Posted on May 10th, 2015 by wombwithaviewblog.com

A Mother’s Day Wish

My blog is nothing without paying homage to the celebration of life and the incredible women who help to create it!  Hopefully, you are training them right. Because you have a little one on the way, you deserve breakfast in bed and whatever else you command with the tinkle of your handy-dandy little bell (or foghorn, whichever your prefer). All moms deserve to kick back from time to time – and this day is one of those times! Let’s talk about what we can expect to see in a 9 Week embryo.

The 9 Week Embryo

Below is a 3D image of a 9 Week embryo:

9 Week embryo in 3D

You can see little arm buds and leg buds getting bigger.  What looks like a tiny lump on the top of the belly is just part of the cord.

Below is a 2D image of a 9 Week embryo:

9 Week embryo in 2D

Baby is upside down here and you can see from the dimension taken that it is measuring just about a whole inch now!

A scan at this gestational age will very likely be performed transvaginally. At least, this method will provide the best image, by far!

Below is a video of the kind of movement you might see at Week 9: Movement at Week 9

Pretty amazing, right?

I don’t think it’s too much to ask to spend one day a year sans the multiple hats that come with motherhood..chef, chauffeur, maid, teacher, referee (for those of you blessed with more than one little angel). It’s the most difficult, most enjoyable, and most important job any woman will ever have. Shaping and molding our future generation of leaders is no small task! And a pretty exhausting one, too.

To carry them (or not!), raise them, care for them, discipline them, and love them defines us as Mothers. Any woman who puts her all into this job deserves to spend this day any way she pleases! Enjoy it! And for those first time moms-to-be…relish the peace and quiet now – while you still can 😉

If you want to see a post about our embryos at Weeks 7 and 8, just click the link.

Thank you to all moms for reading and subscribing! Feel free to email me at wombviewerblog@gmail.com with your questions or comments!

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Posted on July 13th, 2014 by wombwithaviewblog.com

Elective 3D Ultrasound Businesses – How Safe Are They?

This post calls out to all the expectant moms looking for early gender ultrasounds from elective 3D ultrasound, privately-owned, non-medical businesses. Regardless of what they advertise, please read this first before scheduling your visit! Moms, just do your homework. You have a right to know before you go!

3D ultrasound fetal face 33wks

Just look at this shot! It’s so precious, isn’t it? Who couldn’t fall in love with their little one more and more with every great sweep of the probe? Heck, I fall in love with your baby with every image like this that I take!

We, in OB/GYN healthcare, understand expectant parents’ desire for images like this, but the safety of you and your baby is the greatest concern for all of us in the field. And there are a few important factors to take into consideration before having your scan performed by a non-medical facility. As a non-medical facility, they are not required to meet the same standards as your doctor’s office.

Why I Cannot Endorse Elective 3D Ultrasound Non-Medical Businesses

Uneducated Staff

The biggest issue I have with these business is something that may surprise you. They are not required to employ certified staff. Anyone can buy a machine, start a business, and charge you to scan your baby, but they don’t have to be a formally-educated or certified sonographer themselves or hire them. Scary, isn’t it??

Some years back, I was mailed a flyer from an elective 3D ultrasound business. The goal? To sell you your own entertainment ultrasound business by offering a franchise and ultrasound education in a matter of days…for anyone off the street with no prior ultrasound knowledge or training. Before this, I had no idea such a business was even legal.

As a certified OB sonographer for 25 years, I can vouch for the level of knowledge and skill we learn initially and acquire over time, through clinical experience and performing diagnostic examinations. Most importantly, our education and experience also applies to the equipment we use to scan you. Anyone performing OB ultrasound should be utilizing the ALARA principle – and any formally-educated sonographer knows what this is. Basically, we learn how to optimize power settings in order to use the lowest level needed to obtain a good image. This is recommended by the medical community because long-term effects of ultrasound are still being researched. Someone who is not formally-trained likely has no knowledge of how to do this or even know it exists.

Ask about RDMS credentials (or DMS, meaning they have recently graduated).

