Posted on September 14th, 2017 by

What is the Yolk Sac?

In this post, I’ll explain the yolk sac, its role in your pregnancy, what you should expect to see, and when we can expect to see it. Additionally, I’ll share an email I received from an anxious mama regarding an image her doctor gave to her. She didn’t see a yolk sac and was concerned one may not be there.

anxious mama: I recently received an ultrasound at 7 weeks 5 days. My doctor said everything looked great, and we were able to see its little heartbeat. When I got home and looked at the photo a little closer, I couldn’t find a yolk sac. Would you mind looking at it and letting me know if you can see a yolk sac or anything else you may notice? Thank you so much. This is my first pregnancy after having a miscarriage and I am slightly protective. 🙂


In short, if there’s an embryo, a yolk sac must exist! I didn’t see a yolk sac in her image, either. That said, it may be positioned on either side of the embryo, in which case you may not be able to see it in your particular image.

What’s the Role of the Yolk Sac?

The job of the yolk sac provides nutrients for the embryo until the placenta develops. No yolk sac, no baby. Your baby cannot develop without it! So, if your doctor said all looks good and you see a heartbeat, there has to be a yolk sac in there somewhere.

When Can We See a Yolk Sac?

The yolk sac is typically seen somewhere after 5 Weeks gestational age, before we ever see an embryo at Week 6. We normally continue to see the yolk sac every week until somewhere around Week 12 or so, maintaining its same appearance. As we near the end of the 1st Trimester, however, we are less concerned about identifying the yolk sac. As long as Baby is growing appropriately, documenting it is not as important as it is in early pregnancy.

What Will You Expect to See on Ultrasound?

A yolk sac looks like a tiny white circle. Most often, you will see your embryo cuddling up against it. Below is an image of an embryo at 9 Weeks and a great image of the yolk sac right up against Baby’s bottom.


9 Weeks, 9 Weeks pregnant, pregnancy Week 9, yolk sac

Embryo – 9 Weeks

However, sometimes we are not able to obtain the yolk sac in the same image with the best view of your embryo or fetus. Check out the image of the twins’ yolk sacs below.

Yolk Sac, twins

Twins’ Yolk Sacs – Week 6

Here you can see an image below of the same scan with just the embryos shown.

6w6d Dichorionic/Diamniotic Twins, 6 Weeks pregnant, 6 Weeks, 6 Week Twins

Twins – Week 6

I will also add here that I understand how frightening and what an anxious time it is for women to try again for Baby after a pregnancy loss. No matter how early someone miscarries, it’s still a loss and emotionally draining.

When a miscarriage happens very early in one’s pregnancy, we call it nature’s way of taking care of something which was not developing properly. From a human, spiritual, or emotional viewpoint, I like to think that Baby decided he or she needed a little more time! I always say our babies come to us when they are ready, not always when we are ready for them. They have to be ready for this great big world, too!

As providers, we don’t take special pains to give you an image of the yolk sac. It’s just not as doggone cute as your Little Sprout! 🙂

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Posted on August 15th, 2017 by

6 Week Ultrasound – Twins!


Whether one baby or more, we have great expectations for your 6 week ultrasound! Not everyone can expect to have an ultrasound at this early gestational age. If you do, however, the first thing you can expect is a transvaginal ultrasound. Yep. Babies are just too tiny as you’ll see below, so we need the magnification and better resolution of the vaginal probe.

We expect to see some pretty amazing changes brewing! This post is dedicated to 6 Week babies x 2, aka twins!

Twins at 6 Weeks

If you have followed the twin pregnancy from Week 5, this post is a continuation. Did we see two babies? Two heartbeats? YES! Yay! This was a great milestone! This is a dichorionic pregnancy, meaning both babies came from two separate eggs. This particular pregnancy produced “fraternal” twins. This, of course, means these babies can either be the same sexes or one from each camp, Teams Pink and Blue. Woohoo – that would be a fun shopping trip!

