances of having an ectopic may increase if you also have a previous history of an ectopic pregnancy, a history of endometriosis, a history of a tubal ligation, or get pregnant with an IUD in place. This may not be a complete list of risk factors.

My Experience as a Sonographer with Ectopic Pregnancy

I have had patients in the past where we just knew she MUST have an ectopic but try as we might, we just couldn’t see it right away. After a second, third, or even fourth scan were we finally able to confirm what we suspected.

I have also had the misfortune, only a couple of times in my whole career, of finding an ectopic pregnancy with an embryo and a heartbeat. Unfortunately, these pregnancies cannot be saved. They have to implant on their own and can’t just be “placed” inside of the uterus.

These scans can prove very challenging and definitely put one’s ultrasound ability and expertise to the test. Knowing what to look for and where is the biggest piece of the puzzle for all you newbie sonographers! (Google images of ectopic pregnancies. They will definitely help you if you’ve never scanned one before.)

What To Do

As I’ve said many times before, I cannot give specific pregnancy advice. However, I can confidently advise this. If you know you are early pregnant and begin feeling pain in your pelvis or back, call your doc ASAP! They will determine how soon they want to see you!

Best wishes for a healthy pregnancy!

Please email comment below if you found this post helpful!

And, as always, you can email me at wombviewerblog@gmail.com.

 

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Posted on July 27th, 2017 by wombwithaviewblog.com

Consulting Dr. Google About Your
Abnormal Fetal Ultrasound

 

Don’t do it, Moms-to-be! As much as you may be tempted, I have to caution you to not web-surf regarding your abnormal fetal ultrasound. Here’s why…

Because you surf the net for these details, you end up finding an entire spectrum of possibilities ranging from normal to severely abnormal fetal findings. And most of them may not apply to your circumstances at all. The result is usually the same. Your imagination runs away with you, and you start to worry that everything you’re reading applies to you and your baby. I always know a mom has been consulting Dr. Google when I get questions like “Is my baby’s bladder inside its body??” My response is usually the same…I reassure her with an “It sure is!” Then with a little smile, I advise “Quit looking up stuff on the internet!” Moms’ responses are usually the same, too. “I know, I know…I just can’t help myself!”

In this day and age of anything we want to know at our fingertips, it is nearly impossible to NOT research something that piques our curiosity. So, naturally, when you get your ultrasound results from your doctor, and he mentions you have a lot of amniotic fluid (polyhydramnios) or your baby has cysts on its brain (choroid plexus cysts), you freak out a little (or a lot). It’s completely understandable! But these findings may VERY WELL not be a reason to panic!

If Your Doc Wants to Refer You

Sometimes, we sonographers (even the experienced ones) detect things we just can’t explain. This doesn’t mean something detrimental to your baby; it just means we can’t fully explain it. We know this is disconcerting to an expectant parent(s). Usually, if something requires the attention of a high-risk specialist (aka a perinatologist or MFM or Maternal Fetal Medicine), your doctor will tell you when he discusses your ultrasound results. In such a particular case, he/she will usually express that something noted on the examination stands out as abnormal (or possibly a normal variant – something that’s a little different but considered normal), and he would like a second opinion.

In my experience, if your provider feels it is not grossly worrisome, he/she will say so. Your doctor will then refer you to MFM so they can do a more extensive Level 2 ultrasound. The perinatologist should discuss this ultrasound with you, provide an opinion on the issue, and the severity of the problem. MFM will also let you know if they feel there really is no problem.

If Your Report is Normal

If you are not referred to a perinatologist, then it’s very likely that nothing worrisome enough was seen on your ultrasound. Your doctor will also let you know that your ultrasound was negative or unremarkable. At times, we can’t see something well because of Baby’s position or other factors. Usually, it’s something like Baby’s heart or spine. In these cases, your doc may want to look again to ensure a normal appearance. There are many minor findings that we may note on a regular sonogram which may not be alarming to your doctor. Mostly, they just require a follow-up later to see if the issue is resolved. They mostly turn out to be insignificant, especially if no other abnormalities are seen with your baby. In other words…they are likely not a big deal!!!

So don’t make yourself worry! Don’t ask Dr. Google, ask your doctor instead. Make a list of all your questions, and he/she will let you know if other tests are needed. I know it’s tempting, but this is only the beginning of all the things that drive us crazy as moms! Save your sanity for when your kid is a driving teenager!

As always, thanks for reading!

Please feel free to email with any questions or comments at
wombviewerblog@gmail.com.

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Posted on July 25th, 2017 by wombwithaviewblog.com

The Ultrasound Bladder Prep
~ What Is It?

 

To drink or not to drink! That is the dilemma, and the facility performing your test has the answer to your ultrasound preparation questions. Being required to fill your bladder depends on a few factors…how far along you are if you’re pregnant, the type of ultrasound exam performed, and the protocols of your doc’s office, hospital, or out-patient center where the ultrasound will be conducted. The protocol or policy for how to conduct your test varies from place to place.

I know what you might be thinking. Every site says something different. You’ll find the most comprehensive info here. Why? Because I performed these tests for years. The info here is accurate, and reflects most all scenarios. However, at the end of the day, the facility where the exam will be performed should be able to tell you exactly what ultrasound preparation they want you to follow. And only what they say matters!

The Prep

The dreaded bladder prep may vary a little from one place to the next, but goes something like this:

 

  • Empty your bladder 1.5 hours prior to your exam
  • Drink 32ozs of fluid (preferably nothing carbonated) within 30 minutes
  • Have all fluid down 1 hour prior to your exam
  • Do not pee until exam is complete! 😩😵

 

To clarify, let’s say your appointment is 10am. You will pee at 8:30am, drink from 8:30 to 9am, and have all the water down by 9. Most bladders require the full hour to fill completely. Do not pee before your appointment time! This action, of course, defeats the whole purpose for drinking, but you would be suprised at how many do.

Will you feel like you have to pee before this hour is up? Oh, yes ma’am! Not many people allow their bladders to fill to this capacity before they feel the urge to tinkle. It might very well feel like the L O N G E S T hour of your life. Don’t even look at one of these 🚽, or listen to this 🚰 or this 🚿. I promise. You won’t be happy if you do!

There is a bit of good news to all this. Once full, the exam (for a very experienced sonographer) is pretty quick…5-10 minutes in most easy-to-see negative cases.

But Why a Full Bladder?

ultrasound preparation

Full bladder pelvic ultrasound

Blame the laws of Ultrasound Physics for this one. Sound waves travel more easily through fluid than tissue. Think of your pelvic anatomy from front to back. First is skin, then fat, then muscle, then intestines or bowel, then your bladder. Your uterus sits behind your bladder. So, if you drink lots of water and fully distend your bladder, it provides a window to the uterus. Also, your bowel contains air and gas which can limit what we see. Filling your bladder pushes the intestines aside. It’s actually kinda cool, but not so much if you’re the one doing the drinking.

Additionally, the uterus of most women tilts forward (anteverted) or toward the front of your belly. Filling the bladder aids in pushing the uterus backward a little – not up or higher, as I’ve read in some pregnancy books or sites. When the top of the uterus tilts back a little, a better angle is created to see more clearly. Occasionally, a uterus decides to go rogue and tilts too far backward instead (retroverted). Sometimes it tilts so far back that it folds over on itself (retroflexed). This is a totally normal variant. Often, however, the full bladder only helps minimally in these circumstances.

Transvaginal Ultrasound (Endovaginal) Approach

TV probe, how much water to drink for your ultrasound

 

Whether you are pregnant or not, the rules are the same for a transvaginal ultrasound exam. An empty bladder is required. The TV provides a more magnified view, so a full bladder just gets in the way. Inside the vagina, the probe is closer to your organs allowing us to see them more clearly. AND we don’t have to fight to see past your bowel like we do with the belly approach.

If you’re early in your first trimester, usually less than 11 or 12 Weeks, you will (9 times out of 10) have a TV. This is, BY FAR, the best way to see so early because Baby is so tiny. If your uterus is enlarged with fibroids (very common muscle tumors), your sonographer may try to scan you with TV first. However, if your uterus is too large to see well with the TV probe, she may end up attempting the abdominal approach. If this happens, you may or may not need to drink. Quite often, we can see what we need without making you drink an ocean of fluids.

I can’t speak for all private practices, but we only required a bladder prep for some GYN studies. Only those who were not sexually active or refused the TV exam needed to fill!

Trans-Abdominal Approach

In most hospitals and out-patient imaging centers, you’re going to be drinking, sister! Your exam is typically read by a radiologist in these facilities.

Most of the time, radiologists are of the mindset that certain anatomy will be better seen with a full bladder EVERY time and on EVERY patient. This isn’t necessarily true, but most of these docs want to start with a full bladder first. Commonly, they’ll have you empty for a vaginal scan if they want a better look. To be fair, I haven’t worked in the hospital setting in 15 years. Maybe they’ve adopted more modern policies! If they haven’t, they should.