Equipment Maintenance and Safety

They are not required to maintain safety standards for their equipment. Machines need maintenance to ensure they are performing properly and safely. Cracked probes and cords that are worn, old, and/or not properly cleaned or maintained can be an electrical hazard to their customers. Maintenance is costly, and I just have to wonder how many of these businesses elect to bypass it because they can. You may not necessarily know whether their equipment is safe.

No Physician on Site

Though not a diagnostic exam, a physician is not on site in case a problem is detected. And detecting an obvious problem is much less likely for someone not formally trained.

Unrealistic Promises

Now, let’s address fetal sex. After all, most of you who are super anxious to find out if you can shop for pink or blue want to know as early as possible! Most of these places advertise 100% accuracy of fetal sex guesses from 12 or 14 Weeks. This is irresponsible and something they actually cannot do. They can’t guarantee a gender guess is 100% accurate. They can only guarantee you a refund if they’re wrong. I’m sure you many of you wouldn’t consider handing over your money if you knew this is what they meant by their “guarantee.”

A guess too early in pregnancy is a toss-up. You are paying good money, and in some cases, a lot of it. How qualified is the guess if the person scanning you isn’t certified with a level of OB ultrasound experience? Furthermore, any obstetrician or radiologist will tell you that no ultrasound can be considered 100% accurate. As a matter of fact, even DNA blood tests for first-trimester genetics or amniocentesis cannot boast of 100% accuracy – these tests are 99+% accurate. Ultrasound cannot come close to this in the first trimester.

My advice to a mom- or family-to-be is to keep an open mind regarding a sex guess too early and to wait for your anatomy screen before investing in paint!

They Do Not Perform a Diagnostic Exam

But sometimes they say or advertise that they do. Some of them even call themselves a diagnostic imaging center. They’ll tell you that they’ll scan a little to make sure Baby is okay. I believe this gives the expectant parent a false sense of security. No sonographer can legally tell you your baby appears normal by ultrasound.

Please be aware that no one can call an elective ultrasound scan “diagnostic” in any way! Your healthcare professional must order a diagnostic exam. You must be scanned by a certified sonographer in a medical facility where at least one physician is on site. Finally, an official report must be generated for a physician’s interpretation and signature.

No one scanning in an elective 3D ultrasound business can promise a diagnostic test!

Undisclosed Information

Finally, they don’t have to advertise any of the above! They have no requirements to inform you of any of the issues above. If you ask, they have to answer honestly. So, be sure to ask!

 

A Message To Those Who Are Not Qualified to Scan!!!

Make no mistake about it. Waiver or not, if you scan a pregnant woman for fun and miss a problem, you are still liable. You are not trained to recognize these problems or how to handle them. How would you handle seeing something you feel is abnormal or that you cannot explain? What would you say? If you cannot call yourself a formally-educated sonograper, you have no business picking up a probe. Most of us who practice OB every day only get slightly better at breaking terrible news. This unfortunate experience will inevitably be yours at some point.

Moreover, you don’t know how to use the equipment safely or optimally. It takes a bit of artistry, (again) proper training, and experience to be able to create good 2D images – also needed in order to create good 3D images. Providing sub-standard images takes advantage of the customer paying for it, especially when they assume you know what you are doing.

Anyone can set up a 60″ monitor and some comfy seating. Anyone can show you how to press a few buttons. It doesn’t mean you can call yourself a sonographer. If this is your goal, go to school and learn how to do it the right way. Also, it doesn’t mean you are providing a fair service for the money.

 

Please Do Your Research on 3D Ultrasound Non-Medical Businesses!

Know before you go, ladies! Call in advance to ask if the person scanning you is a certified sonographer with OB experience and not a former used-car salesman. If not, you would be better off with this elective scan at your doctor’s office instead. A sonographer there is far more likely to detect an obvious problem. And your doctor or another physician would be in-house to discuss it with you and answer your questions.

I’ve made it no secret in my past posts that I’m not a fan of these cash cows. I believe that non-medical personnel should not be scanning pregnant women or utilizing medical equipment.

For the safety of the expectant parent, ACOG, ACR, and AIUM do not recommend elective scans at these sites. 

