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Abnormal Fetal Ultrasound?

Consulting Dr. Google About Your
Abnormal Fetal Ultrasound

 

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

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

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

If Your Doc Wants to Refer You

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

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

If Your Report is Normal

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

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

As always, thanks for reading!

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

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Fetal Demise – The Hardest Part of Our Jobs

Fetal Demise

The hardest words to hear as a parent-to-be. The hardest words to utter as a healthcare provider. Patients or family who have never experienced such a loss look often look at me oddly. When they exclaim that I must have “the most fun job in the world,” and my response is that I, in fact, do not. People frequently refer to a career in OB sonography this way. I then have to explain why; nothing about discovering a fetal demise is fun.

I’m often asked if we tell a patient when we see something bad. My answer is always, “For the most part, no.” And I go on to explain that it’s my job to find and document a condition or pathology and to discuss my findings with her physician. It’s then her physician’s job to discuss the findings with her, to answer any questions she has, and to discuss the course of management of her pregnancy. Only your physician can fully answer all the questions you may have about potential complications in your pregnancy.

However, there are times when we have to speak up. When I set the probe down on a patient’s belly to smear the gel, I sometimes know instantly that I’ve detected a major fetal malformation. And sometimes, (thankfully, not a frequent occurrence) we know immediately there is no cardiac activity. A parents’ first instinct is to ask to see their baby’s heartbeat. These circumstances require me to break the unfortunate news to the patient. Otherwise, she is expecting me to narrate cute images of Baby’s face, take measurements, and show her that beating heart.

Typically, I will scan for a second with all attention on Baby’s heart. I’ll then direct my attention to my patient, show her where I should see a heartbeat, and express my sincere apology. I’ll attempt to give her whatever comfort I can, for as long as I need to do so. I’ll then explain that I need to alert her doctor. Most often, the physician will come in and observe as I scan real-time, holding her patient’s hand in an attempt to provide support.

I try to work quickly to document necessary information. We measure Baby’s femur (thigh bone) to estimate gestational age at the time of death. We must take images of any identifying abnormalities in an effort to determine cause. At times, the physician can assume a chromosomal issue; oftentimes, they may have no immediate explanation in light of prior normal diagnostic scans.

Usually, as the patient and/or spouse and family experience the shock and emotion of such a tragic event, we put our entire schedule on hold. These are the only moments we couldn’t care less about keeping on track with appointments. I always gave these patients priority — a little time and privacy to grieve together before escorting them to their physician’s exam room or office.

It’s a sad and frightening time for mom and dad and dis-heartening for the providers. I know that our physicians value the relationship they have with their patients. They want to grieve with you, console you, and attempt to answer the flood of questions sure to follow. An unexpected fetal demise is one of the most difficult experiences for our patients. None of us ever want to deliver such news; unfortunately, it’s the dark side, the lowest valley of an otherwise seemingly joyous career.

Our job is to wear a brave face, but please don’t take this as a lack of empathy. Even though we may seem stoic, whether with you or after you leave, we cry for you, too.

Many blessings to all you expectant parents out there!
If you’ve experienced a pregnancy loss, I hope this helps!

 

Fetal Malformations – The Challenging Poker Face

Fetal malformations make up part of our job…

And it’s one we like least. Diagnosing major fetal malformations that are extremely rare. Most sonographers in general OB only find a few in a long year career unless she works in a high-risk facility like Maternal Fetal Medicine.

I can’t talk to the patient about what I am seeing, knowing the bomb will drop as she visits her doctor and he/she explains the ultrasound results. Even as I scan, I feel a vast array of emotions that I must hide. Many times the physician comes in to observe such a scan. But when this scenario is not the case, every result must come from her doctor. You can read more about why here.

Your doctor has built a relationship with you during your pregnancy, your physician is in charge of your care, and only your physician can fully explain the scope and nature of this abnormality. Furthermore, you will surely have 100 questions about how it will affect your pregnancy and the prognosis for your Baby. Only your doctor can answer all of these questions; the sonographer simply cannot.

The greatest challenge for any sonographer is to act like nothing is wrong. Many times, all I wanted to do was to put my arms around my patient and give her a big hug. Instead, I have to force a smile, hand her a few images, and tell her where to wait for her doctor.

She’s been on my mind all night…