The gestational sacs at the 6 week ultrasound were still discrepant from one another. We could not explain why the gestational sac of Baby A was smaller or why that of Baby B was larger. This finding still concerned us. However, the fact that we saw two strong heartbeats and two babies who measured essentially the same were both very reassuring! See the images below for measurements of the embryos.


6 Weeks, 6 Weeks pregnant, twins 6 Weeks

Baby A Embryo

You’ll note here that Baby A was measuring a whopping 3.5mm!


6 week ultrasound

Baby B Embryo

Baby B measured about the same at 3.4mm.


Now check out the heart rates!

6 Weeks, 6 Weeks pregnant, twins 6 Weeks, heartbeat 6 Weeks

Baby A Heart Rate

This is the heart rate for Baby A. Note that it measures just over 100bpm which is a great start!


6 Weeks, 6 Weeks pregnant, 6 Weeks twins, heartbeat

Baby B Heart Rate

Baby B’s heart rate was just a tad faster at 109bpm. Both heart rates were just what we want to see – strong, steady, and rhythmic.

If you want to follow these twins, this link combines Week 7 and Week 8. You will be impressed at how much bigger they look in only one week’s time!


Best wishes for healthy, and feel free to comment below!

~You can email me at with your questions~

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Posted on August 13th, 2017 by

Ectopic Pregnancy Explained


An unfortunate circumstance of pregnancy, especially a desired one, is the ectopic pregnancy. In this post, I’ll talk a little about what we look for with transvaginal imaging, and how they can sometimes be extraordinarily difficult to diagnose.

What’s An Ectopic Pregnancy?

An ectopic (pronounced ek-top’-ik) pregnancy is one that is displaced. This type of pregnancy is one that implants somewhere other than within the lining of the uterus – where it’s supposed to be. An ectopic frequently occurs within the tube, commonly referred to as a tubal pregnancy. I’ve also seen them within the adnexa, usually the area between the ovary and uterus. Very rarely, a pregnancy attaches abdominally. (Rare and bizarre!)

How Do We Know to Look for an Ectopic? Your low hCG Levels

One sign that leads us to look for an ectopic with ultrasound is a very low hCG level. Now, this alone is not alarming. It is, however, when combined with other factors. Your level of hCG should essentially double every two days in a normally-progressing pregnancy. If this isn’t happening, we become concerned that your pregnancy is not a good one.

LMP Dating Doesn’t Measure Up

Many women are unsure of their LMP. Maybe their periods are very irregular. However, if your periods are like clock-work and you are very sure of the first day of your last period, not seeing a pregnancy within the uterus at a time when we would expect to see one would worry us. For example, from about Week 5 on, we would expect to at least be able to confirm the presence of a gestational sac within the endometrium (lining of the uterus). See the image below for a super-early (~4 1/2 Weeks), normal intrauterine pregnancy:

ectopic pregnancy

If You Have Pain

If the above factors come into play and you also have pain, we increasingly become concerned for the possible presence of an ectopic. Too early in your pregnancy, even with an ectopic, you may not experience pain immediately. Even if you don’t, the other factors are enough to raise an eyebrow and spark the hunt. Typically, the pain occurs on the same side as the ectopic. You may be watched very carefully and followed with blood work and serial ultrasounds until we’ve either proven or disproven the ectopic. Physicians want these patients treated as soon as possible because they can pose a serious health risk for mom.

If We See Bleeding in the Pelvis

Another characteristic of an ectopic via ultrasound is the presence of free fluid or bleeding in the pelvis. A large collection of blood can be seen around the uterus and ovaries when the ectopic starts to bleed. We tend to raise both eyebrows when we see this and all the other factors mentioned above are part of the equation. The extra fluid tends to cause an increase in pain.

If We Find an Unexplained Mass in the Adnexa or Tube

Most of the time these pregnancies present as a mass somewhere outside of uterus, usually in the tube between the uterus and ovary. Either the pregnancy implanted in the tube on its journey to the uterus or it never made it to the tube at all. In these cases, the egg was released, but the “fingers” at the end of the tube failed to catch the little guy. Most often, these masses do not look like the typical normal pregnancy. The masses can be vague and difficult to see depending where in the pelvis they are located.