These businesses were borne of the expectant parents’ desire to see their baby at will, to bond with their baby, and to share with their families a special event. We understand this movie theater experience isn’t something you can receive at your doctor’s office, but the first and foremost concern is the health of you and your baby. I think any expectant mom would agree.

Even though this can be a fun experience for the family, the potential for serious issues is real. We can’t tell you not to go, but please do your homework first! If nothing else, ensure the person scanning you is qualified to do so! Educate yourself, and make an informed decision. Giving these places your hard-earned cash may not be worth your while.

Best wishes for happy and healthy!

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

For your most reliable 3d ultrasound information, subscribe here.

 

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Posted on April 29th, 2014 by wombwithaviewblog.com

Great 3D Ultrasound Images

Sometimes, beautiful 3D ultrasound pics are just effortless! Well, when I was finally able to get this baby girl to flip over, she was more than happy to pose for the camera. We asked; she listened. What a good baby girl! Let’s hope she listens as well when she’s two! (My youngest one didn’t — such a little pill!)

The result this day was just great imaging. Mom was 27w3d here which proves an optimal time for a 3D scan. Of course, all the other factors have to line up, as well. Every mom hoping for some great 3D pics needs to have a nice pocket of fluid in front of Baby’s face.

2D facial profile, 3D ultrasound pics, 27 Weeks pregnant

Notice the black in front of her face here. This is one of the reasons we can see it so well with 2D imaging. But it’s also why we were able to obtain the beautiful 3D images you see below.

Babies have begun to develop some fat in their skin, so cheeks look a little more plump now.

3D ultrasound pics, 27 Weeks pregnant

 

3D ultrasound pics, 27 Weeks pregnant

 

Mom was happy to share:) Thanks, Mom! She’s a keeper!

Email your great 3D ultrasound pics! I’d love to post them on my site!

FYI – Before you visit a non-medical 3D business for your images, please read more on how to educate yourself before making your appointment and paying your money!

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Posted on March 31st, 2014 by wombwithaviewblog.com

I commonly get questions about the report as I pull up this page on the monitor when I am revealing Baby’s weight after taking a biometry (that is, the measurements of Baby’s head, belly and femur).  Patients usually want to know why the measurements I took differ from the current gestational age.  The fact is they can..this is not an exact science so even a difference of a week can be totally normal.  Sometimes, a large difference can simply reflect a dating issue, meaning you are either farther or less along than you thought.  Your doctor knows how to differentiate between the two.

Check out part of the report below.  This is an old exam on a Baby B who was growing just fine!

SONY DSC

First, notice GA.  This is the Gestational Age of Mom currently.  EDD of 8/15/2007 is the Estimated Due Date determined earlier in the pregnancy which corresponds with the GA.

Below that, you’ll see AUA or Actual Ultrasound Age.    It says 19w3d, a couple of days farther along.  This is merely an average of all four measurements taken and is considered consistent with GA, meaning her due date will stay the same.

The biometry consists of the BPD (width of the fetal head), HC (head circumference), AC (abdominal circumference) and FL (femur length).  The names in parentheses refer to the physicians whose charts for these measurements are programmed into the software.  The values are taken in centimeters and each one represents a GA based on that measurement.  You can see that the BPD measured 8d larger.  This is totally normal.  All the other measurements were pretty close to GA within a couple of days.  Again, these all demonstrate normal growth.

Below the dimensions you’ll see EFW or Estimated Fetal Weight calculated in grams with a small standard deviation and also displayed in ounces.  This is determined by the four above measurements entered into the system by the sonographer.

Below that are ratios of these measurements.  If baby isn’t growing properly, it will reflect here but we will also see that in the individual measurements.

Below that is an M-Mode or Motion Mode which demonstrates the fetal heart rate (HR) taken.  120 – 160bpm or beats/minute is totally normal.

This is only a small portion of a report on twins but enough to explain Biometry.  This concludes Ultrasound 101.

Have a great day, people!

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Posted on January 28th, 2014 by wombwithaviewblog.com

There’s been so much hype surrounding 3D/4D ultrasound and I have posted on this before but it’s been a while so it’s worth revisiting!

