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?!

Subscribe for all the information you want
on fetal ultrasound!

You can email any questions you have at wombviewerblog@gmail.com!

 

Comments: 8 Comments »

Posted on April 17th, 2016 by wombwithaviewblog.com

Every once in a long while, or blue moon, I receive an email posing a phenomenal question regarding diagnostic ultrasound! And it’s not one about fetal sex, much to my sheer happiness. Keep reading to see what was on her mind..

concerned mama:  Hi there! I would love to get your opinion on something, if you don’t mind. I was born with bilateral congenital hip dysplasia, and therefore have a 1/12 chance of having a baby with the same issue. I was just wondering, is there any way to spot this on U/S? We have already had our 12 w NT ultrasound, but I was wondering if I should ask at our next one (19w). I know it’s not a major life threatening issue, but I just wondered if it would be worthwhile to ask about when we next see a sonographer. In case early U/S can help you spot red flags for dysplasia, here is a shot of my little one, I believe in spread eagle position, showing both hips (?). I’m no expert 🙂

Thanks for any info you may have! 🙂

wwavb:  Excellent question! In short, no. (Her image was omitted here since it is not relative to her case or this post.) Hip dysplasia is questioned by the pediatrician during neonatal examination and can be confirmed by ultrasound of the newborn by scanning the hip joint in a particular plane while applying pressure at a specific point to see if it’s pushed out of place. I did a few of them many, many years ago and cannot recall all the details of the exam, per se.

Thanks for the great question and I hope you will continue to read! Many blessings for a happy, healthy pregnancy!

wwavblogger
***

It has probably been something close to 20 years since I’ve performed just such an exam. Wow, time flies when you’re having more fun than one can stand in the hospital setting.

If I remember correctly, hip dysplasia is a repercussion of certain long-term fetal positions and I seem to recall a correction involving the newborn in leg braces for a relatively short period of time. Please, PLEASE ask your OB or pediatrician if you have questions about the most current and up-to-date information on the subject and treatment of this condition.

And KUDOS to this reader for asking me a question I’ve never gotten in my entire career!

Many blessing to all you expectant lil’ mamas out there and don’t hesitate to email me with your question by clicking on the ASK ME page above. Thanks for reading!

Comments: No Comments »

Posted on March 12th, 2016 by wombwithaviewblog.com

Everyone wants a healthy baby. It’s something we, as humans, take for granted unless we know of someone who experienced the misfortune of having a child with problems. Anyone who has ever come up against the discovery of a fetal abnormality on ultrasound can relate to the devastating feeling of receiving the news. No matter how insignificant the issue, even if your physician wasn’t worried, you sure were.

If a patient does not have a medical background, or if not one in OB, the incomplete understanding of what was seen can feel torturous. Moreover, the lack of a definitive diagnosis and waiting on more appointments and tests and results only adds to the anxiety. Sometimes the testing leads to a distressing diagnosis of a baby with life-long complications, a structural malformation requiring surgery after birth, or a syndrome that is not compatible with life. These are some of the most dreaded words an expectant mom can hear from her care-giver.

Why a Referral?

Sometimes, things we see may be cause for concern enough to warrant a referral to Maternal-Fetal Medicine (MFM). This way, a perinatologist (high-risk OB doc) can determine the nature or severity of a problem. They may know exactly what is seen, what to call it, and how to follow it. For those who are very lucky, following a concern for period of time results in resolution of the problem. Hallelujah! Your constant companions, Worry and Anxiety, get kicked to the curb! You feel you can finally exhale, breathe again! No longer do you spend your days contemplating the what-ifs of your pregnancy, your newborn’s life, or how it might impact the lives of your whole family. You can finally get some well-deserved sleep and actually enjoy things like your baby shower, decorating the nursery, or filling the closet with precious miniature clothing.

When Some Don’t Feel Relief

Some patients, unfortunately, never experience the “hallelujah” moment. One of my patient’s some time ago (with a new pregnancy) complained about the extent that her doctors followed one of her previous pregnancies for a suspected problem. A mass appeared on ultrasound in her baby’s abdomen. The area, surveyed for months, spontaneously resolved. Her physician’s could never explain it nor was there any reason for them to see her again. As a result, MFM released her back to the care of her regular OB physician. Though she may have felt relief, her  annoyance with the situation trumped any other emotion. Her impression reeked of disdain, not of “prayers answered” or “great fortune” or “blessings galore bestowed.”

Her only comments were “what a total waste of time it was…months of anxiety and follow-ups for nothing.” This may be an understandable reaction. No one wants a problem to continue or progress to the point it requires surgical intervention at birth. Most patients express appreciation or gratitude; a few, without the ability to see the bigger picture, feel only anger at the diagnosis. They endured inconvenience by a number of doctor’s visits and suffered worry for “no reason.” If providers could magically know in advance whether everything we see will or won’t be a problem, it sure would create a lot less stress for our patients and their docs who manage their care.

A Sonographer’s Job

The scope of a sonographer’s job is to look for and find abnormalities, big and small. And there have been many occasions when my great partner sonographers found something others may have missed. I’m sure this patient ultimately felt relief that her baby was healthy; I hope looking back, she realizes the opposite result of her frustration would have been far worse. Potentially, she may have felt differently if she spoke with someone who didn’t get the good news she did – like maybe the patient whose baby had three barely identifiable heart chambers instead of four. She needed three surgeries in her short little life…one at birth and two more before she turned three.

Ultimately, we are in this field to help everyone. Regrettably, some can’t appreciate the extent, reach, or purpose of the work we do to help them. This particular patient also complained that she couldn’t bring in ten people during her exam, that no one could talk on the phone or video the exam, and that we didn’t give her enough keepsake images. I’ve learned we can’t make everyone happy! Doesn’t this realization apply to just about every facet of life? Career-wise and personally-speaking?