Filling the bladder has long been the standard practice, and radiologists are set in their ways (sorry, guys, you know you are!). They like to start with a full bladder, but the experienced sonographer knows how best to scan to obtain the images needed. I think the protocol should be opposite…TV first and only make the patient fill if absolutely needed! Unfortunately, I don’t make their rules.

Many of these places will also still require you to fill for your anatomy scan at 18-20 Weeks or even for ultrasound exams in the 3rd Trimester. In my opinion, that’s just pure evil. Expectant moms have enough pressure on their bladders as it is! A little fluid in the bladder may help us to evaluate the cervix. But most patients have a little fluid in there anyway. In cases where the cervix isn’t seen well, our friend, the TV probe, is called to action.

Cons to Filling the Bladder

  • Elderly patients (for GYN exams) have a hard time holding their urine
  • Most OB patients have a problem holding it due to pressure from Baby
  • Drinking the water too fast often causes the patient to vomit it right back up!
  • Many do not follow the ultrasound preparation properly. They either do not drink enough water, they don’t have it down in time, they drink more than they needed which results in over-filling the bladder, or they drink all the water then pee right before the exam
  • Not following the prep usually results in drinking more fluid or being rescheduled
  • Some say they weren’t given a prep
  • Sometimes schedulers really do forget to provide the instructions
  • Some patients are dehydrated, so the fluid tends to go where it’s needed and not the bladder
  • But most importantly, it’s MISERABLY painful for the patient!!

 

In my opinion, the cons far outweigh the pros for drinking water for an ultrasound exam. However, your facility could care less what I think and dictates what ultrasound preparation they want you to do for your test! Being able to pee when you want is a luxury. You just don’t realize it until somebody tells you that you can’t! When in doubt, ask if you’re free to pee!

Best wishes for a healthy sonogram (with no bladder prep!)

As always, thanks for reading and feel free to comment or email me with
your questions at wombviewerblog@gmail.com.

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Posted on July 18th, 2017 by wombwithaviewblog.com

The Ultrasound is Radiation
Misconception

First, let me help some of you moms out there relax right off the bat. This is a complete myth, rumor, or misconception. Anyone who has studied ultrasound, as well as every physician, engineer, and manufacturing company in relation to the technology can attest that ultrasound is most definitely not radiation. Those who have conducted biohazard testing in the field over the past forty years can do the same.

Despite what you may have read or heard, regardless of where, this is a total falsehood. Read more about it here below! And please do not let this scare you away from your diagnostic scans.

What Exactly is Ultrasound?

Ultrasound is just that. Ultra Sound, or sound waves that work at a frequency far beyond human hearing. Like a fish-finder one might use on a boat. Or sonar used by the military. Human hearing ranges from about 20Hz (Hertz) to 20,000Hz (or 20kHz). When it comes to creating an ultrasound image, we work in the MHz range or millions of Hertz. An OB probe ranges from about 2MHz – 13MHz.

Ultrasound is a department of Radiology within a hospital, but it does not emit radiation.

Someone Is Spreading the Wealth

The heading is meant to be facetious. Unfortunately, someone is spreading only fear and proliferating ultrasound misinformation. Apparently, she is also someone who hasn’t done her homework. I was floored recently while doing research for my book when I came across a very popular pregnancy book (which will remain nameless) who actually wrote that ultrasound is radiation. If you have read this book, you know who I am referencing here.

She also claims that the Doppler used by physicians to obtain heart tones emits more radiation than scanning equipment! Wrong again, Doppler is ultrasound.

How does this happen? After all, she supposedly had the help of “knowledgeable” medical resources to write the book. Are they the only healthcare providers on the planet who don’t know Ultrasound is not X-Ray? And if not, why not?

I am unaware if this author has since recanted her falsehood. If she did, I give her credit. If not, she owes an explanation and apology to her faithful readers and social media followers. She is incorrectly influencing millions of parents-to-be with this misinformation, and it’s not okay. She is adding needless fuel to the fire, and moms worry about enough as it is.

Additionally, she then goes on to advise moms to only have an ultrasound if they really want one but to not have more than they need. To me, this begs the question…is it radiation or is it okay?

I would like to think she did not intentionally mislead her readership. But as a published author, ignorance is no excuse.

What is Radiation?

It is a transfer of energy that also travels in waves. For example, radiation is found in light from the sun, microwaves, and X-Rays. But not sound waves. And, yes, exposure to radiation can cause cancer. One example is skin cancer from too much sun exposure.

Consider this. When you go to the dentist, what is the first thing asked of any woman? “Is it possible you might be pregnant?” If the answer is “Yes” or “I’m not sure,” they shield your belly to protect Baby from the minuscule dose of radiation from the super quick X-Ray of your teeth.

If an obstetrician’s job is to manage the health and care of Mother and Baby, and it is, why then would docs expose their patients directly to radiation? And what about sonographers? We all would be directly exposed numerous times a day, every week for the duration of our careers. None of us, patients nor sonographers times decades, have died from cancer due to ultrasound exposure.

Is Ultrasound Safe?

So far, with the prudent use of commercial technology, there have been no known bioeffects on the fetus, mother, or sonographer. Biohazard testing over decades has demonstrated the creation of heat in fetal tissues during higher than recommended settings and extended scanning times. The long-term effects are still being studied. Therefore, it is the feeling of ACOG (the American College of Obstetricians and Gynecologists, ACR (American College of Radiology), and the AIUM (American Institute of Ultrasound in Medicine) that the benefits outweigh the risk, and they justify the use of ultrasound only for diagnostic purposes.

They do not endorse the private entertainment ultrasound scan in the strip mall near you. These facilities are not regulated to maintain the same standards as medical practices for patient safety. They are not required to hire formally-trained and credentialled sonographers or to properly clean or maintain ultrasound probes or equipment. Be sure to do your research prior to scheduling your appointment in one of these facilities!

My Two Cents

One of the reasons I started this blog five years ago is because patients were misinformed – by Dr. Google, family, or friends. I expect as much from a random non-medical blogger, and I became even more enraged to find misinformation doled out on popular pregnancy sites. But in a published book? Unforgivable.

It’s one thing to express one’s opinion. But when you’re making tons of money by persuading expectant moms to adopt your line of thinking, you have the responsibility to get your info right. No one says anyone has to be a fan of ultrasound. And as a mom, you have the right to decline. Before you do so, speak with your provider. You need only to understand your choice. Any mom who ever delivered a baby with serious problems was happy to know about it in advance for planning and educational, emotional, and delivery purposes. This, in fact, is the purpose of obstetric ultrasound.

And if you’re all about moms and choices, and those choices are power? The power only comes from a parent who makes an informed choice, not one based on misinformation. It is my wish and goal to simply and accurately explain ultrasound for moms-to-be and stamp out the misconceptions. Understanding is also power:)

Here’s to a happy, healthy, and informed pregnancy!

As always, thanks for reading!

Please feel free to email your comments or questions to me
at wombviewerblog@gmail.com.

 

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Posted on July 6th, 2017 by wombwithaviewblog.com

Gender Determination in an
Ultrasound Report?

I’ve received questions lately regarding where to find fetal sex or gender determination in an ultrasound report. Can you always find this information in a report?
The short answer? No, not always.
Actually, we mostly do not record fetal sex, and it’s mostly not important to your doc. Typically, fetal sex is not pertinent information to the examination. Though parents may desire it, physicians don’t need the gender determination to manage your care and that of your baby if both are healthy. The above is true for most general OB practitioners in the US. However, every physician practices a little differently, and one can certainly dictate if he or she wants this info on all patient reports (if possible to determine). The case may be different if you are seeing a high-risk OB doc, aka a perinatologist. Their reports consist of much greater detail and may possibly include a fetal sex/gender guess.

Example of a Blank Report

gender determination
In the images of a sample report taken from a monitor, you’ll notice there is a whole host of blanks to fill, but fetal sex is not one of them. On the first page where you see Sex: Other, this refers to the patient. Patient demographics were not entered here, so the Sex option defaulted to Other. We always include your LMP or EDC/EDD – aka baby due date. The larger blue space would be filled with fetal measurements, estimates of gestational age, and fetal weight as they are obtained.

OB ultrasound report

OB ultrasound report
In the pages above, you’ll note the list of fetal organs and structures we attempt to document on a mid-pregnancy anatomy screen. We only fill out the section called BPP in the third trimester when your doc orders this particular examination. And the CVP is usually only filled out when performing a Fetal Echo or detailed heart examination.