If You Have a History

Moreover, your doc may consider you at an increased risk of an ectopic if you present with all the above findings and a history. Your chances of having an ectopic may increase if you also have a previous history of an ectopic pregnancy, a history of endometriosis, a history of a tubal ligation, or get pregnant with an IUD in place. This may not be a complete list of risk factors.

My Experience as a Sonographer with Ectopic Pregnancy

I have had patients in the past where we just knew she MUST have an ectopic but try as we might, we just couldn’t see it right away. After a second, third, or even fourth scan were we finally able to confirm what we suspected.

I have also had the misfortune, only a couple of times in my whole career, of finding an ectopic pregnancy with an embryo and a heartbeat. Unfortunately, these pregnancies cannot be saved. They have to implant on their own and can’t just be “placed” inside of the uterus.

These scans can prove very challenging and definitely put one’s ultrasound ability and expertise to the test. Knowing what to look for and where is the biggest piece of the puzzle for all you newbie sonographers! (Google images of ectopic pregnancies. They will definitely help you if you’ve never scanned one before.)

What To Do

As I’ve said many times before, I cannot give specific pregnancy advice. However, I can confidently advise this. If you know you are early pregnant and begin feeling pain in your pelvis or back, call your doc ASAP! They will determine how soon they want to see you!

Best wishes for a healthy pregnancy!

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And, as always, you can email me at


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Posted on April 29th, 2017 by

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?!

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Posted on April 24th, 2017 by

Amniocentesis…All Women Need One??

Who needs an amniocentesis? When should an expectant mother consider an amniocentesis? What factors help a patient decide if an amniocentesis is right for her? Only your doctor can help you make this decision, but you can find out a little more about first-trimester genetic testing…some very basic information…here.

The internet is filled with all kinds of misinformation, right? I think most of us realize this and, hopefully, take forums of personal opinion with a grain of salt. However, I read an article last night in a popular parent/child site that I felt was a bit disturbing. We expect more credibility from these sites, don’t we? Shouldn’t we expect their information comes from a knowledgeable source? Maybe it did, but the author should have been more careful with her words. Maybe an author should have to meet more strict guidelines before publishing important recommendations for pregnant women.

So, the article was all about ultrasound…a subject with which I’m pretty familiar. She had a few tidbits of information incorrect. Of course, I had to respond with a comment correcting them. But one statement I vehemently disagreed with was one regarding amniocentesis. The author stated that any expectant woman over the age of 35 or with a family history of genetic abnormalities should have an amniocentesis. Should? This statement should have never been printed. Women faced with this option may search the internet for information to help them decide. I would like to think their decision would not hinge on an article found on the internet. In the same respect, I’m sure their readers consider them a reputable site filled with only accurate information.

The truth is that no woman should just hop aboard the amnio train (we use “amnio” for short in the field) without a serious discussion with her obstetrician. Granted, no obstetrician would perform an amnio without discussion and signed consent from the patient. However, I would hate for this article to automatically sway any pregnant woman to believe she needs it. The test and its results are not without repercussions. With that, I felt my next post should expound on the topic to the extent of my experience with it.

Things to Consider Prior to Amniocentesis

Genetics gets quite complicated, and some patients find it difficult to understand all they’re told. For this reason, I won’t go into too much detail about the different types of testing and what they can detect. This is mostly because I do not have this information. However, your doctor does. Most patients don’t just jump right into having an amnio. A patient is usually first asked whether she wants chromosomal testing.

Desiring this testing is typically based on a patient’s “need to know.” Why do you want the information?  If your mentality is such that you will have this baby no matter what, and you don’t need to know anything in advance, your doctor may say first-trimester testing is not for you.

However, if you are the type of patient who NEEDS to know normal vs abnormal, a host of other questions opens up for you. Will you abort this pregnancy depending on results? Or is abortion out of the question? If so, do you simply want to educate and prepare yourself and family for what is to come? If so, this testing may be for you.