Diagnostic ultrasound aids a physician in finding a problem. In so doing, a physician can better manage the health of mother and baby to prepare for a safer delivery. Also, she/he can prepare the family through education for the challenges that lie ahead.

What’s the Answer?

Unfortunately, there is no crystal ball in medicine. All we can do is our job, which is to find a problem. At the end of the day, I will always prefer to catch an abnormality than to miss one. And we are always over-the-moon ecstatic when we find a potential problem turned out to be nothing! Life is all about perspective, isn’t it? We can either take up residence in the victim mentality or be thankful for the blessings in our lives.

Here’s sending you blessings and well-wishes that your diagnosis turns out to be nothing, too!

You can send your comments, images, stories, and questions to me at wombviewerblog@gmail.com!

Thanks for reading!

 

Comments: 2 Comments »

Posted on August 8th, 2014 by wombwithaviewblog.com

When a patient told me today she worried about her follow-up ultrasound scan for an entire month I knew I needed to address this issue.

This scan was ordered by her doctor 4 wks after her anatomy screening ultrasound and the patient thought something was wrong with her baby.  When she revealed this, I tried to ease her anxiety by explaining the protocol of these examinations.  On the anatomy screen we have a whole checklist of maternal and fetal anatomy to measure and document.  When parts on our list are limited, and oftentimes they are, most doctors will typically bring the patient back a month or so later for a second attempt to complete the checklist.  Adequate visualization of all these structures relies on so many variables, especially fetal position.  Most of you already know that if Baby is facing your back, we just can’t obtain that portrait for which you’ve been so desperately waiting.  It also means we can’t document all the facial structures we’d  like to see.  Another example is when Baby is lying on her back; in this position, we cannot evaluate the spine adequately.

Limited visualization is very different from questioning an abnormality.  When this happens, your doctor discusses the problem in question at your very next visit, answers any questions you have and refers you to a Perinatologist, a high-risk OB doc, for an evaluation of the suspected problem and recommendation for treatment.  Every doctor manages their patients a little differently, but this is how our docs handle this issue in our practice. There are many things we see on a regular basis that are quite minor that we follow-up and manage ourselves but your doctor knows when you need a high-risk assessment.

So, if you’ve gone in for your anatomy screen recently and you didn’t get to see this:

SONY DSC

Don’t panic!

Maybe Sweet Pea will let you see his great profile next time:)

Comments: No Comments »

Posted on July 19th, 2014 by wombwithaviewblog.com

Ultrasound Advice for New Sonographers

New sonographer ultrasound advice is a topic that needs addressing for anyone new to the field. It’s a tough place out there for you. I know, I lived it, too.

A Fine Example of Negligence

I felt a bit distressed to learn something recently. It is an important lesson for any new sonographer, especially. A recent graduate of a sonography program landed her very first job out of school with a temp agency. With essentially no work experience, her recruiter advised her to “Fake it ’til you make it.” I thought I’d faint. She lied saying her recruit had one year of experience and placed her in an OB practice to work alone. The lack of responsibility of this recruiter left me surprised and horrified. The quality of exam a patient receives was obviously of no importance. This is unfortunate.

Moreover, the horror this new sonographer experienced is another story. Even though she had a brief period of training by the sonographer going on leave, she was uncomfortable with scanning or reporting anything on her own. With no experience to call on, she did not possess the confidence to call a case normal or abnormal. Where does someone even begin to construct a report when she is unsure of what she sees on the monitor? This is unfortunate and a precarious circumstance for all involved.

Don’t get me wrong. Everyone has to learn, and all new sonographers need the opportunity to become better. But, like so many things in life, there’s a right way and a wrong way to accomplish this task. It has to be fair to both the sonographer in training as well as the patient. Therefore, the following is a message to all sonographers who have just stepped out of the classroom and into the real world of practice.

Turn the Table…

From a slightly different perspective, please consider the following ultrasound advice. If it were you, your daughter, your mother, or your sister on the examination table, wouldn’t you want to know if it was the first exam performed by your provider? We all like to feel as though we are in good hands, competent hands when we seek medical attention or advice. Wouldn’t it be disconcerting to know the person scanning you is new, overwhelmed, and lacks the knowledge in all ways to perform your exam properly? Every patient deserves to have their examination performed by someone who is knowledgeable and properly trained. After all your hard work in school, you deserve to be properly trained!

Just in Case Your Instructors Didn’t Tell You…

You are not qualified to work alone. You need direct supervision from someone with qualified experience. You need direct supervision for all of your exams performed for at least three solid months. After that, you need to ensure you work in an environment with at least one other experienced go-to sonographer for questions..because you will have them. You will have a lot of them. We all did.

You should never lie about your experience, even if a recruiter tells you to do so. Potential employers need to ensure how much they can rely on your skill and experience outside the classroom. Your class time and clinical rotations count as experience toward taking your registry examinations, but it doesn’t go far toward real-world experience. You were in school and learning. You will still be learning volumes over the next few years. No one ever knows it all, and this is a field where you will continue to learn your entire career.

Students and new technologists, once you have scanned about twenty-five normal cases (give or take), you will be able to scan a normal exam on your own pretty easily. Tackling pathology is a whole other ball game. You will feel more comfortable you taking on the challenge of an unfamiliar process when you develop more confidence in your skill and ability. Everyone’s learning curve is different. If you learn new things quickly, you may feel more confident in your skills in less time. If you have a no-fear personality, you’ll have less problem jumping in with questions or presenting cases to physicians when you are unsure of a diagnosis.

What About a Private OB Practice?

