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 October 20th, 2015 by wombwithaviewblog.com

The Gender Scan – Determining Fetal Sex

I think most of you reading probably would believe that most of the emails I receive have to do with parents wanting me to confirm fetal sex…sometimes desperately so. And sometimes determining fetal sex is an impossible task during the gender scan.

I try to explain in my replies that my guess is only as good as the images they send me. I don’t believe it is quite understood what I mean when I say that ultrasound is entirely subjective, but the person performing the gender scan has total control over the images obtained. The sonographer creates these images utilizing a number of controls to optimize the image. She also uses her own discretion to determine a good angle with the probe she is holding.

Yes, there is a standard here but I have to brutally honest. Just as people excel in some areas of life and/or profession, some are also bad. There are good docs and bad, good nurses and bad, good cashiers and bad. This is a painfully obvious fact when I open these image attachments! It’s also possible these operators are not formally-educated sonographers at all! Read more here on some elective 3D businesses.

In addition, just one angle is not enough to see well. However, only one angle can be depicted in one image at one time. I wasn’t there during your gender scan, so I don’t know anything about the variables that could have made imaging difficult.

I just know a technically bad image when I see one. Sometimes, I can tell an operator did not take measures to improve the image. In those cases, I can only assume that someone did not know how to use them correctly. If the person scanning you is new to ultrasound or not a real sonographer, the image may not appear optimal to someone who is experienced in sonography.

Great Images for Determining Fetal Sex!

Below are some great images of fetal sex that I’ve taken myself.

female fetal sex, 18 Weeks

The above depicts an underside view of typical-appearing female parts from about 16 – 22 Weeks pregnant. The side arrows point to labia, the middle to the clitoris.

 

gender scan

Female labia in the 3rd Trimester

 

male fetal sex, 28 Weeks

Male genitalia, late 2nd Trimester

 

male fetal sex, 3rd Trimester

The above demonstrates a side view of typical-appearing male parts from about 27 Weeks on.

 

So, all that said, if the image you send is not an optimal one, I may not be able to take a guess on fetal sex. Even if your sonographer felt sure of her guess during the gender scan, I may not feel I can agree based on limitations of the image. That doesn’t mean your sonographer got it wrong, just that I cannot concur with the former guess because the image quality is not there. If I didn’t observe the scan myself, I am unable to see your baby’s parts from many different angles!

Below are the links I typically email on my posts regarding fetal sex:

Early Gender Pictures
Boy Vs Girl
Twin Gender Reveal

Until next time, feel free to reply, comment or email with your questions at wombviewerblog@gmail.com! You can also subscribe to the right:)

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Posted on October 5th, 2015 by wombwithaviewblog.com

Fetal Gender Determination – What Makes It Impossible!

Fetal gender determination is not always a walk in the park for us sonographers. Ultrasound, like many technologies, have their limitations. There exist many factors which can make fetal gender determination mission impossible! Your OB docs understand there are a number of variables that prevent good visualization in every ultrasound we perform. Unfortunately, many patients do not.

So, if you’ve been losing sleep in anticipation of this long-awaited news, read this first! My goal is to inform expectant moms so that you go into your ultrasound exams with realistic expectations. I sincerely hope that through understanding these limitations, you’re able to leave your experience feeling happy. If all you can see is Baby’s heartbeat, it’s an opportunity to bond with your new addition that doesn’t come everyday.

Is Fetal Gender Determination a Requirement?

Definitely not. Fetal gender determination is not a routine part of a diagnostic examination. It may be information you desire, but it’s not typically information your physician needs. The anatomy screen at about 18 – 20 Weeks or so is ordered to rule out structural fetal malformations. Most U.S. practices do not mind providing a fetal gender determination as a courtesy IF the sonographer feels she can see well. And we LOVE to give you this information, if we can!

What Factors Impair Fetal Gender Determination?

Some of these factors that can get in our way of how well we see are listed below. They are very common! Actually, some of them confront us on a daily basis.

  • A breech fetus
  • A fetus with the rear against the uterine wall
  • A foot or feet in the genital region or crossed feet
  • Closed legs
  • The umbilical cord between the legs or against the fetal body
  • Body habitus or too much weight around a patient’s middle
  • Uterine fibroids or contraction
  • A decrease in amniotic fluid
  • Genital malformations
  • Early gestational sac age

Even one of the above factors can prevent even the most experienced sonographer from determining fetal sex. A good sonographer knows when the views are good enough to provide you with a guess. A good sonographer also knows when not to guess! What you don’t want is someone who is inexperienced but willing to guess anyway. Many times, it’s not just one but several of the above variables that limit what we see. Unfortunately, we can’t change any of them.

Another little fact I’ll add here is that a non-arguable truth of the modality is Ultrasound’s laws of physics. The farther sound has to travel, the weaker the returned signal. The more tissue the sound waves have to penetrate, the worse the image. In other words, the more tissue there is around a patient’s middle, the more fuzzy the picture. The more fuzzy our picture is, the less we can see Baby’s parts. Any not just fetal gender, any parts. All it takes is one of the above factors to ruin the party. More often than not, a combo of factors will cause a little unwanted rain on your parade.