Your regular ultrasound is 2D, that is to say it is 2-dimensional so we only see two planes at a time.  Our regular vision is 3-dimensional so that we perceive depth.  Therefore, the ultrasound image is like looking at a flat piece of paper.  It carves out a 2mm slice thickness and we see whatever is in that plane.  We move the probe around in order to make a mental 3D picture in the sonographers’ mind so that we know how your baby is positioned and where to find all the parts.  It’s as complicated as it sounds!

We usually say the best time for a 3D scan is when you are about 27-28wks.  Yes, it’s possible to do it later but the farther along you are the more engaged the head gets, the less room baby has and the harder it can be to see..ergo, we may not be able to get good images.

What we need for a good image…

Baby needs to be looking up or even a little to one side with a great pocket of fluid in front of the face, no cord, limbs or placenta in the way!  If all these things are so, we can get AMAZING images!  If not, we can’t.  It’s kinda all or nothing.  Sometimes we can get a partial face shot but those are not always great.  See the image below:

SONY DSC

 

Compare to the much better 3D image below.  Huge difference!

SONY DSC

To further clarify, 3D is a frozen image, 4D is seeing baby move in 3D…yawning, sticking out the tongue, opening his/her eyes (which freaks some people out but I think it’s cool, of course).  So if baby is active, we can record these video clips.  We typically save all images and clips to a DVD for you to take home.

Be sure to ask your doctor about the policies regarding these exams at his/her office, especially regarding what time-frame they want you to schedule and their policy if baby is not cooperating.

More here regarding elective 3D non-medical ultrasound businesses!

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Posted on January 21st, 2014 by wombwithaviewblog.com

Ah, the anatomy screen ultrasound.

Better known to many as “the scan where I can tell the gender!” Many of you moms out there may already know determining boy or girl is not the purpose of the scan but rather a sometimes side-perk. This post is dedicated to the routine or Level 1 anatomy screen and what we look to document on it.

When Is It Performed?

The anatomy scan is routinely ordered by your doctor to be performed between approximately 18 – 20 Weeks of pregnancy. We can perform this scan a little later as long as your doc gives the okay but, typically, not earlier. Those who are antsy to find out their baby’s gender will usually ask to have the anatomy screen earlier, but your doc will likely not sign off on that one. The reason for waiting is that Baby and his/her organs need to be large enough to be able to evaluate them well. We already prepare ourselves to battle Baby’s position. Along with the other limitations of ultrasound, scanning too early just adds another and defeats the purpose. And if Mom has extra weight around the middle, the screen will sometimes be pushed back a little further. We can see a little better with a little bigger baby.

What’s the Purpose?

This exam is ordered to rule out structural malformations on Baby. We want to ensure that all Baby’s parts exist where we expect them and are functioning properly. Diagnosing serious problems in advance is the real purpose of ultrasound. Physicians can then prepare a plan for management for mother and baby and assist in providing the parents and family all the education and counseling needed.

Even if you elected to have genetic testing early on, it can’t detect some abnormalities, like a heart problem, for example. Additionally, some chromosomal problems are not obvious on ultrasound. Unfortunately, no test can detect every problem which is why you are offered different types of testing.

If your pregnancy is high-risk to start or if a problem is detected, your doctor may elect to send you to MFM (Maternal Fetal Medicine) for a Level II anatomy screen. This just means the sonographer evaluates a few more structures and takes a few extra measurements. The perinatologist, or high-risk OB doc, reads the scan and forwards a report to your general OB doc.

It’s true that we may detect findings which require follow-up and end up resulting in no problem. Thank goodness! You may feel like you ended up worrying for nothing. However, if a serious problem was found, you’d probably be happy you knew about it in advance. Special circumstances require life-saving surgery for Baby immediately after birth or require special NICU accommodations that your local hospital may not offer.

True story!

My co-worker and partner in crime in ultrasound (of all people!) discovered her child had a heart condition, a very rare one at that. Instead of four chambers, he had two. She had innumerable tests prior to delivery by MFM and a perinatal cardiologist. They needed to make every effort to determine the extent of his problem before he was born. Even though one of our local hospitals had a NICU, it wasn’t equipped to manage his severe heart defect. Moreover, she could not deliver him vaginally because it put too much stress on his heart. She had to deliver him out of state, and he required surgery immediately after birth. He did great! Thanks to the incredible and extensive knowledge of some very dedicated neonatal cardiologists!