Sonographers in a private practice need a great deal of experience. They need to be able to work independently and have enough confidence in their skills to tackle a challenging case without breaking a sweat. They should feel very comfortable scanning patients in every week of pregnancy with no question regarding the protocol of any exam. Do we still turn to our co-workers for a second eye from time to time? Of course, we do. It’s all part of continuing education and proactively learning where we have the opportunity to grow. It’s imperative. Remember, we never know it all!

In our office, we do not hire anyone who is not registered in OB/GYN with less than three years of full-time OB/GYN experience. How can a physician trust your work if you don’t trust it yourself? A physician relies heavily on the experience and ultrasound advice of his/her sonographers to provide competent and thorough examinations. How can they properly treat their patients otherwise?

Your job as a sonographer is to find pathology. You can’t diagnose what you don’t recognize, and you won’t recognize what you’ve never seen. This is just the nature of the beast.

Be Your Own Advocate!

I’m sorry if your educators failed you. They have a responsibility to not only teach you in the classroom, but what to expect outside of it. This is not your fault. It reminds me of an old adage which says that you can’t know what you don’t know. So, before you take your first job or any job thereafter, ask yourself if you are experienced enough to commit to it. Then ask if you will have supervision. Start out in a teaching hospital. Sonographers are thrilled to share their knowledge with you in such facilities! Learn what you need before you think about branching out on your own. You owe it to yourself in order to become a better sonographer. You owe it to your patient to provide a quality examination.

Patients: if this is overly concerning to you, it should be. You can always inquire as to the experience of your healthcare providers!

Subscribe to the blog for more ultrasound advice for new sonographers and expectant mothers!

Comments: 2 Comments »

Posted on July 12th, 2014 by wombwithaviewblog.com

Technology has its pros and cons. We THINK we want to know the second we conceive…but do we really? When all we can see is early first trimester sacs, your doc cannot confirm the pregnancy is off to a good start. At least not until we can see an embryo and strong heartbeat at 6 Weeks. Some patients find out that (often times) ignorance is bliss. The wait is long and miserable! This is why your doc will elect to scan you around Week 7 or 8.

Early First Trimester Sacs – Week 4

Very early in the pregnancy, less than 4 Weeks gestational age, we can’t see a thing. To clarify, we start to see a gestational sac at around 4 Weeks. This sac will measure only about 2mm and will literally appear as a tiny black blip within the uterus. All we can report at this time is that we think it’s an early sac.

Week 5

Monumental changes are happening every week!  At 5 Weeks pregnant, we see a much bigger sac. However, it’s only enough information to say, yes, the sac has grown, it measures around 5 Weeks, and that is good. Around 5 1/2 Weeks, we should see the presence of a yolk sac. It looks like a little circle inside of the sac and provides nutrients for Baby who is still too tiny to see by ultrasound. Below is about a 5 1/2 Week pregnancy of twins (obviously! Dichorionic/Diamniotic or fraternal).

Yolk Sacs, 5 Weeks pregnant, twin pregnancy, early first trimester sacs

 

Week 6

6 Weeks pregnant, 6 Week ultrasound, 6 Week embryo

By the next week at 6 Weeks gestation, an embryo measuring about 3.5mm with cardiac activity should be seen! A nice, round yolk sac and a bigger gestational sac factor into what we expect for this exam. Baby is still very tiny, and it can be difficult to visualize well if the embryo is lying against the wall of the gestational sac.

At 7 Weeks we can see a little better, and Baby is a few mm larger. But 8 Weeks usually gives us a great image of what we want to see!

Week 8

Baby, on your 8 Week ultrasound, is much easier to measure at this point.

8 Weeks pregnant, 8 Week ultrasound, early first trimester

Isn’t the growth in two weeks incredible?!!!

It’s all a process of Mother Nature. It can’t be rushed, and only time will tell if your pregnancy is growing appropriately! If you think you are farther along by your LMP (last menstrual period) dates, we perform an ultrasound, and we don’t see what we expect, it can feel like such a long wait! There’s no way to know whether the pregnancy may not be progressing normally or whether you may just be too early!

It’s so hard to wait. And it may feel like the longest week or two of your life before your doctor orders another scan!

What most women do (and I caution you to not!) is to talk to friends and family and search Dr. Google furiously for what to expect. Only no article or blog post can predict the outcome, and only that next scan will (hopefully!) give you answers.

Here’s sending you best wishes and much-needed patience to all you expectant moms out there!

Email me at wombviewerblog@gmail.com with your questions or comments:)

 

Comments: No Comments »

Posted on June 29th, 2014 by wombwithaviewblog.com

Internet Pregnancy Advice Isn’t Always So Reliable!

I know it’s such a difficult temptation to resist, but Dr. Google really isn’t the best doc to consult when you’re experiencing questionable symptoms. Especially, not when it comes to pregnancy, and practices across the country see it every week. Relying on Dr. Google for internet pregnancy advice only opens a can of worms causing more fear and worry…and more questions.

We’ve probably all done it at one time or another. Isn’t it just so easy to click on a Symptoms Checker or post your question onto your pregnancy group’s community forum? Maybe someone else has experienced the same thing, it turned out to be nothing, and your fears can be put to rest? The problem is that no one else in the world is you — or your baby.

We would see this quite a bit in the practice I worked for — a patient is given ultrasound results by her doctor, she goes home to Google the information, and then calls back to the office in a complete panic over what she’s read. The internet is filled with more information than we need and more than applies to you in your pregnancy. You are likely causing yourself more worry than necessary.

TMI

What you’re getting in your internet searches is the whole spectrum of findings and worse-case scenarios. This is also the case on almost every blog and site, no matter how credible. In your forums, you have other pregnant moms with no medical background, all discussing their results with only partial knowledge of her case and missing links. At the end of the day, twenty people experiencing pain may yield seven different outcomes. And because people gauge their symptoms differently, there’s no way for you to compare their level of pain to your own.