What Can We Do to Help?

We can try a couple of variables in an attempt to see better. Jiggling your belly or turning you to each side sometimes helps. We do this in the hopes that your change in position will also change Baby’s. Alas, it doesn’t always work.

What We Can’t Do

Unfortunately, we can’t scan you indefinitely! In an effort for fairness, we always try to get our next patients in as close to their appointment times as possible. Sticking to this schedule can be tough when patients arrive late or when we find abnormalities. Most patients are allotted a 30-minute appointment for their ultrasound exam. However, not all of this time is scanning time.

Before we scan you, we need to examine your chart for your history, an order from your doc, and an indication for the exam. After the exam, we need time to type up your report and send it to the physician. Most of us are nice enough to take more time with a patient if our schedule allows. I always did. Unfortunately, some of my patients (not understanding ultrasound) didn’t think I did!

What You Shouldn’t Do!

An unreasonable action disgruntled patients take these days includes airing their rants on social media. Consider, first, that venting your frustrations reflects poorly on your physician and practice. And you could be fired. Yes, a patient can be fired! In other words, I would advise against this method of revenge. If you are unhappy, you have the right to discuss it with Administration. But just know a practice does not have to tolerate any behavior deemed irrational or unreasonable. Just like one can fire an attorney, a plumber, or doctor, a patient can find herself in the same situation.

A Modern-Day Problem

Unfortunately, our society has become one of immediate gratification, even demanding it in the face unreasonable circumstances. I’m reminded of a few former patients and a like-minded character from one of my favorite childhood movies. Anyone remember Veruca Salt of Willy Wonka fame? These patients actually got angry, yelled, cried, and ranted in a place of medical business, much like the toddlers they would have themselves in another couple of years – all because I couldn’t tell them the sex of her baby. This. Is. Unreasonable.

I realize some sonographers don’t try very hard. In most circumstances, however, most of us make a sincere attempt to obtain this information for our patients who want it. We cannot, however, change the laws of physics.

Moreover, some patients mistakenly assume that because we couldn’t make a fetal gender determination, we must not be able to skillfully perform their diagnostic examination otherwise. Please keep in mind that medical professionals never judge such as gross incompetence. Rather, ranting such on social media is reflective of the patient’s ignorance, a lack of understanding of how the technology works. So, please! Don’t do this:)

We hate when our patients leave foaming at the mouth. Remember, this scan is about Baby’s health first! Just ask any mom who didn’t have a healthy baby.

Please feel free to leave comments below or email me at wombviewerblog@gmail.com with your questions and subscribe for more great ultrasound information!

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Posted on July 25th, 2014 by wombwithaviewblog.com

Male and Female Gender Ultrasound Pics!

Okay now, readers, this is a perfect example of how we can sometimes determine gender at less than 17 Weeks! The images below represent twins and their perfect images of male and female gender! It just doesn’t get better than this.

These babies dated at 16w4d and depict textbook images for boy and girl fetal sex. They make a perfect side-by-side comparison!

These were very easy potty shots. We’ve just gotta love it when not just one baby cooperates but two in the same belly. These babies hardly made me break a sweat. I’ve even labeled their parts for you. So, hopefully, they make for easy reading for you. Check them out below.

Baby girl, on the left, is showing off only her bottom. Imagine her feet pulled up over her head. Flexible little things, aren’t they?

male and female gender ultrasound, 16 Weeks pregnant

Female, left and Male, right – Twins, 16 Weeks

male and female gender ultrasound, 16 Weeks pregnant

Baby boy, on the right, is showing off his thighs and bottom.

Unfortunately, not all babies cooperate like these. Some babies don’t want to show off the goods, and there’s little we can do to make them move. I know we sure would have many more happy mamas out there if we could!

More Links for Male and Female Gender
Ultrasound Pics

http://wombwithaviewblog.com/female-gender-on-ultrasound-2/

http://wombwithaviewblog.com/boy-girl/

http://wombwithaviewblog.com/boy-vs-girl/

http://wombwithaviewblog.com/twin-gender-update/

http://wombwithaviewblog.com/third-trimester-male-gender/

Happy fun comparing these images to your own!

Email me at wombviewerblog@gmail.com with any questions. 🙂

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Posted on April 26th, 2014 by wombwithaviewblog.com

14 Weeks Gender & the Too-Early Guess

Read below for some props (thanks!) and a question about 14 Weeks gender from a new reader and subscriber:

First Email

reader:  Hi! I’m expecting my third little one in October. Before I ask my question, I just wanted to say that I’ve been reading your blog for the past 3 hours while my kids are down for a nap. I love it! I went for a private 3D ultrasound on Monday, and he said it was a girl! We are so excited because we have two little boys already. I’ve heard so many horror stories since I had it done, and I’m terrified he was wrong. I clearly see ‘three lines’, but I’m no ultrasound technologist. What do you think? Thanks in advance! I’ve already subscribed, and I’m excited for more!