Exception to the Gender Determination Rule

There always seems to be at least one exception to every rule. Because the responsibility of a sonographer is to search out structural malformations, we also have to report suspicions of abnormal external genitalia. In other circumstances, we may see particular abnormalities that we might group together, as in the case of certain syndromes. Sometimes, knowing fetal sex helps physicians either support or rule out a particular chromosomal or structural problem. Some of these are gender specific. In the pic below, we have a designated space on a Comments page to expound on our findings. We can add fetal sex here if we feel it is pertinent information to the findings.
OB ultrasound report
In some countries, fetal sex is neither reported nor discussed with parents due to the cultural preference of one sex over another. And some facilities are beginning to incorporate policies against providing parents with this news due to litigious reasons. Unfortunately, such is life in the good ol’ US. Facilities want to limit their liability for guessing incorrectly by simply not allowing their sonographers to guess at all.
So, if you don’t want to know your baby’s sex (or even if you do!), don’t expect your ultrasound report to disclose that information. Your sonographer creates the images and report. We only include what we need and leave out anything we don’t!
Best wishes for happy and healthy!

As always, you can email me with your comments and questions
at wombviewerblog@gmail.com.

 

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Posted on July 5th, 2017 by wombwithaviewblog.com

Baby Gender ~
How Do We Know?

 

Determining baby gender by ultrasound is not as easy a task as most think. Actually, gender misconceptions pertaining to ultrasound are so common that I thought it worthy of yet another post.

Making a male vs female determination requires far more expertise than just sticking probe to belly. And babies do not just automatically cooperate! Baby’s legs need to be wide open and other parts cannot be covering over external genitalia. If so, the chances of holding that “reveal” party are slim to none.

Another common misconception is that we can force Baby to move. I promise you that every sonographer on earth would use a magical “make Baby flip” button. A girl can a dream, but I think this technology lies in our distant future. Unfortunately, babies get comfy and only move into another position if they get the urge. And not a moment sooner!

Determining sex accurately is all about angles. Being far enough along with Baby in the right position is only part of the task…when I’m the one scanning, that is! Most of my emails come from people who want a second opinion. However, most of the time, it’s one I cannot give! Either Baby is too early or the image it’s just plain, well…terrible. In these scenarios, the truth is I just can’t comment on what I can’t see.

Most sonographers don’t mind telling you your baby’s sex, by the way! The problem for us comes when we can’t see what our patients want to know. Even if we explain all the reasons, patients sometimes become upset or angry. I have scanned tens of thousands of babies. Anyone who has scanned as much can recognize when gender is obtainable and when it isn’t.

Tips For Your Baby Gender Ultrasound

So, here are a few recommendations for you to follow before your next ultrasound. No guarantees! But if you are busting at the seams to find out what you’re having, these tips just might work!

  • Try eating or drinking something about 30 minutes prior to the exam. Baby typically becomes more active after eating. Now, I’m not condoning a double espresso and Snickers combo (yummy, yes; smart, no). We don’t want your fetus launching into orbit. Instead, try enjoying a hearty and healthy lunch or breakfast prior to your scan.
  • Keep an open mind! Understand that not seeing the sex is definitely a real possibility. Whatever you do, not planning a gender reveal party for the same day is a smart idea.
  • Don’t shoot the messenger! In other words, your sonographer can only tell you what she sees. If that is an uncooperative fetus or if visualization is poor, she may not want to risk a guess. Remember, that you want an accurate guess, not just any guess. Most importantly, an experienced sonographer knows when not to guess. I so hate it for parents when they get excited about one sex, only to discover differently on a future scan!

Believe me! We would love to do our part to help you plan your party, shop for baby clothes, or decorate a nursery. It’s the most fun when we can! And when we cannot, it’s a real bummer – for you, because you leave disappointed and for us, because we’re (sometimes) blamed as the party poopers.

Textbook Baby Gender Images

I’ve posted these before, but below are a couple of really great images of external genitalia, first boy then girl.

male baby gender determination ultrasound

male fetal sex, around 28 Weeks

female baby gender determination ultrasound

female fetal sex, mid-second trimester

Also, if you send an email asking for a second opinion earlier than 18 Weeks, you may receive the links below to other posts containing very easy, no-mistake pics of boys and girls!

Female Gender Scan

16 Week Ultrasound

Boy vs Girl Ultrasound

Twin Gender Ultrasound

3rd Trimester Ultrasound – Male

Thanks for reading!

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Posted on July 1st, 2017 by wombwithaviewblog.com

Pregnancy Wives’ Tales – Are They True?

We’ve all heard them – pregnancy wives’ tales. As a result, maybe you’ve Googled your fingers to the bone researching them. What wives’ tales do you have to share? I’ve heard them all and can say that NO one tale is consistently true! However, you can’t make your grandmother believe it.

So, let’s address a few of the old wives’ tales patients asked me about the most!

The Chinese Birth Chart

Nope, not even this. The Chinese are responsible for some really delicious egg rolls, but I’m afraid their birth chart is not 100% accurate. What I do believe, however, is that I could probably eat fried rice every day of my life. 🙂

The ring or needle test can determine gender and number of kids you will have…

FALSE, but it is still fun to play. If you’re not familiar, you string a piece of thread through the eye of a needle or your wedding ring. Hang it over your belly, holding it by the string end. If the ring or needle moves back and forth in a line, you are carrying a boy. A circular motion means your baby is a girl. The number of different patterns of movement is supposed to define the number of kids you’ll have. Mine was wrong and right. It determined I would have two kids, the first a boy and second a girl. I had two girls.

So, I wonder. How is a destiny of seven daughters determined? Does the needle just make an infinite circle pattern for seven minutes? Hmm…

The Drano test can determine sex…

FALSE! I have no idea where this originated, and I can’t even recall what means boy or girl. It just seems the Drano was supposed to change color for one sex and stay the same for the other. What I do know is this. Don’t do it! This drain unclogger should not come in contact with your skin and can also cause some caustic fumes which could be harmful to you and your baby.

Experiencing heartburn determines whether your baby will have hair…

FALSE! Lots of patients with heartburn have bald babies and vice versa. Women often begin to feel the effects of some serious heartburn later in the 3rd Trimester. This is typically because your uterus is growing up as well as out! This puts pressure on your poor stomach, so it has much less space than normal. You feel full sooner when eating, and that pressure causes our much-dreaded indigestion. I remember all too well that Tums turned into a staple of my daily diet with both my girls. Unfortunately, the egg rolls didn’t work.

With ultrasound, hair can be easily seen at the nape of your baby’s neck as long as there is a good pocket of fluid there. If so, it’s pretty funny to watch it float when pushing on Mom’s belly, especially if it is long and thick! Ask your sonographer if your baby’s head is in a good position to see if your baby will have a wig full of hair at birth!

How you “carry” signifies whether you will have a boy or girl…

TRIPLE FALSE! Most noteworthy, I’ve encountered this one most often. I don’t know whoever decided to link these two things together, but they could not be more unrelated. How you carry has more to do with your stature, torso length, belly size, and whether you’ve done this before. The more pregnancies you carry, the weaker the muscle tone becomes. Of course, everyone is different, but Baby may feel a little lower with each pregnancy. And last time I checked, the lucky little swimmer who made it to your egg first still has final say!

You can determine Baby’s sex by which side your placenta is implanted, left vs right…

Hmm, this is something I started being asked about within the past couple of years ~ the Ramzi Theory, named after the guy behind. However, it’s been disproven. Furthermore, the placenta can implant anywhere in the uterus. The most common position is posterior, or along the back side of the uterus.

But what about the placenta on the front side of the uterus (anterior)? Or along the top (fundal)? What about the complete previa (covering the cervix and bottom of the uterus)? And there are all sorts of variations of placental location in between — meaning they can be a combo of two or more locations. My advice is not to rely on this one!

The Nub Theory

pregnancy

12 Week Female Fetus

While this one is not so much a wives’ tale, it has been getting lots of hype lately, so I’ll address it. Basically, at about 12 Weeks, external genitalia either sticks up, if a boy, or out, if a girl. The angles and skill of the sonographer as well as Baby’s position all factor into this appearance and guess. You can read more about the Nub Theory here.

At the end of the day, this theory is only about 73% accurate. Personally, I wouldn’t paint a nursery based on 70ish percent…but that’s just me.

A Local Favorite Pregnancy Myth

My mother always swore by this one, and her deep Sicilian roots tell her it’s true. Her little old Sicilian friend down the street, Mrs. Camilla, predicted every one of her children’s and grandchildren’s sexes…by the moon. Mom doesn’t know a thing about her methods, just that she got it right every time. There’s simply no arguing with a sixth sense, right? Or a Sicilian mother. Take my word for it. Don’t waste your breath. Don’t even try. 😉

***

Right, wrong, or indifferent…share your own experiences with pregnancy wives’ tales and funny stories here! I’d love to read about them and, so would other moms. Just email me at wombviewerblog@gmail.com!