You know, as humans, we’re a bit flawed in our thinking. We tend to convince ourselves of what we believe to be true, whether that information holds water or not. The last thing you want is to read something which convinces you that you don’t need to call your doctor when you really should have. Don’t convince yourself a problem isn’t real; let her staff ask the important questions and determine whether you need to be seen!

The Best Advice!

Your doctor is your best resource for managing your pregnancy and any potential problems which may be associated. Only she/he holds your chart full of pertinent medical information about you and your baby. Your obstetrician can examine you and listen properly for your Baby’s heart tones or perform an ultrasound. Only your doc can advise you on what the next step should be or determine if ordering further testing is warranted. Whatever your concern, discuss it with your obstetrician or other healthcare professional managing your care.

And in case you’re more concerned with bothering your doctor after hours, this is precisely the reason for on-call staff around the clock! Your physician is your best advocate. He would rather you ask him (or his qualified staff) than your friends or family.

*FYI*
If you begin to experience your symptoms early in the day, don’t wait to call until midnight!
(To clarify, this doesn’t mean not to call because it’s midnight — just not to wait!)
 Don’t wait to see if your problem will go away. They’ll want to know about it sooner than later!
Also, you don’t want to put off treatment if you need it.

Remember this. Dr. Google cannot lay hands on you, examine you with his handy-dandy speculum, advise you, console you, or discuss test results. This is why you have an obstetrician. Moreover, Dr. Google didn’t attend so many years of medical school and surely won’t be the one to catch your precious bundle of joy on his or her birthday.

Direct all your concerns to one who will be — that’s why she’s in the baby business!👶

You can email me at wombviewerblog@gmail.com with any questions!

 

Comments: No Comments »

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.

***

This is our swimming ool.

Notice there’s no p in it.

Let’s keep it that way.

***

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;)

 

 

Comments: No Comments »

Posted on June 18th, 2014 by wombwithaviewblog.com

I would love to share this really funny experience with one very over-protective Dad.

A couple of years ago, I had a patient who was coming in every week for BPPs or Biophysical Profiles as they are called. I explain this exam in greater detail in the link above, but it is simply a way to determine the well-being of a fetus by scoring the baby on his/her movements. We also measure Baby’s amniotic fluid and monitor Baby’s weight, as well.

During these scans, babies are sometimes napping…or maybe lazy. Sometimes we have to “force” a little movement by nudging baby which we accomplish by poking at mom’s tummy. If Baby is REALLY asleep, we sometimes have to poke quite a bit. I, of course, always ask Mom if I am hurting her. And I’m surely not hurting Baby. Your Little Love Bug is well protected by the amnion and fluid and mom’s uterus which is, essentially, one big muscle. But Dad, on this particular day while joining Mom for the visit, felt that I was — and he let it be known.

I start poking around on Baby and Dad pipes up saying, “You need to stop that. You’re pushing too hard.” I assured him that I wasn’t and asked Mom again if I was hurting her. She actually laughed a bit, stated she was fine and instructed me all to just continue doing what I needed. She also tried to calm Dad, but he wasn’t having it. After a little more vigorous poking, Dad said, “You’re gonna cause Shaken Baby Syndrome!” Some Dads joke about this, but this one was serious. Mom laughed out loud, and I reassured Dad that Baby was well-protected in there. We certainly would never do anything to, intentionally or otherwise, cause harm to his little one.

He eased up but wasn’t happy about it. He was starting his job early…over-protective of his baby girl before she ever even arrived.

Comments: No Comments »

Posted on June 15th, 2014 by wombwithaviewblog.com

First, I’d like to extend a huge congratulations to a reader who recently delivered!👶 I love answering your ultrasound questions. I love it more when I actually help a reader. This is what she had to say…

Hi! I hope you had a lovely time on your holidays. Just had to say I had a little boy at 38+5, and he was a MASSIVE 8lb 7oz :)  Not half as bad as I imagined. Many thanks for your help to me!

Feedback and Your Ultrasound Questions…

I’m always excited to get your feedback! The whole point of my blog is to answer questions you have about ultrasound accurately. Considering the vast forums on pregnancy where everyone chimes in on their personal experiences, taking to heart unreliable information has the potential to do harm to you or your baby. Everyone is an expert; everyone has an opinion. Though I believe most genuinely care and try to help, I have found much about ultrasound to be misleading or incorrect in some way.

I have loved breaking the news to expectant parents about whether they would be shopping for pink or blue! And I’ll still be happy to try to decipher someone else’s images for my readers. In my effort to bring to you factual and truthful information about your ultrasound examinations, part of that truth is doing my best to help you understand your exam. Ultrasound will always be, first and foremost, a medical examination of mother and child. Your sonographer needs enough quiet and concentration to ensure your baby appears healthy! Afterwards, break out the party hats, and let’s have some fun!🎉 Of course, the level of fun completely depends on how photogenic your new addition is feeling that day. Poo, sometimes, it just isn’t what you expected, even when you lost sleep in anticipation😫

That said, the highlight of many workdays revolved around very happy couples who were mindful of why they were there, so happy to be expecting, and loaded with ultrasound questions! I love to impart  ultrasound knowledge to anyone willing to learn it. If I could also deliver a few awesome keepsake images of their future addition and enjoy a few laughs in the process, all the better. I still feel honored to have been a third objective party who was privileged to orchestrate it all!

Best wishes for a beautiful experience!

Email wombviewerblog@gmail.com with your comments, questions, pics and suggestions!

I’ll do my best to answer them for you!

 

Comments: No Comments »

Posted on May 24th, 2014 by wombwithaviewblog.com

Today’s post is all about ribs but not the kind we love to bathe in barbecue sauce. It’s all about fetal ribs today.