Do I Have to Have It?

Absolutely not. As a patient, you have the right to decline any test. I’ll advise, however, that you discuss this option with your healthcare provider first. You need to communicate with your physician the reasons for your decision so that she/he can counsel you on what declining means for you and Baby. Your doc will also want the opportunity to clear up any misconceptions you might have about the technology.

If one of your reasons is because you believe ultrasound is radiation, you’re in luck!

Ultrasound is not radiation!

You can click on the link above to read more details about this factual bit of ultrasound info. In fact, please do!

What Things Do You Document?

We have a long list of structures to document on your anatomy screen. Some of the things we look for on this scan are as follows:

Cervical length – we measure the length of your cervix.

Placenta – we evaluate its shape and features and tell your doctor where it is located.

Amniotic fluid – we tell your doctor if the general amount of your fluid is normal.

We measure your baby as shown below. However, please note the images were all taken at different gestational ages!

The head from side to side (BPD or biparietal diameter) and around (the HC or head circumference):

BPD, HC, anatomy screen

We measure around the belly (the AC or abdominal circumference):

AC, anatomy screen

Another image of the fetal abdomen is seen below without the measurement:

fetal abdomen, anatomy screen

 

And the femur length (FL):

FL, anatomy screen

 

These measurements estimate a weight which is usually about 8 ozs. at about 18 Weeks.

We document internal organs and other structures:

Parts of the brain, orbital lenses, facial structures like a nasal bone, upper and lower extremities, heart (very basic views), spine, stomach, kidneys, bladder, umbilical cord insertion, and umbilical vessels.

After we take all these images, we formulate a report for your doctor in great detail regarding the above parts. We also document what structures could not be well seen. Usually, if your baby doesn’t cooperate to allow us to see everything we’d like, your doctor may or may not send you back for a follow-up scan at some point to attempt a recheck.

How Do I Get Results?

Only your doctor (or MFM doc) can give you results! Never, never, never the sonographer. For those of you who have had the terrible experience of a problem on your anatomy screen, you have a hundred questions and your doctor is the only one who can answer them for you properly. Your doctor is the one with whom you have the important relationship. He/she manages your pregnancy, not your sonographer.

So, What About Gender?

Most facilities, as a side perk, will allow your sonographer to give you this information if she determines that it’s possible. Unless we see a problem where gender plays a role, boy or girl is not important to the health of your fetus, and your doctor doesn’t really need this information. We know, however, that it is important to those of you who want to know. And there is nothing wrong with wanting to know! There is also nothing wrong with waiting to find out, and that decision is as personal as picking out a name.  Believe me, I couldn’t wait to find out myself. Yes! I scanned myself! A perk of the career;)

A little side note here…many facilities are beginning to put restrictions on gender determination. As more and more legal cases pop up over wrong gender guesses, facilities will take more precautions to limit their liability. And if you decide to visit a non-medical ultrasound facility for a fun scan, please read more about them in the link provided and ensure your sonographer is properly educated! (No, they don’t have to hire real sonographer!)

***

We love a fun family! And we can’t deliver your little sweat pea, but this is one priceless piece of info we SO enjoy delivering when we can! It’s a big job which requires time, focus, and concentration! For some guidelines on how many to include in your entourage for this exam, click this link for a little insight into a sonographer’s recommendations!

It’s okay to know, to keep it a mystery, or to even have a preference. It’s just not okay when that’s all that matters.

Questions? Great! Email me, and I’ll answer what I can!

 

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Posted on January 12th, 2014 by wombwithaviewblog.com

As promised, a more light-hearted (and even comical, if I do say so myself) post!  I’m going to give you a little test.  What do you see below??

 

unnamed

 

Did you say a smiley face??  If so, you are entirely wrong!  BUT you are among hundreds who have guessed the same.  I cannot tell you how many people have asked, young and old alike, if we were looking at baby’s face or if baby was smiling.  Do our faces really look like this??  I always ask this of myself, to myself when anyone asks this question but then I remember that they can’t read ultrasound and to the lay person it really is like looking at clouds.  You can make all sorts of crazy things out of the images passing by on the monitor.  That’s why you have me, the narrator, to point out what you are REALLY seeing.