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Posted on June 28th, 2017 by wombwithaviewblog.com

Email Your Ultrasound Images!

ultrasound images

3rd Trimester Feet!

Got Some Precious Ultrasound Images?

Okay, so what do all you moms-to-be out there do before Baby gets here? Show off your great ultrasound images, right?!

Well, I’d love to see them, too. Email me those shots near and dear to your heart to wombviewerblog@gmail.com, and show off your little punkin’ to the world at the same time. Baby’s face, profile, 2D, 3D, hands, feet, or even your 4D video clips would all be perfect to post. And if you also have great shots of male or female fetal sex, send those, too!

I’ve personally taken some really great pics over the years. Baby yawning, sticking out the tongue, puckering those lips, and even flipping the bird! Who doesn’t love a cute set of baby toes? How about a ton of hair? If you got it, flaunt it! We moms like to brag on our cute kids, so it may as well start before they even get here.

(Full disclosure! Uploading your images means you consent to my using them for promotion of my blog or future books. As always, I keep your privacy private omitting all identifying info. Can’t wait to see them!)

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Posted on June 23rd, 2017 by wombwithaviewblog.com

Ultrasound Gender Determination ~
Pink or Blue?

 

Ultrasound gender determination can be tricky! Especially too early in pregnancy. Or any time they just won’t cooperate!

gender determination

Female Gender 16 Weeks

male gender, 16 Weeks pregnant

Male Gender 16 Weeks

 

How many times have all you moms out there, young and old, heard the story that goes, “They told her it was a ‘this,’ and they decorated an entire nursery, and it came out a ‘that’! Those ultrasounds are wrong sometimes, ya know!”

A dollar for every one of those comments would buy me my dream cottage on the Amalfi coast! However, I understand why this happens, and sonographers everywhere need to apply more discretion. First of all, you may already know that it’s not the machine that’s wrong. The sonographer or observer scanning you evaluates what she (or he) sees and determines Baby’s sex. The whole process is entirely subjective! And inexperience sometimes causes sonographers to excitedly guess or, otherwise, cave to the pressure from anxious parents. Unfortunately, sometimes guess incorrectly.

Advice Regarding Gender Determination for the New Sonographer

First rule of thumb for any newbie sonographer out there…don’t guess! Don’t put a percentage on your guess, and don’t say “I think.” Also, don’t say “It kinda looks like ‘this,’ but let’s wait until next time.” Parents may want you to guess, but they also want you to be right! Just a word of caution here – some patients may become upset with you if you don’t guess. But if you’ve exhausted your bag of tricks and you still are not sure of what you are seeing, you owe it to the patient to explain this. It’s something you have no control to change, and you would rather they not become attached to the wrong sex. Hopefully, they will understand!

Psychologically and emotionally speaking, most parents start to really become attached to one sex or the other. They begin to envision the first dance recital or baseball game by the time the next ultrasound exam rolls around. On more than a few occasions in my career, someone else guessed incorrectly (usually, too early!), and I had to be the bearer of bad news. After witnessing the affects of “mistaken identity” (shock, anger, tears, sadness, guilt), I adopted a personal policy long ago to only offer a guess when parts were obvious. In other words, Baby had to be in a great position to easily see a penis and scrotum or labia/clitoris. Even though my policy upset a number of my patients in the past, I truly believe refraining from tossing out any old guess is in their best interest and can save them some heartache later.

True Story!

One grandmother, so excited by the doctor’s early guess, flew right out and bought thirty-two dresses! Yep, 32. She did so despite the doc’s warning about his level of confidence and told her to wait for the sonogram with me. Fortunately, he got lucky with his baby girl guess, and grandma was a very happy woman (and a little less rich)! However, you can imagine the disappointment in returning all those frilly frocks if doc was wrong. I always hated giving such news!

Please, all you excited moms-to-be, remember your sonographer doesn’t withhold information about fetal sex just because! We’d actually really rather all our babies cooperate quickly and easily! It’s such a bummer for us both when they won’t. You can’t plan all the fun things you imagined you could. Shopping, party planning… And believe me, I always preferred when my patients left my room hugging me instead of cursing my existence. A magic trick to make Baby flip on command? It’s too bad we aren’t bestowed with super powers upon certification!

 

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Posted on June 15th, 2017 by wombwithaviewblog.com

To Video or Not to Video of Diagnostic Ultrasound?

That is the question. Depending, the decision to take a video of diagnostic ultrasound may not be left up to you. If your fetus doesn’t have one of these in there…

video of diagnostic ultrasound

…you may not be able to, either.

You might not like it very much, but your doctor’s office or other medical facility performing your diagnostic scan may have policies against it. And, boy, have I had my share of disgruntled patients because of it.

Why Can’t I Video My Diagnostic Ultrasound?

The answer is plain and simple.

In the modern-day world of social media, doctors and administration alike don’t want any part of an unread examination floating about the web. Exams aren’t read by a physician until the scanning portion is complete. Unfortunately, in the litigious U.S., they must take certain precautions to protect their examinations. And, yes. It is your baby, but the exam itself legally belongs to them.

Regardless of the medical implications, these policies just drive the pregnant population to private scans. If you’re an avid reader of mine, you know I’m not a fan. I think it’s always better to have any ultrasounds with your doc’s office (or other facility recommended by her/him).

Another option to consider is to simply ask your physician if he/she will allow you to record the heartbeat while listening with the doppler. Maybe your doc will be the one performing a scan; it doesn’t hurt to just ask. Usually, they don’t mind, and they make the rules for their practice. We sonographers just have to enforce them!

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Posted on June 7th, 2017 by wombwithaviewblog.com

The Myth of Early Fetal Sex Determination

As a sonographer of many years, I know that ultrasound is subjective, but expectant moms seem to continue to be surprised by incorrect early fetal sex determination. And I seem to be receiving more and more emails about this ever-growing problem. Nothing makes me angrier than when another sonographer tries too early to hand out a sex guess! I get angrier still when some businesses make this promise as a marketing ploy.

It just isn’t fair to the patient or customer. I feel these facilities take advantage of pregnant anxious moms who have a desire to know the sex of their baby as soon as possible. After all, it is one of the most anticipated events in pregnancy! However, these mothers-to-be wouldn’t spend their money on an ultrasound if 3D non-medical businesses didn’t exploit that desire. They advertise a promise or guarantee for early fetal sex determination at 12+ Weeks! So, what is the public to believe except that they can deliver on that promise? The truth is they know it’s only a guess. If they guess right, they got lucky. If they guess wrong…oh, well. Here’s some of your money back.

I think developments in the technology have yielded a little too much ambitious guessing in the fetal sex department. Resolution has improved so greatly over the years that we see better than ever with the most modern equipment. But just because we can see “a little something” sticking out, in no way or shape or form, means you’ll be investing in blue paint.

I want to educate every fertile, human-growing woman or parent-to-be out there that even the best ultrasound equipment on the planet cannot differentiate a boy from a girl. To this day, determination of sex is still dependent on the experience and skill of the person holding that probe to your belly. But also know that a sonographer’s skill doesn’t mean squat when external genitalia has just begun to grow. It’s anyone’s guess!

We have all heard a similar story. A customer pays for an early scan and is told one sex. “Congratulations! I’m 100% sure!” Lo and behold! At the mid-pregnancy anatomy screen (or later), the penis has magically fallen off and now all the sailboat motif and cute suspenders have to go back. Or vice versa. The question I always get is, “How did this happen???”

 

Loads of Room for Error

So, just how DID this happen?

Easy. It’s the scanning observer’s opinion, but it’s still just a guess. You assume he or she is experienced in making this determination…maybe, maybe not. Especially when this person displays such confidence in his/her guess, you feel sure that they must be correct in their guess. But it doesn’t mean they are; they can still be very confidently and entirely…wrong.

This is why!

External genitalia is just starting to develop later in the first trimester, and it will continue to morph and change in appearance over the next several weeks. All babies have a little something sticking out at 12 Weeks. But if Baby is a girl, that tissue will shrink and become recognized as a clitoris later on, with labia seen on each side. If a boy, this part grows a little larger and becomes a penis. The scrotal sac develops over the next few weeks but is still quite small. And we cannot see testicles until somewhere around 28 Weeks (or maybe slightly earlier).

 

The Nub Theory?

early fetal sex determination

12 Week Fetus

Most readers ask if this test has any validity. The answer is “some.” If (and, again, subjectivity comes into play here), if an observer knows what fetal angle to obtain and how to read the angle of the nub, you might have a 70% accurate guess. But that’s a few IFs. The observer also has to know when the angle is equivocal, meaning the protruding part is not one way or the other but somewhere in-between. In these cases, a guess cannot be made. Keep in mind here that even if the angle is perfect, there is still a ~30% chance of an incorrect guess! In other words, it’s not a hugely reliable predictor.

