Posted on January 21st, 2015 by wombwithaviewblog.com

When you bring family for your sonogram, your smallest ultrasound exam guests sometimes provide the best entertainment for us sonographers! I have posted some “kids say the funniest things” in the past. Most of the time when parents bring small children, especially for a lengthy ultrasound exam like the anatomy screen, it truly can be very distracting and disconcerting.¬†Every once in a while, however, we have a child in the room who is simply entertaining…like the one who thought his baby sister looked “weally weird” from one of my most recent posts. He said, he was NOT making the mistake of going to another sonogram. Hilarious.

A totally precious little girl was in today with her Latino family. She must have asked me a million questions. The exam I had to do was pretty short and sweet, so it didn’t require too much brain power. Fortunately, I could indulge her a little. Every time Grandma thought she was talking too much, she would tell her in Spanish to stop and pay attention. That would work for about thirty solid seconds before the onslaught of more questioning. She was so cute and smart and SO well-spoken for only four!

For those of you who have had a sonogram later in the third trimester, you know how big Baby looks on the monitor. My little guest sees the baby’s abdominal circumference fill the image. Out of total quiet she exclaims, “My baby cousin has a really big head…and her butt is GRANDE!”

Any kid who can make me laugh out loud can visit me any day of the week! ūüėČ

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Posted on June 28th, 2014 by wombwithaviewblog.com

As a kid, I used to go swimming at a friend’s house and I’ll never forget the sign posted on their cabana.

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This is our swimming ool.

Notice there’s no p in it.

Let’s keep it that way.

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I always thought it was so funny and clever! And her mother meant it, with all her Italian beauty and ferocity, threatening us that we better not do it! I have to laugh at that memory.

That brings me to a pool that most definitely contains some “p” and lots of it. I’m, of course, referring to the amnion.

For people who don’t already know this, you may be grossed out. However, this function proved necessary in order for us all to get here! Since we’ve all had to drink a little pee in the past, let’s talk some physiology. The amnion is predominantly made up of fetal urine, and it is one of the things we evaluate on ultrasound. Baby starts to swallow amniotic fluid later in the first trimester. During the anatomy screen, we look for fluid in the fetal bladder and stomach so that we know baby is swallowing and the kidneys are functioning properly. We also evaluate the amniotic fluid level.

Anything fluid on ultrasound appears black, so the stomach, bladder, and amniotic fluid are black. ¬†Patients will typically ask, “What is that hole?,” when really it is a fully-distended stomach or urinary bladder they are seeing. Below you’ll see an image of a full fetal bladder.

SONY DSC

 

So, there ya go, Mrs. Pat. Pee in the pool is a good thing;)

 

 

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Posted on February 7th, 2014 by wombwithaviewblog.com

Can you skip your anatomy screen?

Of course, a patient has a right to refuse any test! I’d recommend a discussion with your obstetrician, however, so your doc understands your reasoning. Your doc will want to clear up any misconceptions you may harbor and ensure you understand the consequences for your decision. However, students practicing ultrasound on your fetus does not constitute a replacement! Here are all the reasons why.

True Story…

A patient requested her anatomy screen examination be cancelled because she went to a facility where students practiced on her. She stated they already did the scan, so she didn’t need to have it done a second time.

¬†Students practicing on your belly is not a formal or official scan; it’s just practice;)

Your diagnostic examination was ordered by your physician and must be performed in a medical facility with a written order by your doc. No order, no exam. That examination must be performed by credentialed sonographers, must include specific documentation, and must be interpreted by a radiologist or your physician. Click on the link above for more info about what you can expect from your anatomy screen!

Can students practice?

Yes, ultrasound students routinely practice on pregnant bellies, and that’s okay — as long as it’s also okay with your doc! I always recommended they have written permission from your physician, but that isn’t carved in stone (just my opinion!) And I personally recommend waiting until after your real anatomy screen is complete — if anyone is going to question a problem, you’d want that to be your doc…not a student or instructor.

Holy cow…me as a student…you would not¬†have wanted that to count as your official study! Actually, that goes for any student. They should have a supervising instructor guiding them, but their casual practice is no substitute for the real thing…medically, ethically, or legally. Students are still struggling to figure out what’s a head and a butt on your baby and how all the buttons work. “Hmm, where is that knob again to make the image brighter?”

Yep, there’s a L O N G learning curve to ultrasound, and no one knows that better than me! Whew, ¬†excruciatingly painful.

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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!)

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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 November 9th, 2013 by wombwithaviewblog.com

Holy cow. Another anatomy screen, another request to call someone, text someone, or seal in a special envelope the special results for your Gender Reveal party. The pressure is on! But David Copperfield, we sonographers are not. And since we can’t reach in there and rotate the little sweat pea, sometimes we just can’t deliver (no pun intended) on the gender surprise.

I hate when this happens! Mostly because they usually leave the room hating me. But what can we do?

I’m sure most of you are familiar with this event? Gender Reveal parties have become a big way to celebrate how parents, family, and friends find out the sex of their baby. I have to admit it’s a cute idea and must be totally fun, especially with all the creative ways expectant parents have discovered to broadcast the news. But a word of caution! Some patients schedule their party for the same night as their sonogram. And even though most people know gender cannot always be determined at the 18 – 20 Week scan, some still hope for the best and plan the party anyway.

Being able to determine the gender should never be a guess. We’ve all heard the stories from our patients…”My cousin, Martha, was told five times it was a boy until a girl popped out. It must have been the thumb or the cord in the way.”