Bone on ultrasound shows up white because it is very dense. Water, on the other hand, is the opposite and shows up black. Ultrasound cannot travel through bone, so as your baby’s bones become more dense, they cast a shadow behind them. Viewing certain parts behind them become a challenge, like the heart.

Next time you have a scan, notice the appearance of  baby’s bones. Look for the perfect black lines of the shadow behind the bone. Notice we cannot see anything in that shadow. Therefore, anything that lies behind bone is not well seen.

Take a look at the image of this baby’s ribcage below. Notice the arrows pointing to the white dots which represent the fetal ribs and the black shadow that follows each one. Ultrasound 101. You’re quite welcome!

SONY DSC

 

 

Comments: No Comments »

Posted on May 8th, 2014 by wombwithaviewblog.com

I LOVE IT!  What a breath of fresh air I received from a reader – someone who actually wants to avoid fetal sex determination! Now, don’t get me wrong. Though I held off on the potty shot for my first, I was a full-time certified sonographer working several years by the time the second came along. I personally couldn’t wait to see for myself. I even scanned myself in the process (we all do this, by the way)!

This post comes from someone who definitely fits into Club Minority. She wanted to wait for The Stork, but that was just not good enough for everyone else in her family!

distressed mama:  Hello, I’ve really enjoyed reading your blog. From everyone’s posts, I can see that I am in the minority — my husband and I want to be surprised with the sex of the baby on the day I deliver.
We got the anatomy scan a few weeks ago, and the tech was very respectful of our wishes. She didn’t reveal the sex to us, and we left with the attached pictures.
We sent my sister the top picture in a text message. Upon seeing it, she immediately said, “I think I know what it is…,” and blurted out her guess. That really bothers me because it seems that the rest of my family believes her and is taking her opinion as fact. I still don’t want to find out, but I don’t want anyone else to be so certain that they know, either!
Based upon the first picture in the set of 3 I’m sending, is the sex of the baby obvious to you? I figure that if you can’t tell, then my sister who is NOT a trained ultrasound tech can’t tell, either!
Thanks for your blog, it’s always fun to hear what you think about these ultrasounds from “the other side” of the wand!
fetal sex determination

wwavblogger:  I LOVE IT!!  First things first. Absolutely, positively NO genitalia in that shot whatsoever! The black oval in the pelvis is baby’s bladder and I’m guessing she thinks she sees something just above that which is a very small section of umbilical cord at abdominal insertion. Either way, you are totally correct in that if I can’t see parts, neither can anyone else! Tell your fam they have a 50/50 shot at guessing;)

***

Everyone the expert, right? And, yes, the desire is overwhelming for patients to know gender as soon as the pee stick shows +. However, sometimes the desire comes more from the family than the patient!

From the other side of the wand, I can tell you people often believe what they want to see, not what’s really there. Distressed Mom, be sure to let us know what The Stork drops at your door!
Thanks for reading!
Have a similar story? Do you desperately want a surprise?
Is your family driving you nuts with constant harrassment to find out?
If so, email me with your experience at wombviewerblog@gmail.com!

For your most reliable ultrasound information, subscribe here.

 

Comments: No Comments »

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!

Comments: No Comments »

Posted on April 22nd, 2014 by wombwithaviewblog.com

Mistaken Fetal Gender Guesses

It’s possible. We’ve all heard a story or two, right? Being too early in gestational age is one way to ensure mistaken fetal gender guesses. Baby insisting on keeping still in a difficult position doesn’t help, either. There’s more at stake here than just being “wrong.” Parents start to identify with being a mom or dad to a new baby girl as soon as you speak the words. Thoughts jumpstart to dance recitals and her wedding day. Dads immediately daydream of the fishing partner they always wanted, or they run out to buy his first tiny baseball glove.

These are strong emotional ties that often get broken when someone casually throws out the gender card on ultrasound. Beyond the need to return some beloved items, comes the sometimes feelings of guilt or loss when the true gender is identified.

How “Mistaken Identity” Affected One Mom:

reader:   This is my second pregnancy and I am 18 Weeks. At my 20 Week ultrasound of my first pregnancy, I was told by the head ultrasound doctor (radiologist?) that it was definitely a girl, and I picked out a girl’s name. I ended up going into labor early at 30 weeks.

At the hospital while an ultrasound was being done, I kept asking if she was ok. The poor tech said, “Why do you keep saying she? Were you told it was a girl?” We said yes. She said, “Well, I see a scrotum. I’m going to get the Dr.” So, it turns out we were the first time this head doctor ever got it wrong, and now we are legend at his hospital.

We were already calling the baby by the girl’s name we picked, and I had a really hard time with the news. The only way I can describe it is like I had to grieve this little girl I had in my head that was suddenly gone. I wouldn’t change a thing about the amazing toddler boy I have now. But at the time, I was a wreck. Needless to say, I don’t want to go through that again. I was told today that the baby is a girl (again), and it is hard for me to believe. So, I just want to see what you think!

18 Weeks pregnant, female gender, mistaken fetal gender

 

wwavblogger:  Wow! Your story is EXACTLY the reason I implore sonographers to give careful and cautious consideration when determining gender!

I learned many years ago that even if I say I am not sure but give a “possibly,” parents are already thinking ballet slippers and pink tutus or sailboats and whales! It’s so true.  It’s just an emotional attachment you begin to develop as soon as an inkling of pink or blue is mentioned.

 Now, not having scanned you real-time myself, looking at one single image can be tricky. By this image only, it looks like dance recitals may be in your future! It does appear like the typical three lines we see in a baby girl. Just know that I can’t guarantee it, though! PLEASE, send me another image of gender every time you have another scan in this pregnancy, especially since she already has the perfect name!
***
Did you or someone you know experience a case of mistaken identity by ultrasound?
If so, feel free to email all about it at wombviewerblog@gmail.com!