 

So, What’s the Best Advice?

Later is better! Wait for your mid-pregnancy anatomy screen at 18 – 20 Weeks. Below are great images of typical and normal-appearing external genitalia of each sex at this age:

male gender, 2nd Trimester

Male Fetus

female gender, 2nd Trimester

Female Fetus

If Baby isn’t cooperating, don’t put the heat on your sonographer to guess anyway. Part of a good sonographer’s job is also to know when NOT to guess.

The truth is that no one should be providing a guess for sex determination much earlier than this in pregnancy, especially for a fee. And certainly not with a 100% positivity attached.

Just because someone says she is 100% sure, doesn’t mean she is right.

Business is business. As long as parents will pay for it, someone will take your money and offer a guess. This is the unfortunate bottom line in the non-medical ultrasound business. I’m not saying you shouldn’t go to one of these places. Maybe you just want to see a heartbeat and bond. This is understandable. But I caution you to pay for fetal sex determination earlier than 18 Weeks.

Advice Regarding Early Fetal Sex Determination

All you moms who are thinking about paying for an early scan at a strip mall near you (or anywhere!), please first consider the above info. It might just save you a few bucks and some disappointment later. Alternatively, if you are the kind of person who can remain entirely neutral about any sex guess and just want to have some fun watching Baby move, go for it. Have a blast.

The biggest issue here is our own nagging, relentless, compelling need to know as soon as possible. But more of the same will keep happening. Businesses won’t quit selling early fetal sex determination as long as pregnant moms are buying. Let’s pass the word around, ladies. Just don’t buy what they’re selling!

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Posted on June 3rd, 2017 by wombwithaviewblog.com

Funny Ultrasound Stories and the Kids they Belong To

 

Frequently, parents do bring their other kids in for the ultrasound experience. And, sometimes, this is a good decision. As a general rule, kids about four and over find it pretty interesting and ask a lot of questions. They seem to understand that it’s their soon-to-be new baby brother or sister in there…even if they don’t quite understand how he or she got there in the first place. Out of the mouths of these babes is where some truly funny ultrasound stories and comments come from. It’s a cool experience and a neat bonding moment all rolled up into one little prenatal package.

But First…What Makes for Not-So-Funny Ultrasound Stories?

A toddler can be a total nightmare for your ultrasound experience! If you are considering taking your two-year-old (or less) as a spectator for your diagnostic anatomy screen, please reconsider! I promise. Your small child has no clue what’s on the “TV” and is truly not interested. No matter how much you point to the monitor in an effort to catch his attention… He just wants his toys or nap or snacks. Otherwise, he may just want to run around the exam room (which we can’t allow because he may get hurt!). It’s completely understandable! He’s two, and running around is his world. Anyone with a toddler knows how upset they get when they are held against their will.

Often times, he cannot understand why this strange lady is touching his mom…and he is not okay with that. He’s protective and doesn’t understand that what’s taking place is not hurting Mom. This usually results in crying, not an amusing ultrasound story. Poor things, they get really distressed! At this point, your sonographer isn’t able to concentrate on your examination and you aren’t able to fully enjoy the baby that should be the center of attention. This is what you came for…a bonding experience with your new baby. Your spouse wants to relish the moment, too! The last thing your partner wants to do is to leave the room with your toddler.

*Advice! Bring a third party (friend, grandma, etc.) who can take
the child back to the waiting room if your child is loud or upset.

You’ll be happy you did!

Don’t Forget the Floaties

However, what is so entirely cute is when kids do become engaged in what is taking place. The questions and statements that follow make for some of the funniest and cutest ultrasound stories! I’ll share some with you.

My all-time favorite is this. Mom comes in with her five-year-old son. He’s kneeling next to her on a chair, his hand on her shoulder watching intently. He’s quietly supporting her…so sweet. I’m pointing out baby parts as the fetus lies very still, napping. Mom is explaining all the body parts and organs as we go along. Suddenly, Baby starts to wiggle around like a little jumping bean, and Big Brother’s eyes fly open. He asks, “What’s he doing in there?!” I replied, “He’s swimming!” He stares hard at the monitor. All is quiet. One second, two seconds go by and mom and I are eyeing his expression. He’s searching and searching. A look of confusion comes over his face, and his eyebrows knit together. Then he asks a very concerning and valid question. “But where are his floaties???”

More Funny Kid Comments

From the youngster who wasn’t so happy about the strange little human in his house… When someone asked, “What’s your new baby brother’s name?” His reply? “Stupidhead.”

A seven-year-old big brother was very excited about his little sister and the state of her health. As I pointed out her spine on the moniter, he exclaimed “It’s a good thing she has one!”

Kids were always fascinated with the appearance of the fetal spine. Frequent comments were that it looked like alligator or dinosaur teeth.

A comment from a big sister: “Does he have clothes on in there?”

Two adolescent boys, about 12 and 10 years old, crossed fingers and squeezed their eyes closed in anticipation of sex determination of their new baby on the way. I froze the iconic image of little brother parts and broke the news. They squealed and cried, “NO! NO! NO! It can’t be! IT HAS TO BE A SISTER!” Poor little guys. They cried inconsolably for the entire remainder of the exam.

When a mom explained to her young son that he was going to have a little sister, he examined the ultrasound image with a very perplexed look and asked, “So, where is her pee pee?”

And last, but not least… Mom planted her feet in stirrups. As I began to insert the vaginal probe for her first-trimester scan, her very inquisitive four-year-old refused to sit in the chair next to her mother as commanded. Curiosity forced her to continually peek under the drape with confusion, and we couldn’t help but giggle with all her questions. “What’s she putting in your tootie, Mommy?” “Mommy, what’s she doing?” “What’s that thing in your tootie, Mommy?” …You get the picture. Now, that is funny.

Share Your Funny Stories!

We all could use a good laugh, couldn’t we? I know you moms have some hilarious moments to share, so please email them to wombviewerblog@gmail.com. I’d love to share them with other moms around the world, too!

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Posted on May 30th, 2017 by wombwithaviewblog.com
transvaginal ultrasound, endovaginal, TV probe

TV Probe

Transvaginal Ultrasound ~
You’re Gonna Put What WHERE?!


I always know that face…the one with the saucer-like eyes and mouth gaping open in utter shock as soon as I speak the words “transvaginal ultrasound.” I point to the probe sitting so innocently on my machine. Poor thing…it gets such scathing rejection and so little credit!

I can’t really blame the patient. After all, a gynecological scan isn’t exactly something people volunteer for (unlike the OB ones – at least they have something cute to ogle!). I can’t tell you HOW MANY times patients have said, “Boy, these are more fun when there’s a baby in there.” A dollar for every one of those comments and I’d have a penthouse in Manhattan by now.

Most patients still in the baby-making stages of life are typically pretty familiar with a transvaginal ultrasound. It’s how we see Baby early in the first trimester or monitor the cervix. But many young or older women are not familiar with my long skinny friend. Some are mortified at the thought of this exam. To note, these patients are always there because of a problem which could be a whole myriad of issues from crazy periods to ovarian cysts.

The Transvaginal Ultrasound Protocol

One thing is for sure. Give me a woman with pelvic pain and, I can promise you, the last thing she wants to see is any ferociously-long object headed down south. I first apologize then promise that it’s quick and painless. I also add that at least they didn’t have to drink a gallon of water and hold it. Okay, I’m over-exaggerating. Some facilities still require patients to drink approximately 32 ozs of fluid for a transabdominal pelvic ultrasound (a scan on top the belly). You can read more about bladder preps here: How Much Water to Drink for Your Ultrasound

This little fact is usually enough to get a deliberately labored, “Okaaaaaay, what do I have to do now?” But it’s still a consent! Goal.

Transvaginal Ultrasound Provides You a Better Exam!

Vaginal ultrasound is probably, to me anyway, THE best ultrasound invention since ultrasound’s inception. I tell patients it really is the difference between night and day. It’s much like looking out of a clear glass window versus one with a sheer curtain drawn. I would say that about 95% of the time, I can see better when using the vaginal approach. A very large uterus or pelvic mass, however, would require an abdominal approach.

Did you just say you want a little Ultrasound Physics 101?? Well, I thought so! I’ll make it short. The transvaginal probe is built to deliver a higher-frequency sound wave which doesn’t penetrate very deep into the body. It offers by far the BEST resolution because the uterus and ovaries lie close to the probe. When we scan over the pelvis with a full bladder, the fluid provides a window for the uterus and ovaries behind it. However, by the time the sound waves get all the way down to those organs and back, we have a somewhat compromised image. The vaginal probe requires an empty bladder which allows us to see the uterus better.