What’s Included in Genetic Testing?

Some genetic testing includes bloodwork and/or ultrasound, the NT or Nuchal Translucency test which are all usually performed somewhere around 10 weeks to 12 weeks. It does not always include an ultrasound; that depends on what type of testing your doctor offers. The NT scan requires certification of the sonographer who takes special pains to measure a fold of skin behind your baby’s neck.


NT test

This measurement, IF it can be obtained, then goes to a lab with your bloodwork. Sometimes the measurement cannot be obtained if Baby is not in a good position or if the image is not clear enough. Recent developments in bloodwork have become more reliable than performing an NT. Some physicians, therefore, no longer offer the NT and only offer the bloodwork. Some docs still offer both.

What Do the Results Mean?

If you elect to move forward, the next thing your doctor may explain is that this testing only determines your RISK for certain abnormalities; it does not confirm an abnormality. It is a risk assessment only. Your obstetrician’s office may perform this testing, or she/he may refer you to Maternal Fetal Medicine (a perinatologist, otherwise known as a high-risk OB doc).

If your results come back as low risk, GREAT! It means the chance that your baby actually has these abnormalities is low. Your next test would then be your anatomy screen at 18-20 Weeks to rule out structural malformations.

If your testing comes back as high risk for a particular problem, it will state which problem along with your risk level. This is where amnio comes into play. The amnio WILL confirm whether your baby really has this problem. You will have to decide whether you want to have this procedure or not. Your doctor will explain the risks and benefits of an amnio. The risks may be almost non-existent for infection and (last I knew of) around 1% or less for miscarriage. The risk may be significantly less, so be sure to discuss this with your doctor. The benefit, of course, is determining exactly what kind of abnormality you are dealing with so as to help you prepare in whatever way you feel is best for you and your family.

How Is an Amniocentesis Performed?

Basically, a sonographer will scan you to look for an adequate pocket of fluid. The doctor performing the amnio will determine what is a good pocket and what isn’t. Typically, they like to stay away from Baby’s head and your placenta, depending on where it is located. A nice pocket of fluid might look like the image below.

amniotic fluid test

Pocket of Amniotic Fluid

The sonographer will measure your baby’s heart rate and anything else the physician requires. The physician will then clean off the area of your skin with betadine just above the desired pocket of fluid (as long as you’re not allergic to it!). Sometimes she may use a numbing agent for the skin, sometimes not. If not, it’s because she can only numb the skin and not down deep. The numbing agent feels very similar to the needle used to withdraw the fluid, like a stick and a burn and a lot like a bee sting. Since this is the case, some docs would rather stick you only once and elect to not numb the skin.

If you have an aversion to needles, you may want to look away. The needle is long because it has to reach the fluid. Sometimes, your physician will use ultrasound guidance to insert the needle into the pocket of fluid. Once there, the doc will attach a syringe to withdraw the fluid. Once she has enough fluid, she’ll remove the needle and push the fluid into a vial. The vial goes off to the lab for testing. If all goes according to plan, the whole procedure of performing the amnio will take about ten minutes or so. Pretty quick!

Your sonographer or doc will clean off your skin and add a band-aid over the site. Many times you may even have a hard time seeing on your skin where the needle inserted! Your sonographer will usually measure Baby’s heart rate one more time, and your doc will give you instructions on receiving results.

What If I Really Don’t Want an Amniocentesis?

It’s important to note here that if you do not elect genetic testing and your ultrasound later reveals significant abnormalities, your doctor may strongly recommend an amnio. She/he may also do so in the case where you don’t really want an amnio, but your testing came back as high risk. Your doctor cannot force you to have an amnio. However, knowing what is at stake helps them manage your pregnancy and delivery more safely and effectively.