I always tell patients either I’m sure or I just don’t know. Just tossing out a guess isn’t fair to the patient! And a 70% or 80% guess means your sonographer is just not very confident about that guess. Guessing leads to a return of the dearly beloved tutu for a football jersey. I simply do not want to be responsible for all the consequences that follow – especially the emotional ones for mom and dad or partner.

I will say, however, I have enjoyed taking a picture of cleverly annotated gender and wrapping it up in a peek-proof envelope for my patients. It’s a bit time-consuming in this age of electronic medical records, but we do understand the excitement that goes along with such a visit. I am so happy when I CAN share that with you!

I hope all sonographers do their best to give their patients gender information accurately, but in the event we can’t make this determination – don’t shoot the messenger. After all, even though you may say you want us to guess, you’d rather us be correct;)

I know it’s a bummer! But wait to schedule your party. And if Baby’s sex cannot be determined and you decide to visit an elective¬†3D non-medical business, please do your research! Be sure to ask if their sonographers are formally educated and not some random Joe Blow off the street. (Yes, it happens!) Look¬†for RDMS or DMS credentials after his or her name.

Apparently, nobody likes yellow cake anymore. ūüôĀ

 

 

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Posted on July 27th, 2012 by wombwithaviewblog.com

How Many Sonogram Visitors are Okay?

Believe me! We moms who are also sonographers know how important your sonogram visitors are to you. You have counted down the days and lost sleep just waiting to see your baby and to find out the gender. Your family is excited, too, and maybe even flew in from another city or state. Visitors during your sonogram are typically allowed. But realize that your uterus may not be the only crowded womb in the house! Your entourage of friends and family may crowd the ultrasound room, too. As a result, they may not be welcomed at the start of your exam depending on the policies where your scan will be performed. Here’s what to do and what not to do on your Big Movie Day.

First Things First!

The most important piece of information I’d like to impart here includes the most important aspect of our job…to make sure your baby looks okay. I would always feel just a tinge of anxiety before setting the probe down on any mom’s belly. A looming fear exists in every sonographer that we’ll discover your worst nightmare. As I casually smear the gel around your belly, you don’t realize that I’m first confirming a heartbeat. All I need is a half-second pass over your baby’s heart to appreciate the flutter. I breathe a sigh of relief and move on with the exam.

We require lots of concentration to make sure we aren’t missing a thing. We have many measurements to take and images to document, especially on an anatomy screen examination. Sure, we can make small talk and usually I do. As a matter of fact, I always enjoyed the “teaching” aspect of my career. Most parents are enthralled and appreciative when I point out all Baby’s organs as I document them, one by one.

Even though we perform this examination every day, it is one of the most comprehensive and detailed examinations in our repertoire. Distractions create a bit of anxiety that we’ll forget something on our very extensive check list.

My Advice Regarding Your Visitors

Most places have limits on how many sonogram visitors you can take into the room for your exam. So you¬†are not disappointed on your big day, call your doctor’s office or facility where the exam will be performed and ask about their policies.

I have found that the best way to approach any entourage is to simply have all other sonogram visitors remain in the waiting room except for one support person, usually a spouse. After the initial diagnostic portion of the exam is complete, everyone else can then join in the fun. At that point, it’s play time and the real work is done. However, this approach is¬†often met with resistance.

We don’t ask your friends and family to wait behind because we are mean people. But, in all our experience, we know that you may have never considered the possibility that this event would be anything but fun and exciting. The unfortunate reality of our jobs is that not all babies are normal, and most parents do not wish to receive terrible news at the same time as grandparents, cousins, and nieces. Such an experience ranks high in the hearts of most couples as an extremely private matter, one they would rather not share with an audience. Ask any couple who has endured this misfortune. Moreover, receiving such devastating news is accompanied oftentimes by shock and sadness, as one might expect. Many couples want time to grieve before breaking this news to family or their other children.

When Visitors Make Our Job Difficult

Most of us moms know how to tune out our kids when the need arises. However, any distraction in the ultrasound room makes a thorough evaluation of your baby more of a challenge. Circumstances that create a poor environment for providing you with the most optimal exam possible are usually caused by visitors. Chatting family members, a fussy or crying child, and family crowding behind the sonographer or touching the monitor all wreak havoc on our concentration.

Additionally, even though most patients understand this concept, your ultrasound exam room is not the place for cell phone conversations. You name it, I’ve seen it! I’ve had visitors on their phones talking gossip, ironing out bills, conducting business, discussing court cases, and ranting about dysfunctional family. I’ve had to ask them to end their calls or to please step outside.

Finally, patients frequently show up for their exams with a small child or children and no one else to take them outside if they become upset. We do understand this is one sonogram visitor you can’t leave outside if you have no help whatsoever. But a screaming child in an 8×10′ room is no small distraction. I’ve found children pulling images out of my machine, opening drawers where needles were stored, and digging in biohazard trash cans which contain the blood or body¬†fluids of other patients. Yuck! I’ve literally stopped my exam so I could wash Little Bit’s hands.

biohazard trash, sonogram visitors

Unbelievable? Maybe, but I can pretty much guarantee every sonographer has similar stories!

Best Wishes for Your Next Scan!

So, all you moms with your big sonogram coming up, I hope you enjoy your experience! I hope your baby is cooperative and you have a sonographer who is engaging. I hope she narrates all your baby’s parts for you and gives you some great pics. Most importantly, I wish you a healthy new addition to your family. If you can oblige your sonographer just a few minutes of pin-dropping silence, she will love you for it! And if you bring another adult with you who actually takes the screaming baby outside, she’ll love you forever.

Email wombviewerblog@gmail.com with your questions, pics, or stories!

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