We cover the probe with a condom or glove and insert it into the vaginal canal like a tampon. Be sure to let your sonographer know if you have a latex allergy! We place the probe against the cervix only; it does NOT enter into the uterus. The cervix remains closed (unless you’re in labor), so it cannot be inserted past this point. The sonographer obtains a magnified image of the uterus and ovaries and the areas immediately around them. We measure the uterus, endometrium (lining of the uterus), ovaries, and any pathology that we see related to those organs. Air and gas are not our friends, so sometimes those factors interfere with a good image.

How Long Does a Transvaginal Ultrasound Take?

About fifteen minutes, longer if the exam is complicated by pathology or if views we need are difficult to obtain. (By the way, “pathology” doesn’t always mean a worrisome or dangerous process!) When it’s over, the patient usually says the exam wasn’t that bad at all! Frequently, they will share the reason for their trepidation. It’s mostly because a friend had one done by a technologist with a heavy hand, making it quite a painful experience. I’ll usually respond by saying, “Firstly, you should ALWAYS tell someone when your exam is that painful. And, secondly, we don’t need to see your tonsils!” I’m not a comedienne, but that comment usually gets a much-needed laugh, and the end of the scan is very much appreciated:)

***

More coming about transvaginal ultrasound and your early OB scans with the release of my new book about first-trimester ultrasound. Hopefully, very soon! You can receive automatic updates on the book (along with a little something special when it publishes!) and the most current posts by subscribing to my blog. You’ll see where in the right margin! >>

Once again, THANKS FOR READING!

And please feel free to email me any questions you have at wombviewerblog@gmail.com.

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Posted on April 29th, 2017 by wombwithaviewblog.com

Diagnostic Ultrasound In a Nutshell

Ever wonder about what us sonographers really do when we perform your sonogram? Or why your paperwork called your exam a “diagnostic ultrasound?”

What Does Diagnostic Mean?

Anything “diagnostic” describes a test performed to try to find a problem. So, diagnostic ultrasound is ordered to rule out problems in pregnancy for Mom and Baby. Most people are very familiar with ultrasound but most consider it a fun and exciting event allowing you to see your baby and determine gender. And, yep, it can be all those things. However, first and foremost, ultrasound is a very important diagnostic tool used by your doctor to find structural abnormalities, follow fetal growth, and determine multiples. And this only scratches the surface!

What Do We Look For?

In a nutshell, my job requires me to document what I see and to make a report about it. More intricately speaking, I have to document with images and measurements everything I can see relative to fetal and maternal anatomy. Of course, what I can see and need to document all depends on how far along you are–your gestational age. Once I write a detailed report, I can present a complete ultrasound picture of your case to your physician.

What Things Can I See on Mom?

A few organs and measurements we try to see on mom are as follows:

  • The uterus and some types of pathology (like fibroids which are muscular tumors and very common)
  • The ovaries (those become obscured later as the uterus gets larger)
  • The cervix, which holds in the pregnancy and is sometimes observed for length in the 2nd trimester

What Things Can I See on Baby?

What parts we can see on Baby varies greatly depending on your gestational age. But a few things we look for are:

  • Baby’s size, to determine age or follow growth
  • Internal organs, depending on age, include the brain, heart, stomach, bladder and kidneys
  • Upper and lower extremities (arms and legs), again, depending on age. We try to see fingers and toes on your anatomy screen, but they can be a challenge–especially if the fists are closed in a ball.
  • Baby’s spine
  • Baby’s umbilical cord
  • The placenta and where it’s located
  • And last but not least! Maybe, possibly, if all the stars align and Baby cooperates, you just might be able to find out fetal sex.

How Does It Work?

Ultrasound is just that…sound waves which operate at a frequency far beyond human hearing. Ultrasound is not radiation. Sound waves, much like a fish finder, are sent from crystals in the transducer (the probe placed in the vagina or rubbed on your belly) and transmitted with the help of the ultrasound gel. The waves penetrate the tissues directly below the probe until they reach Baby. They bounce back and create the image you see on the monitor. Factors like the size of the patient and fetal position can limit what parts we see and how well we can see them on the examination.

Additionally, many other diagnostic ultrasound examinations are performed on various other parts of the body, as well. Ultrasound is THE most technologist-dependent modality there is. This means the machine does nothing without someone operating it. This precisely explains why some mamas receive a “baby girl” guess only to discover a little wee wee later on in the pregnancy. If the operator, or person holding the probe, lacks experience scanning fetal sex–oops!–wrong guess. And we’ve ALL heard those stories, haven’t we?!

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Posted on April 29th, 2017 by wombwithaviewblog.com
Ultrasound results, twins

8-Week Twins!

Ultrasound Results – What’s the Big Deal?

Your ultrasound results must always come from your physician! But why can’t your sonographer just tell you if everything looks okay? It’s so irritating when she won’t talk, right?

The most frequent question a patient asks is if everything looks okay, healthy, or normal. Usually, to the patient’s dismay, this is something we just can’t discuss with you. Read on for details about why we have to be so doggone tight-lipped!

Ultrasound Results Have to Come from the Docs

My usual response when a patient asked this question is “Your doctor has to look at all of these images and he/she will discuss your ultrasound when you see him/her next.” Only your physician has the legal right to give you this information.

Yes, it is my job to know what I am seeing and to recognize it when something does not appear normal. However, sonographers are not physicians. We are trained to perform your ultrasound examination; we don’t manage the health of you and your baby. Your doctor studied for many years learning how to do just that. And only your doc or other healthcare provider can answer the multitude of questions you will positively have in the case of a suspected problem.

Our job is to share what we see with your doctor. Your doctor examines the information and concludes whether he or she agrees with our findings. The doc then shares his/her interpretation of the information with you along with what options he/she recommends next.

But, But…

Occasionally, I will have a persistent patient or spouse who will say, “Yeah, but you KNOW whether you see something wrong or not.” I’ll admit that I do, but I always defer to the physician’s interpretation. We just have to stick to our guns! I know it simply comes from a place of parental anxiety. We do understand.

For the nervous patient, waiting for ultrasound results can feel like a lifetime. I do empathize. A previous pregnancy loss or abnormal ultrasound is enough to scare serious fear into the hearts of anyone. I want expectant moms to understand that if your sonographer says something inappropriate, she could lose her job. Only your doctor can calm your fears and reassure you about your pregnancy issues in a way that no one else can. Your results are part of the sacred and private relationship between you and your doctor!

Finally, on to end on a positive note, most of us are more than happy to educate you about what you see on the monitor (minus a diagnosis!). I loved sharing how we measure and pointing out all your Baby’s parts for any inquisitive parents or family.

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Posted on April 28th, 2017 by wombwithaviewblog.com

Reliable Ultrasound Information
for Expectant Moms

Factual ultrasound information can be hard to find. No one knows that better than a newly-expectant mom with loads of questions! How do you know what’s accurate and what’s not? With so much info at our fingertips, too much Googling just seems to lead to more unanswered questions, doesn’t it?

As a sonographer (ultrasound technologist) with formal training and twenty-five years experience in OB/GYN, I am amazed by what I read on other sites about ultrasound. And it’s not just from blogs and forums filled with personal opinion. Misinformation also comes from parent/child sites and even some of the most popular pregnancy books that the general public would expect to be reliable. These articles or posts or books, I realize, are written by authors with no obvious medical training or experience. But their information should be coming from reliable sources. If they interviewed someone in the medical field, facts can become a little lost in translation from interviewee to print.

Five years ago, I ran across a blog about ultrasound…the uses, technical details, what we can see, and how we can see it. The level of wrong in this post left me dumbfounded! It was clear to me that this person had absolutely no medical knowledge whatsoever. It’s not too hard to spot when they use the terminology incorrectly in nearly every sentence. What bothered me the most was that someone left a comment thanking this so-called author for the “valuable” information. It struck me then that many people actually do believe anything they read on this crazy web thing.

So, Where Can You Find Accurate Ultrasound Information?

If you have a curious knack for researching ultrasound on the internet, just be sure to check out someone’s bio. Look at the author’s credentials. Do they reference their experience and knowledge in the field? You can determine whether that individual’s level of experience with a particular subject before taking the information at face value. If an author is not a sonographer, physician, or medical professional with ultrasound knowledge, just know that what you are reading may not be entirely accurate. And if you have questions about what you read relative to your pregnancy, ask your doctor! She or he is always going to be your most reliable source for credible advice on your health and that of your baby.

ultrasound information

9 Week Embryo

My Pledge to My Readers

My desire to create a platform where an excited new mom can find accurate info about ultrasound drove me to create this blog. Hopefully, expectant couples with curiosity about their scans can find a little general info here.

Please feel free to email me at wombviewerblog@gmail.com. Ask me your questions; tell me your ultrasound stories. Remember, no blog, no site, no forum can replace the healthcare professional! We are not your doctor, we do not manage your pregnancy, nor do we have any knowledge of the health of you and your baby. Carefully consider what you read, and direct any concerns to your doctor for the best advice you can follow. 🙂

Stay tuned for the release of my first book
about first-trimester ultrasound! 