What to Ask Your Doctor about an Amniocentesis

It’s hard for us to ask questions about something if we don’t fully understand it. That’s understandable! Some questions you can ask your doctor are:

  1. What fetal abnormalities does the testing detect?
  2. What kind of genetic testing do you offer?
  3. Will my insurance cover this testing?
  4. Who will perform these tests?
  5. Where is testing performed?
  6. When will I get results?
  7. Why is the testing recommended?
  8. What are my options after receiving results?


Having a thorough conversation with your doctor about these issues and how you feel about them is of utmost importance. And, yes, some genetic testing today can determine your baby’s sex with greater than 99% accuracy. However, your doctor will not allow you the option for sex only. No one should take genetic testing lightly. Opting for these tests brings about other serious implications that you must weigh, as you can see by the above explanation. If you have a sincere interest in the testing, knowing that you may face serious future decisions, genetic testing may be for you.

So, for all the above reasons, one should be careful when throwing out recommendations to pregnant readers about what they need and don’t need, about what they should do or not do…especially if she is not a physician herself. In short…ladies, rely on your doctors for pregnancy advice! No pregnancy site or blog, including my own, can take the place of an informative and knowledgeable conversation with your obstetrician.

Here’s to your happy and healthy pregnancy:) You can email me at!

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Posted on January 16th, 2017 by

Your Week 10 Ultrasound ~
How Big is Your Baby Now?


10 week ultrasound, week 10 ultrasound, week 10 fetus, week by week pregnancy

10 Week Fetus

Congratulations! Your baby has a new name. After so much hard work as an embryo, Baby is now a fetus. Wow, already excelling in so many ways. So, without further ado, let me introduce your fetus and what you can expect to see during a Week 10 ultrasound examination.

If you recall, the start of Week 9 has Baby’s CRL measuring around one inch and 10w2d (above). He or she is about 3.4cm (2.5 cm = 1 inch). This means your little nugget is still not quite two inches from its large-appearing head to its teeny weeny bottom. Baby’s forehead still appears quite prominent and facial features are still quite limited. If we can obtain an absolutely perfect side view of Baby, you can appreciate a profile including the tiniest of noses and lips. Of course, arms and legs are longer and feet are barely appreciated.

Just a note of caution here! You will likely still have the dreaded vaginal ultrasound at this point. I know, I know. Stirrups are never fun. But the image obtained with this method still yields the best quality for Baby’s peanut size. This is part of our job–utilizing whatever method is going to produce the best image.

You are in for a show, Mom. Your baby can look like quite the jumping bean at this point. It’s entirely possible Baby might not move at all during your scan, but they do demonstrate periods of stillness combined with periods of crazy movement. Don’t be alarmed if your baby is very still and quiet during your scan, especially if your scan is super quick.

Only four more weeks until you reach the second trimester! Exciting stuff. 🙂 Wanna check out Week 11 right now? Click here.

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Posted on January 20th, 2016 by

Embryonic Movement at 9 Weeks!

In the embryonic movement department, what a difference a week makes! Your baby is still an embryo at 9 Weeks, but he/she only has one week to go before “fetus” status at Week 10!

When is the Earliest Detectable Embryonic Movement?

How early can we detect your baby’s movement with ultrasound? The earliest signs are typically seen around 8 Weeks of gestational age. Baby, who is only about 15mm now, starts to demonstrate the slightest intermittent wiggle. It may very well be hard to catch, but your sonographer can possibly show you with stillness and a little patience! Of course, transvaginal imaging is by far the best way to see this early in most everyone due to its magnification.

9 Weeks is an entirely different story! Below is an image of an embryo at 9 Weeks taken with transvaginal imaging. Baby is right about one whole inch now, and tiny arm and leg buds can be seen slightly larger than just the week before!

embryonic movement at 9 weeks


Now, below is a video of embryonic movement which is quite entertaining of this same little tidbit breakin’ it down! Shall we dance?! She (or he) is making up a jazzy little tap routine right before our eyes. Just click the link below to watch her go!