Comments: 5 Comments »

Posted on April 6th, 2014 by wombwithaviewblog.com

Studying ultrasound is no easy task. Actually, it was the most difficult and challenging thing I’ve ever done. Check out the email I received from my ambitious Aussie reader below:

reader:  Hi there, I just wanted to start off by saying I love reading your blog!

I especially wanted to message you because, whether I’m the first person to say so or not, mothers aren’t the only readers you have!
I am not pregnant, (or even anywhere near the ballpark of having children!), rather, I am extremely eager to pursue sonography as a career, specialising in Obstetrics and Gynecology so I can do what you do. Showing parents their children for the very first time is such a special moment that it would make all of the hard work and waiting worthwhile.
You truly inspire me and keep me motivated, as currently I’m only starting my path towards becoming a sonographer. That’s because sonography is a post-graduate course, and I am new to university this year. (Thus, about 3 years before I can even begin studying ultrasound)
I hope that you take pride in knowing that your blog is bringing comfort and joy to parents as well as inspiration and motivation to people like me. I really do see you as a role model for the type of professional that I would like to be in the future. Please keep up the amazing work!
You are blessed to have such a rewarding career, even with the ups and downs of pregnancy. I am not so blind as to think that pregnancy is always complication free, especially as a reader of your blog, but I know that the smiles on the faces of just one happy couple could make any day a great day.
I’ll be silently cheering for you to continue blogging!
***
I wish her and every other aspiring sonographer the best in their ultrasound endeavors. Best advice?
 Don’t be afraid to ask questions for as long as it takes to reach clarity.
I’d love to add a message for sonographers, especially those who are new to the field. A quality exam is important. Your thoroughness, accuracy and attention to detail can determine whether your patient goes to surgery or goes home. Ultrasound, being the most operator-dependent modality, requires great experience. I recommend all newly-certified sonographers work in a busy hospital where education and supervision are emphasized. You should NOT try to work in a clinical setting alone right out of training! It will take time for you to recognize pathology on your own. You WILL miss pathology, and it will be a disservice to your patients. I cannot emphasize this enough. Ask questions of your supervisors and physicians. Ask for supervision while scanning. Look up answers. Become informed. Details matter. Talk to your patients and listen. It’s important they feel you care about why they are seeing you. Don’t just be a good sonographer, be a great one. Your patients deserve it. Good luck in your ultrasound career where education and the opportunities to learn are endless. We never know it all so keep challenging yourself!

Comments: 1 Comment »

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!

Comments: 1 Comment »

Posted on March 15th, 2014 by wombwithaviewblog.com

Or, rather, Estimated Fetal Weight. This is the approximate weight of the fetus after we measure the head, abdominal circumference and femur.  Our machine takes this information and plugs it into the software to estimate Baby’s weight.  I’ve posted on BPD, HC, AC and FL before so I won’t focus on HOW we get those measurements today, but instead, the accuracy of them.

I am asked several times per week, “Now how accurate is this weight?”  Are we always right on with birthweight?  No.  Are we always close?  Another no.  But MOST of the time, we are.  It is an educated guess and based only on the measurements WE take and there are many variables that play into obtaining those properly.  As baby gets closer to the EDD (Estimated Date of Confinement), Baby gets bigger, the head becomes more engaged, and the fluid can start to diminish a bit. There is only one right way to measure Baby and all of these things make her harder to see and these measurements more difficult to obtain, especially depending on Baby’s position.

Also, Baby is packing it on in the last month!  Average growth is about 1/2lb per week!  If you’re baby is trending heavier, Baby will usually gain more than the 1/2lb and if trending smaller, then less than 1/2lb per wk.  This is why when a patient comes in at 32wks and asks how much I think her baby will weigh at birth, I always say “If I could predict that, I could have retired a long time ago!” Sometimes babies grow in spurts, too.  We might see a huge head at 30wks and a few weeks later see that everything else caught up.  So, NO WAY to predict!

Technically, our software tells us at term to figure plus or minus 1.5lbs. However, IF I feel that I am getting really easy and accurate views of the head and belly (especially the belly since most of the EFW comes from the AC or abdominal circumference), then I feel pretty good to say that I may be over-estimating by about a 1/2lb.

Remember, if you get an ultrasound and an EFW at week 38 and you deliver at 39, don’t forget to add in that extra poundage!

Here’s to a fat and happy fetus!

And if you have stories you’d like to share or questions about weight, feel free to email me or comment on this post!

Thanks for reading,

wwavblogger 🙂

Comments: No Comments »

Posted on March 1st, 2014 by wombwithaviewblog.com

What exactly do I do? Let’s break it down. This information will definitely be helpful to anyone interested in training for a career as a sonographer. Many are fascinated by ultrasound! So, this may also be an interesting read for those who are merely curious about what we do. This may also be a little long, so hunker down with a good cup o’ joe.

Ultrasound is very technical, so attention to detail is of great importance. We work in the millimeters, so spacial concepts and 3-dimensional thinking are necessary. We can visualize mentally what we are only partially seeing on the monitor. For new sonographers, this gets easier with improved scanning ability over time. None of us were great sonographers right out the gate!

So, what am I? I have many names…sonographer, ultrasound technologist, ultrasound tech or technician. A certified sonographer is someone with a couple of years of experience who has passed a Physics exam and one specialty examination (like OB/GYN). You then earn the credentials of RDMS, Registered Diagnostic Medical Sonographer. There are many other examinations for which one can earn more credentials.

