Posted on July 27th, 2017 by

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


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Posted on September 14th, 2014 by

I do believe this has been one the hardest and longest workweeks I’ve experienced in a really long time, maybe even years.  It was really a combination of so many things..full schedules every day, lots of pathology to document (which takes so much more time), patients not showing up on time and problems we see which require the physician’s immediate attention.  No, my job is not always “the most fun job in the world”, as patients will frequently refer to OB sonography.

The worst-case scenarios are those where we discover a serious fetal problem; fortunately, this is not something we see very often but is nonetheless always tragic when we do. I get asked a lot by patients 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 discuss my findings with her physician. It’s then her physician’s job to discuss the findings with her, answer any questions she has and discuss the course of management of her pregnancy from there.  All the questions a patient may have regarding the findings can only be answered by her physician.

However, there are times when we have to speak up.  When I set the probe on a patient’s belly and smear around the gel, I sometimes know instantly that I’m seeing a major fetal malformation and/or that there is no cardiac activity to be detected.  It’s these circumstances that require me to break this news to the patient, otherwise, she is expecting me to narrate cute images of Baby’s face, take measurements and show her a beating heart.  When none of this is possible, I have to be honest with her.

Typically, I will scan for a second, look at the heart and set down the probe.  I’ll direct my attention to the patient, express my sincere apology and tell her that I’m simply not seeing a heartbeat today or I’m seeing some serious problems with Baby.  I’ll say that her doctor is there (or not there) and that I will discuss what I’m seeing with her doctor who will see her next and answer all her questions.  Sometimes, the physician will come in and observe as I scan real-time, sometimes it’s not necessary as the images speak for themselves.  I have to measure Baby’s femur to estimate gestational age and take images of any identifying features or abnormalities as well as anything that appears normal so that your physician may be able to determine cause. At times the physician can assume a chromosomal issue; often times they have no explanation and will offer an autopsy after delivery.

Usually, as you can imagine, the patient and/or spouse and family are emotional and we take them immediately to her physician’s exam room or office so that they may have some privacy. It’s a sad and frightening time for mom and dad and dis-heartening for your physician, too.  I know that our physicians value the relationship they have with their patients. They want to grieve with you, console you and answer any questions you have. An unexpected fetal demise is one of the most difficult experiences for our patients. None of us ever want to deliver such news. Even though we seem stoic, sometimes whether with you or after you leave, we are crying for you, too.


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Posted on July 3rd, 2012 by

Diagnosing major fetal malformations that are extremely rare and that most sonographers only see once or twice in a 20 year career unless she works in a high risk facility like Maternal Fetal Medicine is one of the most difficult aspects of my job.  I can’t really talk to the patient about what I am seeing, only for her to have a bomb dropped as she visits her doctor and he/she explains what was seen on ultrasound.  Even as I scan, I feel a vast array of emotions that I must hide.  The reason for this is because this news, as devastating as it is, must come from her doctor.  This is the person the patient has built a relationship with during her pregnancy, her physician is in charge of her care and only her physician can fully explain the scope and nature of this abnormality, how it will affect her pregnancy and the prognosis for her child-to-be.  Only her doctor can answer all of these questions the patient is sure to have.  It is the hardest thing for me to act like nothing is wrong when all I want to do is put my arms around her and give her a big hug.  Instead, I have to force a smile, hand her a few pictures and tell her where to wait for her doctor.  She’s been on my mind all night..

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