Posted on July 27th, 2017 by wombwithaviewblog.com

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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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:)

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Posted on August 17th, 2012 by wombwithaviewblog.com

she asked with a condescending tone and a tinge of nasty. Hmm, can I? It’s certainly not required, but most sonographers try to obtain the best ultrasound pictures we can for a patient. When they ask in such a sweet tone (:/), they seem to assume I didn’t try my hardest. This is only slightly irritating.

I am more than capable of taking incredible ultrasound pictures of your baby…if all the stars align. Sometimes, however, the answer to that question is a huge no when all the factors that go into obtaining a good image do not exist. And those conditions are different for each and every scan, regardless of whether it’s the same patient or same pregnancy for a patient.

always tried to give a patient great ultrasound images and would usually give as many images as I could possibly snap. I’ve sent patients out with an au revoir and ten or twenty images when just the right circumstance presented itself. Fortunately for these expectant moms, Baby was showing off, the patient and/or her family were great to work with, and I had plenty of time to play (maybe the next patient cancelled)! I always loved those occasions. However, those three variables change swiftly and drastically like the wind from one patient to the next.

When Ultrasound Pictures Aren’t the Best

Sometimes, the images a patient wants either cannot be obtained at all or appear fuzzy. This can be due to a number of factors.

  • Fetal cooperation IS the name of the game. Without this, cute pics simply are not gonna happen. Especially when baby is facing mom’s back, it then becomes very difficult for me to see the specific organs and structures that I need to document, much less be able to get cute pics for the patient. The prone fetus might look something like this:

 

breech fetus, prone fetus, ultrasound pictures

 

  • Baby needs to be facing upward toward Mom’s belly in order to see the face well. But a few caveats exist. If a nice pocket of fluid is found in front of Baby’s face with no placenta, limbs, or the cord in the way, we can typically get some really great shots of the facial profile. After all, we meet someone’s face, right?! And this is what patients want to see most. Without this shot, the patient usually leaves feeling a little empty-handed. Poo. I hate when this happens. I usually apologize and just say their baby simply did not want to cooperate that day. With Baby looking, a great profile might look something like these:

 

fetal profile, ultrasound pictures

fetal profile, ultrasound, ultrasound pictures

 

If the placenta is anterior (front side of the uterus), Baby’s face is sometimes smushed into it, like a pillow (this usually depends on gestational age and amount of amniotic fluid). Additionally, if the operator is not educated in ultrasound (some 3D businesses) or if the profile is not perfectly optimal, a profile image might look a little freaky and something like this:

ultrasound pictures, fetal profile

Mom worried about this appearance but wrote me later to say her baby’s face looked entirely normal after birth. Yay!

  • Also, the one major thing that can hamper images…extra weight around Mom’s middle. The more tissue the sound waves have to penetrate, the more fuzzy the image will be on the monitor. Thank Ultrasound Physics, but it’s something we can’t change. So, unfortunately, the more a patient weighs, the less likely it will be that good images can be obtained no matter what position baby is in. Same for 3D. We would never advise a patient not to have a 3D scan, but we know (in some circumstances) it simply will not be a great one. All we can do is just try to optimize the images to the best of our ability.

 

I know that some sonographers can be just downright unfriendly in their jobs. Believe me, I’ve worked with some of them! I’ve also had a handful of patients say the same about me. Unfortunately, we won’t ever win over everyone. Sometimes, it’s the sonographer with the attitude…difficult patient load, difficult cases, difficult physicians, little time for play. All these things make it tough for a sonographer to maintain a cheerful disposition and give a patient everything she expects. Are those factors the fault of his/her patients? Absolutely not! Until the patient doesn’t get what she expects…

Sometimes, it’s the patient who brings the attitude. A mix of great expectations versus the impossible mission can create a very unhappy patient. But is this always the fault of the sonographer? Again, absolutely not. We have policies to enforce and limited time. And we just can’t always determine fetal sex – for all the reasons above.

So, at the end of the day, we can jiggle, we can belly-poke, we can roll mom from one side to the other and stand her on her head. Sometimes, those stubborn babies just won’t budge!

“Can’t you get me better pictures?” About twenty times a week, I would just smile, apologize, and regrettably pass to her images of a hand and a foot…and a penis, if she’s lucky!

 

Email me with your comments, questions, stories, and your favorite pics at wombviewerblog@gmail.com!

 

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