Embryo Movement 9 Weeks

Isn’t the degree of movement incredible? Of course, none of it is well-thought-out choreography but is instead the nervous system hard at work. What an amazing work of art we are:)

Leave your comments below if you found this post helpful or even entertaining!

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Posted on August 17th, 2015 by

Your Early Pregnancy Questions Answered

You know, I just don’t have all the answers. I know you may not be terribly shocked by this revelation! That said, I get emails all the time with partial tidbits of relative info from which I am supposed to glean an opinion or diagnosis. Sometimes, it’s just not enough to read between the lines, especially with regard to early pregnancy questions. See the emails below to understand why I just cannot answer some of them!

Early Pregnancy Questions (1)

Vague Mama:  Hi My name is _______.
Here’s my ultrasound.
Thank you in advance.~


The subject of this email read 12w6d ultrasound, and below are some of the images she sent. Can you tell that they are super bright??

early gender, early pregnancy questionsearly gender, early pregnancy questions early gender, early pregnancy questions


Now compare those to an image I took. Even though the baby below is a lot further along (about 20 Weeks), I’m sure you can appreciate the difference! And even a new sonographer can see that these images are of poor quality. It’s very likely they were taken by someone with little to no ultrasound training.

early pregnancy scan

Great ultrasound imaging can only be taught. Truly. I can only assume this person was curious about gender, but she was just too early. Moreover, the images were just too poor.

Early Pregnancy Questions (2)

Twin Mama:  Wow! So glad I found you. Can you please help with my twin ultrasound? We are confident that baby B is a BOY! However baby A is leaving us confused. We were told possibly boy, as well. All guesses on other sites say girl. Just so confused. Thank you in advance for your help. Sincerely…


Nice! This one clearly asks the gender question. However, no gestational age is included so I have to guess based on how big the baby looks in the image. If you guys know me by now, I do not guess gender before 17-18 Weeks. I’ve only guessed at 16 Weeks a handful of times in my entire career.

Too early = too much guesswork = a wrong guess. I hate it when this happens!

This is my professional and very scientific formula on how to incorrectly determine fetal gender. Turns out these babies were 14w4d. In other words, flipping a coin might give you the same percentage of accuracy. And it’s free! There’s not much worse than paying someone to be wrong. Right?!

Early Pregnancy Questions (3)

Concerned Mama: I just have a couple questions I’m hoping you wouldn’t mind helping me with. I just had my first ultrasound abdominally and also had the internal, as well, for dating. My period is very irregular, so I don’t know my LMP. I had gotten lab work done the day before the ultrasound to check my HCG levels. The nurse said they were pretty up there but not yet 14 Weeks.

During my tests, my sonographer would not give me any info. I understand they formally cannot give an official diagnosis, but she wouldn’t even show me the screen. Is it normal that they don’t give you a picture, either? If you could try and answer these questions the best you can, I would greatly appreciate it:) Thank you so much! ~


So, a non-medical mama may not understand the difficulty here. But, unfortunately, I just don’t have all the information to tell her what she wants to know most. With no images, no measurements, no LMP (Last Menstrual Period), and without her medical chart, I cannot tell her anything she doesn’t already know about her case. I cannot even be sure a heartbeat was seen. And without that being stated, I can assume nothing.

The only opinion I can offer here is that it’s really tough to have to wait for results in such circumstances. In this case, my reader had to wait an entire weekend for some answers. It turns out the pregnancy wasn’t a good one which is why her sonographer didn’t show her anything on the monitor. This is always a terrible position to be in for the sonographer and the patient.

I really believe patients should never have to wait days for this kind of result. However, giving results depends on a lot of politics and protocol. The doctor on-call should be able to deliver this news to an anxious mom.

More on Your Early Pregnancy Questions

So, Ladies, just know that sometimes I can’t help you very much, but I always try! Include as much information as you can about your experience, and I’ll do my best to help you make sense of it! ‘Til next time, here’s wishing you a happy, healthy sonogram;)

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Posted on July 22nd, 2015 by


I read something a little disturbing whilst surfing this universal web of ours called the internet.  I don’t often search anything ultrasound related unless it is a medical reference for the purpose of supporting the diagnosis of a case.  I have been told, however, that if I want to increase my visibility of this blog, I must submit my two cents on other sites and provide a link.  It’s very disturbing.  Where do I start??!  There’s so much misinformation out there and it’s very distressing to know people are believing everything they read or are misguided in some way themselves.