 

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Posted on April 27th, 2017 by wombwithaviewblog.com

General Ultrasound Facts

 

Patients have asked me these questions on a regular basis for years. Let’s get some ultrasound facts straight, shall we? I hope it’s helpful!

What’s the difference between ultrasound and sonogram?

Technically speaking, ultrasound is the study of the subject (the field of ultrasound) and a sonogram refers to the examination itself. Although we’re really not picky about what you call it.

 

Is ultrasound safe?

Biohazard testing over the past forty years reveals no ill effects of ultrasound on the fetus, mother, or sonographer. However, increasing levels of heat after scanning for several hours in one area can cause cavitation or the creation of bubbles. This is much longer than the time required for performing a diagnostic test. Since no one can predict the long-term effects, only the prudent and diagnostic use of the technology is recommended by ACOG, AIUM, and ACR. The benefits of the information from diagnostic exams for patient and physician currently outweigh any known risk.

 

Is Ultrasound radiation?

Ultrasound technology uses sound waves, NOT radio waves. I dedicate an entire post to just that subject in the link above. No radiation is emitted by ultrasound equipment or Dopplers utilized by your physician to detect Baby’s heartbeat. X-Ray emits radiation which is why, for example, your pregnant belly would be covered with a protective shield at your dentist’s office for X-Rays on your teeth.

 

Can my baby hear ultrasound? 

Nope, Baby cannot hear the sound waves:) Ultrasound is just that…sound waves that operate at a frequency far beyond human hearing. Human hearing ranges from 20Hz to 20,000Hz. Diagnostic ultrasound operates in the millions of Hertz. Ultrasound probes range from about 2 – 13MHz.

True story ~ I became a little distressed once when a patient asked me if ultrasound sounded like a jet to a fetus. She had just read this in a pregnancy magazine in our waiting room! I reassured her this was inaccurate. This experience marked one of the many reasons I wanted to start my blog–to get reliable info to new moms like you!

 

What’s the difference between 2D, 3D, and 4D?

Almost everyone has seen the gray clouds of 2D ultrasound at one time or another. 2D allows us to see through organs and inside your baby.

Most people are familiar with 3D imaging as a fun way to see the outside of their baby. Additionally, the best and cutest 3D images are obtained later in the 2nd Trimester or early in the 3rd. Baby’s skin has developed more fat at this point which makes for chubbier cheeks! Occasionally, a high-risk practice (MFM or Maternal Fetal Medicine) will usually also use 3D to assist in visualizing a fetal abnormality. We also frequently use the technology for GYN scans to attempt a better look at uterine shape and/or IUD placement.

4D can be described as 3D in motion or a live 3D image. So, where 3D is a still image, a 3D video of Baby moving is actually 4D.

 

ultrasound facts, 3D, 9 Weeks pregnant

3D 9-Week Embryo

Ultrasound Credentials for Sonographers

 

What’s your title? Are you a nurse or in X-Ray?

We’re not nurses, though some of us do cross over from RT (X-Ray) or other areas of Radiology. Sonographer, Ultrasonographer, or Ultrasound Technologist are a few of our titles. We are specifically and formally educated in the field of Ultrasound.

RDMS stands for Registered Diagnostic Medical Sonographer. A sonographer earns these credentials through ARDMS when he or she has passed a registry examination in Ultrasound Physics as well as his/her ultrasound specialty. A certified sonographer typically has at least two years of experience under his/her belt.

DMS refers to someone who has completed some sort of formal or on-the-job ultrasound training but has not yet taken/passed the registry examination.

 

What do you think of those 3D places?

Having posted on this often, I understand a patient’s desire to go, but I’m not a fan. Not everyone who scans an expectant mom in a 3D non-medical business is a certified OB sonographer. Some have no formal ultrasound training whatsoever! I know you may be surprised by this little-known fact, and so was I.

These businesses are not regulated like medical practices. They may not be knowledgeable of or follow guidelines for equipment maintenance. Ultrasound equipment that is not properly maintained can be an electrical hazard for mother and/or fetus! Do your research and at least ensure your sonographer possesses RDMS or, at least, DMS credentials. Please read the post in the link above!

 

Performing Your Exam

 

When can I expect to have sonograms in my pregnancy?

Every practice is different. Most physician’s order a first-trimester ultrasound examination to date the pregnancy. This is usually performed with a transvaginal probe. If no other problems necessitate another scan, you’ll receive your next exam around 18-20 Weeks. Most women know this scan as the anatomy screen where we evaluate fetal and maternal parts for abnormalities.

*Your doc does not order this exam to determine fetal sex!* However, most sonographers will happily provide the info if at all possible (as long as policy allows)! Also, important to note here is that determining sex is never a guarantee nor should it be an expectation. Sometimes, those Little Sweet Peas just won’t cooperate! You can read more here about those limitations. Note of advice for moms: Don’t pre-plan your Gender Reveal party for the same day as your ultrasound! The health of your pregnancy determines whether you will receive more ultrasound scans later in your pregnancy.

 

Can you predict how much my baby will weigh at birth?

While we can measure your baby’s head, belly, and femur for an educated (called EFW or Estimated Fetal Weight) guess for weight at the time of your scan, a large discrepancy for weight determination exists due to fetal position and sonographer skill. We can typically track a trend for large or small babies. We know the average gained weight in the last few weeks is about 1/2 lb per week. However, every baby is different!

 

Ultrasound Facts About Fetal Sex

 

Most expectant moms today already know this little fact. The ultrasound machine is never “wrong” in determining fetal sex. Actually, it is the observer who is incorrect!

Guessing the wrong sex can be due to one or a combination of many factors. It is possible your baby was in a difficult position to see well. Maybe you were too early in your pregnancy for an accurate guess. In addition, an overall poor view can also limit fetal sex determination!

 

Facts About Your Results

 

Yes, the sonographer can read your examination. However, your OB/GYN physician or radiologist must ultimately interpret the images and report we create. Consequently, only your physician can legally give you results! Read more about why here.

However, most of us are more than happy to educate you about what you see on the monitor (minus a diagnosis!). I loved sharing how we measure and pointing out all your Baby’s parts for any inquisitive parents or family.

~*~

Feel free to email me at wombviewerblog@gmail.com with your comments or questions!

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Posted on April 25th, 2017 by wombwithaviewblog.com

Oh, the adventures of becoming a sonographer!


sonographer, ultrasound technologist

Isn’t this facial profile precious? But it’s not just any profile; it’s a technically perfect 2D ultrasound example of a simply beautiful fetal profile. It’s what we sonographers strive to obtain on every baby we scan and reminds me of how I fell in love with the technology…with my own first baby 🙂 I was well into my college career at the time, but nothing else had quite piqued my interest like my first exposure to ultrasound. Boy, I had no idea what challenges lay ahead!

Becoming a sonographer, aka ultrasound technologist, was one of THE biggest challenges of my entire life. The training was challenging, but finding myself in a new field and technology where I was painfully ignorant and unsure? Healthcare is not a place for the timid.

A Sonographer’s Start – Whoa! (What a Challenge)

If I was going to work with physicians, I better learn what I was doing fast or go home. It took a while for the puzzle pieces to fit…a good 6 months to 1 year. Thereafter, little light bulbs of realization would flicker every time I put two and two together. It was a marriage of all things unfamiliar. I was learning to read patient charts, learning about labs and correlative examinations, interaction with the physicians and with my patients. All of these things were a recipe for growing my new career as well as learning the technology. In the beginning, it was more about “How do I not screw up?” rather than “Wow, that was a great case!”

I promise you, it’s not for the squeamish. If another person’s urine, vomit, or blood bothers you, Ultrasound may not be for you. I cannot emphasize that enough! It was a hard year, and I felt like I was walking a tightrope for the vast majority of it. Brutal.

A Sonographer’s Fear

All new sonographers will miss pathology. It’s a fact of the modality. Initially, you are too concerned with getting all the right images. You’re too inexperienced to notice minor pathology. This is why it is so imperative that a newly-trained sonographer has direct supervision from someone very experienced. With lots of experience comes confidence. After a while, a newbie will start to get a feel for his/her scanning ability and stop second-guessing herself. Was I not seeing an organ because it can’t be seen or because I just couldn’t find it? It’s an awful feeling. However, it is one that can be overcome with time and, again, experience.

The more normal examinations a technologist performs, the sooner she will know when a case is not normal. Ten to fifteen scans per day over the course of a year equals a good bit of experience. After the first few months of constant supervision (if you don’t have it, ask for it!), you will start to become a little more comfortable with the examinations. You’ll then only need a supervisor’s help when confronted with abnormal cases. You may not be able to pinpoint a diagnosis, but you know it’s not what you normally see. This is very important in your early career. Eventually, you will be able to put together differentials to possibly explain what you are imaging. It’s a good feeling when you get to this point!