This is a cross-section of the fetal abdomen.  Imagine chopping down a tree and looking down at the trunk..it’s a circle, right?  Same thing here.  On the left is baby’s spine, on the right is the front of baby’s belly.  See my image below for an annotation of all these structures!

unnamed_2

ivc = inferior vena cava or main vein in the torso

ao = aorta or main artery in the torso

gb = gallbladder

uv = umbilical vein – we are only seeing a tiny segment of that vessel in the image.

stomach – self-explanatory!  When baby swallows amniotic fluid, the stomach becomes more distended and shows as black like the amniotic fluid is black.  Sometimes, patients will ask, “What is that hole?”  It’s funny how we associate black spots as holes and they are always surprised when I say that it’s not a hole and it’s actually a stomach that is full!

Anything fluid on ultrasound is black, so the blood vessels appear black, as well.  In the gallbladder, you have bile (a fluid) so it presents as black, too.  The other organ that is present in the image is the liver.  It is difficult to outline the liver but it is the gray stuff above and below the gallbladder and above the stomach.

 

Unbelievable question of the century??  “What is an abdomen?”  No, I’m sure in the heck not kidding.  Slept through biology, maybe? There’s your good laugh for the day.

So, next time you go for a diagnostic ultrasound, providing you are in your second trimester and beyond, look for the “smiley face” when your sonographer measures your baby’s abdominal circumference (AC)!

Hope you enjoyed Ultrasound 101 today!

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Posted on April 16th, 2013 by wombwithaviewblog.com

Can we see boy or girl at 14 Weeks? For most people, the answer is no, and I personally would not recommend someone pay for a scan at that age for the attempt. But 14 Week gender on my patient and friend appeared pretty clear! It was still a guess, but we were hopefully confident.

In these images you’ll see our twins and what I guessed their gender to be at this point. I’ll give you a hint…I was right! Take a close look at these images, and you’ll see the difference for yourself.

This is a shot of each baby’s bottom, so this is all you can see on the image. On Baby A, you see three little white lines. On Baby B, you can see a little something sticking out. So, what is YOUR baby? Upload your images to share!

Both babies…can you guess?

 

 

 

 

 

 

 

 

Look below…did you guess correctly?

 

 

 

 

 

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Posted on March 4th, 2013 by wombwithaviewblog.com

Your’re 12 Weeks pregnant! And so is the uterus below:) Everyone has just worked so hard to get to this point…so much growing and developing! The twins are 12w1d now, fully formed and just have to keep growing from this point. They really look like babies now and not so much the alien they used to resemble. Tiny hands and feet are distinctly recognizable now as you can see in the photos below. Awww!

Some organs can be seen at this point like the stomach as it fills due to baby’s swallowing of the amniotic fluid and the urinary bladder as it becomes more distended due to functioning kidneys. The stomach and bladder appear as black because fluid shows up black on ultrasound. The brain can be seen but is still developing at this point and the heart is a beating machine but still too small to see much detail. All of these things and more will be evaluated around the 18-20wk timeframe or as your doctor orders.

Notice, in the image of the itsy-bitsy bottom of the foot, the scale in centimeters on the right-hand side. The foot measures about 1cm or less than 1/2 an inch right now!

Baby A is showing off today and waving to Mom. Bye-bye ’til next visit!

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Posted on February 23rd, 2013 by wombwithaviewblog.com

What can you expect to see at 11 Weeks?

At 11 Weeks pregnant, take a look at what you should expect to see by ultrasound!

 

11 Weeks pregnant

11 Weeks pregnant

 

These images depict Baby B at 11 Weeks! Both babies are slightly bigger = about 4.3 cm now or almost two inches! The second trimester starts at 14 Weeks. So, the first trimester, thought of as the most crucial one for growth and development, is nearly over. Babies can be seen doing a lot of quick jerky movements at this point. They can be quite active and actually mimic little jumping beans! In the second image, you can see little legs quite distinctly.

 

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