14 Weeks pregnant, 14 Weeks gender, too-early gender guess

14 Weeks gender, 14 Weeks pregnant, too-early gender guess

wwavb:  Hi! First, let me say thanks so much for reading and subscribing. I’m so happy you are enjoying my (sometimes) sense of humor. I really am very honored that you spent three hours of your own personal quality time reading my stuff! Very cool.

So, I am going to guess that you are maybe 14 Weeks? 15? Please write back and let me know. Maybe you have already come across some of my posts. You may already be familiar with my opinion of these ultrasound drive-thrus! Baby looks a bit small in these images, like you may be a little early to determine gender.

If you are less than 18-20 Weeks, wait to paint! This is really the best time (and later) to determine gender, and those images are not proof enough to me to paint pink just yet. Please know I am not telling you he’s wrong, I just cannot concur based on these images.

Second Email

reader:  You’ve guessed correctly! I was 14 Weeks in this ultrasound and did, in fact, read your posts about the drive-thrus. I must say, if I’d had know your opinion before, I probably would’ve waited. He told me he was 75% sure it was a girl and to come back in two weeks for another look for free. I’m definitely not convinced that it is a girl, nor have I bought anything pink. I do hope that it is, though! Thanks for your input!

wwavb:  I hope so, too! Pink is so much fun to buy, and you could use some estrogen in your family! Feel free to email me again when you go back and then again when you go for your diagnostic anatomy screen at 18-20 Weeks. 😉 I’d love to tell you pink, too. Thanks again for reading.

***
To anyone who is reading now or in the future, don’t let anyone take your money to guess gender at 14 Weeks. It truly is a guess, and anyone has a 50/50 shot without looking at all, right?! Please be sure to read my post above on non-medical, elective ultrasound businesses. It’s so important all moms are educated on the safety issues regarding some of them.
My best advice is to wait to buy pink or blue and wait to paint. Also, (by all means) ensure you have a real ultrasound professional scanning you.
Have a great day!
Be sure to email your questions, stories, or pics to wombviewerblog@gmail.com!

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Posted on July 29th, 2012 by wombwithaviewblog.com

Perspectives on Pregnancy Loss

A pregnancy loss is one of the most devastating experiences a woman endures. It is always painful and emotional, even if that loss takes place early in the first trimester before a heartbeat is ever seen. It is especially tragic when it happens much later for all the reasons with which we are familiar. Any time after that first heartbeat is seen, we grow more in love with our child, ponder names, and form that motherly bond.

After so many years in this business, we providers know how often a first-trimester loss happens. We know that physiologically, something wasn’t developing correctly. And many women miscarry before they ever know they are pregnant! It is nature’s way of taking care of something that wasn’t going to be normal. It is still tragic to the patients who desperately wanted a child, and the pregnancy loss can create a void filled with fear. “Why?” is a valid question and probably the one most commonly asked. Very early on, it is also something no one can answer.

An Alternate View of Pregnancy Loss

None of us really understand life entirely, but I do believe that someday we will all find out. I like to spend some time contemplating why things happen the way they do. One thing I’ve always expressed to patients is that our children come to us when they are ready, not necessarily when we are ready for them! So, if you have previously endured the unfortunate experience of losing a pregnancy, I hope this helps in some way.

Maybe, in the whole complexity of the universe, we set out on this journey and decide at some point we are just not ready. Maybe a miscarriage just means that little person needed more time before he or she graces you with his or her life-long presence.

A Friend’s Experience of Pregnancy Loss

I had a friend once who had two normal pregnancies which resulted in two children. They decided to try for a third. She suffered two separate and devastating miscarriages back-to-back and only several months apart. She grieved for months. A year later, when she had no intention of having another baby, SURPRISE! She was pregnant! Naturally, she was concerned right from the beginning.

A few weeks later…SURPRISE AGAIN! It was twins! She carried those babies to term with no problems whatsoever. One day as we were in the midst of conversation about her pregnancy losses, I told her of my “theory.” Tears welled up in her eyes. Maybe BOTH babies were just ready at the same time and said “Let’s do this together!” She said it really did feel like less of a loss to think of her miscarriages in such a way.

Certainly, this scenario can’t apply to all miscarriages, but at the end of the day, whatever thoughts can cause a painful memory to not hurt so much is a better day. Maybe a pregnancy loss is not God taking something “away” …maybe it’s your child saying he wasn’t quite prepared for this big old world yet. To me, it’s mentally a happier place.

Here are a few other links that may help. I hope so!
Miscarriage: A Constant Fear
Early Pregnancy – Blighted Ovum
Concerned Reader: Blighted Ovum on First Ultrasound?

Please feel free to comment or ask questions by emailing wombviewerblog@gmail.com!

Contact me or subscribe for more information on topics such as pregnancy loss, first trimester ultrasound, and fetal sex determination.

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