We start off with some book knowledge. We learn medical terminology, A&P, pathology (disease) and how it presents, ultrasound physics, biology, and examination protocol, for example. In my particular training, we started clinical rotations where we visited different clinical settings for a period of time. We would follow other more experienced sonographers to observe examinations. I learned a little about the technologist/patient relationship like what to say and (most importantly!) what not to say.

We also learned how to present our examinations to the Radiologist, the reading physician. You better have all your ducks in a row here, people! They are tough. They can and will ask you a hundred questions, and you better have the right answer waiting. Like any other profession, some are easier to work with and offer more guidance. Some, well..don’t. After you are more experienced and have proven yourself time after time, the tough ones let up a little:) They know when a sonographer knows her stuff, and they know when they can trust your skill and ability. It just takes time.

We learned how to handle patients in hospital beds, how to transport them, and how to handle their catheters. Learning to keep urine, vomit, or blood off your person was a good time, too! We also learned what to do if it happened anyway and how to not get sick yourself. It doesn’t help your patient! If you have a good teacher, you also learn how to handle patients with dignity and respect. It’s hard for someone to feel that when they lie in a hospital bed. In an outpatient setting, you learn that patients are the lifeblood of a practice. When dealing with the general public, you can’t always say what you want, and you have to learn to filter.  This is sometimes VERY HARD to do!

A sonographer learns scanning ability with hands-on training with a machine and an experienced sonographer at the helm. Ultrasound machines are very much like most computers. They all have the same basic functions, but some have a few more bells and whistles than others. We learn what something looks like by watching someone else.  S…l…o…w…l…y over time we begin to be able to recognize parts ourselves. Then we take over the probe. We have to learn how to hold it and find the parts ourselves. We learn how to properly measure organs and how to adjust 40 knobs so that the image looks the way it should. Additionally, we have to learn image protocol which includes what images to take and how many.

Eventually, after a few months of scanning, these technical details become second nature. As soon as the probe touches the skin, we set about making our image look as needed without much thought. It is only then that we start to recognize pathology. Sometimes, disease processes present exactly as one learned from the book, sometimes not. Oftentimes, we see something we know is NOT normal, but we can’t exactly put a name to the process. What students need to know is that one of the most important things they’ll learn about ultrasound is to first learn what “normal” is.  Once one scans many normal exams, it is much easier to recognize when something is wrong.

We learn all the above for many different parts of the body! Some aspects of ultrasound include Intracranial and Peripheral Vascular (vessels of the arms and legs), Echo (the heart), Small Parts (breast, testicle and thyroid), Abdominal (all abdominal organs and vessels), OB or Obstetric (maternal and fetal), GYN or Gynecology (pelvic organs in a non-pregnant female), and many others. Ultrasound is also performed on the eyes and in more recent years, muscles and nerves. We also spent a bit of time learning about biohazard waste management and HIPAA regulations that keep patient information private.

Over time and with more experience, we learn how to better manage our patients and case loads. I say it’s a process with a long learning curve, especially for anyone starting out with no medical background. At times, I cursed my choice of career, place of employment, and certain unpleasant physicians. I sometimes cried before and after a particularly hellish workday or weekend of call. It was the hardest thing I’ve ever done. BUT I did it. And slowly but surely, the puzzle pieces came together. They began to fit in a way that brought light and clarity to every exam I performed. Suddenly, it just started to make sense.

When I began to ask more questions about something I didn’t understand, I received better response from docs I admired for their extensive education, intelligence, and knowledge. You can’t be afraid to ask questions! It’s important to your docs, their practice, and patients. It’s also important to you, the sonographer, for your own developing skill and ability. This confidence grows over time! It’s a great feeling when you finally get to this point.

To this day, I still get a rush when I recognize pathology and all the puzzle pieces come together. It makes me happy when I can explain something to a patient that gives clarity to her understanding. There’s nothing like a “thank you” (or even a hug!) by a patient. And who doesn’t love positive feedback by a physician who says you did a great job? As difficult as my career was in the beginning, I’m still at it after 23 years. And year after year, post all the blood, sweat, tears and pain, I feel I’ve come a long way:)

 

Comments: No Comments »

Posted on February 20th, 2014 by wombwithaviewblog.com

What’s the NT Scan?

The NT or Nuchal Translucency scan is a first-trimester ultrasound screening test for chromosomal abnormalities which I performed for a couple of years. Sonographers require special certification in order to perform this examination. I will not get into any serious depth regarding the types of chromosomal problems relative to what’s included or excluded. I am not a doctor or geneticist! Ultimately, only your doctor can give you the most pertinent, accurate, and up-to-date information as well as answers to all your questions on the subject! I am literally only scratching the surface here from an ultrasound standpoint.

Email From a Reader with Questions

reader:  I just read about NT scans and how they can be a way to detect Down syndrome. My doctor never mentioned anything about this to me. Do you think it was done during my 12-Week dating ultrasound? Or is this something that you need to specifically request? I’m 29 and have no family history, so I’m not sure if that’s why it wasn’t offered. After my 12-Week ultrasound, she did offer other tests. But she said I wasn’t high risk, and we opted not to do them. Thank you for your time!

wwavb:  I can certainly chime in on this because I did the NT scan for a couple of years. So, I know a bit about them. Actually, you answered your own question! The tests that your doctor talked to you about may have included the NT scan, but you opted not to do them.