Someone wrote essentially a one-liner about her miscarriage.  She stated that she will absolutely never have another transvaginal ultrasound in pregnancy because the one time she allowed it, her baby died the next day.  I was so saddened by this statement.  I attempted to reach out to her with a direct email but it wasn’t possible.  I hope someday, in some small, remote and very unlikely way, she may stumble across this post.

ALL OB PATIENTS!!  Please know that scanning with an internal ultrasound probe in no way, shape or form causes miscarriage or fetal demise.  If this were the case, we would not be allowed to perform the examination! Our docs are in the business of helping you carry a healthy pregnancy and, hopefully, to term.  Transvaginal sonography is the best addition to sonography for early obstetric care and gynecologic studies.  It provides so much useful information for your physician that just cannot be seen with transabdominal scanning.

It helps us find your Baby’s heartbeat and determine gestational age early in the first trimester. It helps affirm for your doctor that your pregnancy is progressing normally or whether it is threatened because of bleeding or a shortened cervix.

Most of you know that your OB/GYN doc has your best interest at heart.  It’s unfortunate and sad that the coincidence of this tragic event happened after her examination..but it was not the cause.  I want you all to understand that having this exam done is what can help your doctor SAVE your pregnancy.  The goal is happy, healthy, full-term babies!  Sometimes we can help you achieve this; sometimes we can’t.  Either way, transvaginal ultrasound likely played an instrumental role in  providing your physician with much-needed and highly valuable information.

If the medical community feels it is safe enough for ourselves and our own families, we certainly want to provide you with the same quality care!

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Posted on July 17th, 2015 by

Every once in a while we have a patient who desperately wants to pin down the EXACT day she conceived so she can determine the father of her baby.  Ultrasound can give you a general time-frame within a few days of reliability early in the first trimester (about 8-10wks gestational age) but it cannot be specific to the day.  Moreover, ultrasound measurements become less accurate the farther along in the pregnancy you are.  Someone who shows up for dating at 23wks, for example, will get an estimate or “best educational guess” for a due date.  Determining paternity by ultrasound is not “cut and dried”.

Some would like us to pin it to the hour.  Sorry, ladies, but we just aren’t this good in ultrasound! Only DNA testing after Baby is born will help you in this case.  Literally, a young girl in college bounces into the practice one day hoping we could differentiate within one week between three possible candidates. She was very cavalier about her dire straights, and her mother who was with her thought it was just as funny. No judgement zone here, but I find it more of a serious matter when you’re talking about the father of a child you plan to raise for the next couple of decades…and beyond!

The first thing your doctor will ask is when your LMP or last menstrual period started.  Most people ovulate between days 10 and 14 but some people have very short cycles and others have longer ones so the actual day the egg is released is quite variable.  Some people experience very irregular periods, oftentimes skipping several months at a time, which is totally unreliable for dating, unless you know exactly the dates you had sex.  Moreover, semen can live for a few days within the vagina (don’t quote me and I’m sure this is an exact science in some literature but I am not an expert in the life cycle of sperm) so it would be hard to pinpoint the exact day of conception.

Getting a good dating scan in the first trimester by someone who is experienced in determining the best measurement is the next order of business, providing Baby is easy to see. I personally feel a transvaginal ultrasound at 8-10wks is the best time to obtain a CRL (crown-rump length, measurement from head to butt) because Baby is not too small or big.  A 6wk pregnancy where the embryo measures a whopping 3mm can be very difficult to see well.  At 12wks the fetus is fully formed and very active which can make obtaining a good measurement challenging.

See the images below to see the difference in a CRL at 6wks, 8wks and 11wks!