A Sonographer’s Advice

It was a slow learning process, at least for me, anyway. Over the years, it became easier to work with the docs. More importantly, I learned how to better communicate with my patients, which has been the most rewarding. It feels really good to correctly diagnose a case. But it feels even better to have a patient sincerely thank you for your help…or give you a hug in appreciation. It feels good to know I’ve made a small but, hopefully, significant difference. It’s been a good career. And for those who are going into it, hang in there because it gets better. For those who have practiced a long time and feel the flames of burnout, take a vacation! We all need to step back and take a breather once in a while.

Every case is someone’s health and life at stake, and not a week goes by still without learning something new. What a sonographer sees (or misses!) will either lead that patient to other tests or lead to a missed diagnosis. It is sometimes intimidating to think that a patient is on your table and yours alone. It’s up to you to find the problem in question.

I always say I would never want to relive those earlier years, yet they have shaped who I am. They helped me become a better sonographer. So get out there! Become a sonographer, become good at it, research and read, and ask questions of co-workers and docs alike. Make a difference in someone’s life. Make a difference in your own 🙂

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Posted on April 24th, 2017 by wombwithaviewblog.com

Amniocentesis…All Women Need One??

Who needs an amniocentesis? When should an expectant mother consider an amniocentesis? What factors help a patient decide if an amniocentesis is right for her? Only your doctor can help you make this decision, but you can find out a little more about first-trimester genetic testing…some very basic information…here.

The internet is filled with all kinds of misinformation, right? I think most of us realize this and, hopefully, take forums of personal opinion with a grain of salt. However, I read an article last night in a popular parent/child site that I felt was a bit disturbing. We expect more credibility from these sites, don’t we? Shouldn’t we expect their information comes from a knowledgeable source? Maybe it did, but the author should have been more careful with her words. Maybe an author should have to meet more strict guidelines before publishing important recommendations for pregnant women.

So, the article was all about ultrasound…a subject with which I’m pretty familiar. She had a few tidbits of information incorrect. Of course, I had to respond with a comment correcting them. But one statement I vehemently disagreed with was one regarding amniocentesis. The author stated that any expectant woman over the age of 35 or with a family history of genetic abnormalities should have an amniocentesis. Should? This statement should have never been printed. Women faced with this option may search the internet for information to help them decide. I would like to think their decision would not hinge on an article found on the internet. In the same respect, I’m sure their readers consider them a reputable site filled with only accurate information.

The truth is that no woman should just hop aboard the amnio train (we use “amnio” for short in the field) without a serious discussion with her obstetrician. Granted, no obstetrician would perform an amnio without discussion and signed consent from the patient. However, I would hate for this article to automatically sway any pregnant woman to believe she needs it. The test and its results are not without repercussions. With that, I felt my next post should expound on the topic to the extent of my experience with it.

Things to Consider Prior to Amniocentesis

Genetics gets quite complicated, and some patients find it difficult to understand all they’re told. For this reason, I won’t go into too much detail about the different types of testing and what they can detect. This is mostly because I do not have this information. However, your doctor does. Most patients don’t just jump right into having an amnio. A patient is usually first asked whether she wants chromosomal testing.

Desiring this testing is typically based on a patient’s “need to know.” Why do you want the information?  If your mentality is such that you will have this baby no matter what, and you don’t need to know anything in advance, your doctor may say first-trimester testing is not for you.

However, if you are the type of patient who NEEDS to know normal vs abnormal, a host of other questions opens up for you. Will you abort this pregnancy depending on results? Or is abortion out of the question? If so, do you simply want to educate and prepare yourself and family for what is to come? If so, this testing may be for you.

What’s Included in Genetic Testing?

Some genetic testing includes bloodwork and/or ultrasound, the NT or Nuchal Translucency test which are all usually performed somewhere around 10 weeks to 12 weeks. It does not always include an ultrasound; that depends on what type of testing your doctor offers. The NT scan requires certification of the sonographer who takes special pains to measure a fold of skin behind your baby’s neck.

amniocentesis

NT test

This measurement, IF it can be obtained, then goes to a lab with your bloodwork. Sometimes the measurement cannot be obtained if Baby is not in a good position or if the image is not clear enough. Recent developments in bloodwork have become more reliable than performing an NT. Some physicians, therefore, no longer offer the NT and only offer the bloodwork. Some docs still offer both.

What Do the Results Mean?

If you elect to move forward, the next thing your doctor may explain is that this testing only determines your RISK for certain abnormalities; it does not confirm an abnormality. It is a risk assessment only. Your obstetrician’s office may perform this testing, or she/he may refer you to Maternal Fetal Medicine (a perinatologist, otherwise known as a high-risk OB doc).

If your results come back as low risk, GREAT! It means the chance that your baby actually has these abnormalities is low. Your next test would then be your anatomy screen at 18-20 Weeks to rule out structural malformations.

If your testing comes back as high risk for a particular problem, it will state which problem along with your risk level. This is where amnio comes into play. The amnio WILL confirm whether your baby really has this problem. You will have to decide whether you want to have this procedure or not. Your doctor will explain the risks and benefits of an amnio. The risks may be almost non-existent for infection and (last I knew of) around 1% or less for miscarriage. The risk may be significantly less, so be sure to discuss this with your doctor. The benefit, of course, is determining exactly what kind of abnormality you are dealing with so as to help you prepare in whatever way you feel is best for you and your family.

How Is an Amniocentesis Performed?

Basically, a sonographer will scan you to look for an adequate pocket of fluid. The doctor performing the amnio will determine what is a good pocket and what isn’t. Typically, they like to stay away from Baby’s head and your placenta, depending on where it is located. A nice pocket of fluid might look like the image below.

amniotic fluid test

Pocket of Amniotic Fluid

The sonographer will measure your baby’s heart rate and anything else the physician requires. The physician will then clean off the area of your skin with betadine just above the desired pocket of fluid (as long as you’re not allergic to it!). Sometimes she may use a numbing agent for the skin, sometimes not. If not, it’s because she can only numb the skin and not down deep. The numbing agent feels very similar to the needle used to withdraw the fluid, like a stick and a burn and a lot like a bee sting. Since this is the case, some docs would rather stick you only once and elect to not numb the skin.

If you have an aversion to needles, you may want to look away. The needle is long because it has to reach the fluid. Sometimes, your physician will use ultrasound guidance to insert the needle into the pocket of fluid. Once there, the doc will attach a syringe to withdraw the fluid. Once she has enough fluid, she’ll remove the needle and push the fluid into a vial. The vial goes off to the lab for testing. If all goes according to plan, the whole procedure of performing the amnio will take about ten minutes or so. Pretty quick!

Your sonographer or doc will clean off your skin and add a band-aid over the site. Many times you may even have a hard time seeing on your skin where the needle inserted! Your sonographer will usually measure Baby’s heart rate one more time, and your doc will give you instructions on receiving results.

What If I Really Don’t Want an Amniocentesis?

It’s important to note here that if you do not elect genetic testing and your ultrasound later reveals significant abnormalities, your doctor may strongly recommend an amnio. She/he may also do so in the case where you don’t really want an amnio, but your testing came back as high risk. Your doctor cannot force you to have an amnio. However, knowing what is at stake helps them manage your pregnancy and delivery more safely and effectively.

What to Ask Your Doctor about an Amniocentesis

It’s hard for us to ask questions about something if we don’t fully understand it. That’s understandable! Some questions you can ask your doctor are:

  1. What fetal abnormalities does the testing detect?
  2. What kind of genetic testing do you offer?
  3. Will my insurance cover this testing?
  4. Who will perform these tests?
  5. Where is testing performed?
  6. When will I get results?
  7. Why is the testing recommended?
  8. What are my options after receiving results?

 

Having a thorough conversation with your doctor about these issues and how you feel about them is of utmost importance. And, yes, some genetic testing today can determine your baby’s sex with greater than 99% accuracy. However, your doctor will not allow you the option for sex only. No one should take genetic testing lightly. Opting for these tests brings about other serious implications that you must weigh, as you can see by the above explanation. If you have a sincere interest in the testing, knowing that you may face serious future decisions, genetic testing may be for you.

So, for all the above reasons, one should be careful when throwing out recommendations to pregnant readers about what they need and don’t need, about what they should do or not do…especially if she is not a physician herself. In short…ladies, rely on your doctors for pregnancy advice! No pregnancy site or blog, including my own, can take the place of an informative and knowledgeable conversation with your obstetrician.

Here’s to your happy and healthy pregnancy:) You can email me at wombviewerblog@gmail.com!

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