The NT scan is an attempt at a measurement of the nuchal area along with a finger stick. The nuchal area is a fold of skin behind Baby’s neck. But we cannot always obtain this measurement. It is probably one of the most tedious examinations I’ve done, and this measurement can only be taken one way. There are a number of variables which depend mostly on fetal position that dictate this. If we can’t obtain the measurement, we cannot perform the test.
NT measurement
If all the stars align, and we actually do obtain this measurement — yay! Success. The sonographer fills out a form which she sends to the lab along with your blood. The lab takes the measurement from the scan and some numerical values from your blood and personal history. All the values then plug into a formula.
The result determines your risk or chances for having a baby with certain chromosomal abnormalities – Down Syndrome is one. This result does not tell you whether your baby has these abnormalities or not, only your risk for having a baby with this problem. If it comes back elevated, you have to then decide whether you want to proceed with other tests like amniocentesis. An amnio can determine if your baby has a particular one of these abnormalities.
For your greatest clarity, you should ask your doctor at your next visit if the NT is something she would have offered. If you have a concern and would like to look into genetic testing, certainly discuss with your doctor what options she would recommend for you. She is your best educator!
*** 
Hope that helped!
Here’s to your happy and healthy pregnancies!
You can email your questions, pics, stories, or comments!

Comments: No Comments »

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.

Comments: No Comments »

Posted on January 25th, 2014 by wombwithaviewblog.com

A lot of people get confused by this.  LMP or last menstrual period is used to determine how far along you might be.  So the first day of your cycle that you started your period is Day 1 and most people get pregnant about mid-cycle, around Day 14.

However, when calculating gestational age, all calculations are measured by LMP.  We know you didn’t really get pregnant until about 2wks later and you may wonder why those two weeks are counted before you were ever pregnant.  It’s just because that’s how it’s always been done.  Way back in OB provider history, no one knew when they actually became pregnant.  All they could go by was the first day of your cycle, so then all types of charts and equipment were made and calibrated for such. People tend to conceive at different times anyway.  There are not many out there who know the exact day of conception (unless they had some help with IVF, etc.).

So, if the first day of your last period was December 1, you would be considered about 7w3d by gestational age today.  And if your dates are consistent with what we see by ultrasound at that time, we would see an embryo that measured about 7w3d +/- a few days.

That’s my ultrasound lesson for the day:)

Comments: No Comments »

Posted on January 23rd, 2014 by wombwithaviewblog.com

What Exactly is Ovulation?

So let’s go way back to right before you found out you were pregnant. A couple of weeks before your baby started developing, you ovulated. Most people have a huge misconception about ovulation, ovarian cysts, and how your ovaries really function. If you have a period every month, then every month your ovary makes a cyst which ruptures and releases an egg…yep, that’s ovulation!

What’s LMP?

Your LMP (Last Menstrual Period) refers to the first day of your last period. This is Day 1 of your menstrual cycle. We also know that most women ovulate between Days 10 and 14. Some people have over-achievers for ovaries and ovulate sooner; some are late-bloomers and ovulate later. You might know which camp you belong to if you have really short cycles or really long ones!

Some people don’t have regular periods. Some may even skip several months at a time! If you are one of those women and you desire a pregnancy, you may need to see your gynecologist/obstetrician. Your eggs may need a little coaxing to get on board with the plan!

The Functional Cyst ~ Not All Cysts Are Bad

Everyone starts out with a bunch of follicles (little fluid-filled sacs) on the ovaries. Each follicle contains an egg. At some point early in your cycle, one of the follicles starts to get bigger and bigger. A follicle that reaches about 2.5 cm is considered a cyst. A functional cyst is expected to rupture once it reaches the 3 cm mark (or slightly greater) — aka, ovulation. One example of a follicle and functional, or ovulatory, cyst are pictured below:

ovulation, functional cyst, ovulatory cyst

Functional Ovarian Cyst – wombwithaviewblog.com

Sometimes we feel mid-cycle pain (sometimes resulting in an ER visit) when the cyst ruptures, especially if it is larger than 3 cm. However, most women never know when they ovulate.

When Cysts Are Not Ovulatory

Many patients equate a cyst on the ovary to something bad. After all, it’s what we hear about most. The ovary can make bad things like any other organ in the body. Not all of them are malignant, or ovarian cancer. They can be non-cancerous (or benign) but may require follow-up or even require surgical removal depending on its size and other circumstances of your particular case. Of course, only your doctor can answer these questions for you!

Egg on a Mission

Once your functional cyst ruptures, the egg sets out on her journey. If she stays on her course, your egg travels through the tube and into the uterus. If sperm is there to fertilize it, great! I’m in business. If not, Tampax is, and two weeks later you have another period. Oh, joy.

I don’t care what any commercial claims… Unless you’re wearing a diaper, you’re better off leaving those white shorts folded safely in your dresser. Don’t even think about it! Ever wonder exactly how many panties, shorts, and sheets we women ruin with our monthly friend? 😵 It’s a conspiracy!

***

So, I hope this post helped you understand the whole monthly thing. Many of my patients seemed to be surprised to have a cyst on the ovary or worried it was something concerning. Creating a functional cyst is simply a monthly event for most people.

And if you’re extra special, your ovaries might even double the fun. If so, you just might need TWO of everything at your baby shower! 👶👶


8 Week Twins, Week 8 twins, di/di twins, ovulation

Any questions for me? Great! Email me at wombviewerblog@gmail.com!

 

Comments: No Comments »

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!

 

Comments: No Comments »

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!

Comments: No Comments »

Posted on January 10th, 2014 by wombwithaviewblog.com

That may be a reference to the limbo, but it’s also a term used for where that head is located in the pelvis as your pregnancy is nearing its end.  Many patients say they feel as if baby has dropped and ask me if their baby’s head is low or if I can tell how low it is.  Nope.  The station of the fetal head is more of a feeling thing that your doctor assesses with a physical examination.  With ultrasound, we can sometimes see that the head is SO VERY low to the extent that we have a hard time actually measuring the head at the proper level.  When this happens, we will say that the head is so low that it is limiting the exam but we can never really “see” how low it actually is.

Either way, at this point in the pregnancy, you know that light at the end of the proverbial tunnel is in your near future.  Yippee!

Comments: No Comments »