6wk embryo

6wk embryo

Baby is so small here that it can be hard to see in some patients depending on how it is positioned!


8wk fetus

8wk fetus

This is the best dating here! Baby is usually pretty easy to see now at about 1/2 inch.  This measurement is accurate within 1-2 days.


11wk fetus

11wk fetus

Dating is still fairly accurate here within about 3-5days.  They move a lot and bend and one can imagine that a bigger measurement will yield a baby a little farther along if he/she is stretched out vs curled in a little ball.


I get it; things happen.  People who are in a serious relationship break up.  They see someone else during the pause..rebound, shoulder to cry on, etc., and then reconnect.  This can be a wonderful reunion! But it can still make for a bit of a hairy situation if these encounters happened within 2wks of one another.

On a final note, imagine yourself in this situation.. You’re pregnant with twins.  You’re in the throes of labor.  Out pops your first baby.  Joy! Success! Beautiful!  Baby B is right behind.  Big push!  He’s out!  Oh.  Wait a minute.  One is black; one is white.  Yes, this definitely happened! Lucy, you have some ‘splaining to do!!

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Posted on May 23rd, 2015 by

The 11 Week Fetus – What Will You See?

You’re almost out of the woods! Your baby is now just shy of two whole inches in length from head to bottom. The 11 week fetus is looking more and more like a baby, and watching baby flop around like a little fish out of water always creates a chuckle for us spectators. Baby will sometimes be quite still, too, resting up a bit after all the cartwheels. So, don’t be alarmed if your baby is quiet during your ultrasound.

Transvaginal ultrasound is still usually the preferred method of scanning as it gives us the best resolution, but we can adequately measure what we need with the abdominal approach in most patients. Depending on where you have your examination performed, you may need to fill your bladder. Ugh, the dreaded bladder prep! Hopefully, you won’t have to drink an ocean of water for your ultrasound exam at 11 Weeks.

What Will My 11 Week Fetus Look Like?

Baby’s arms and legs are almost fully developed! Baby’s head still looks bigger than his or her body. This is totally normal! There is a lot of brain still growing in there. This appearance will stick around for several more weeks. All the black you can see around your baby is amniotic fluid.

In the image below, you’ll see the Crown-Rump Length (CRL) measuring Baby from head to butt on the left-hand side of the screen. Notice Baby measures about 4.3cm now – just shy of two inches (5cm = 2″)! A tiny foot is easily seen in the upper, right which is about 1/2 inch long. Last but not least, a tiny pair of legs and feet can be easily distinguished at the bottom. So cute!


11 week fetus


Hit me up if you have any questions about the 11 week fetus or anything else ultrasound-related at my email address, and subscribe!


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Posted on May 10th, 2015 by

A Mother’s Day Wish

My blog is nothing without paying homage to the celebration of life and the incredible women who help to create it!  Hopefully, you are training them right. Because you have a little one on the way, you deserve breakfast in bed and whatever else you command with the tinkle of your handy-dandy little bell (or foghorn, whichever your prefer). All moms deserve to kick back from time to time – and this day is one of those times! Let’s talk about what we can expect to see in a 9 Week embryo.

The 9 Week Embryo

Below is a 3D image of a 9 Week embryo:

9 Week embryo in 3D

You can see little arm buds and leg buds getting bigger.  What looks like a tiny lump on the top of the belly is just part of the cord.

Below is a 2D image of a 9 Week embryo:

9 Week embryo in 2D

Baby is upside down here and you can see from the dimension taken that it is measuring just about a whole inch now!

A scan at this gestational age will very likely be performed transvaginally. At least, this method will provide the best image, by far!

Below is a video of the kind of movement you might see at Week 9: Movement at Week 9

Pretty amazing, right?

I don’t think it’s too much to ask to spend one day a year sans the multiple hats that come with motherhood..chef, chauffeur, maid, teacher, referee (for those of you blessed with more than one little angel). It’s the most difficult, most enjoyable, and most important job any woman will ever have. Shaping and molding our future generation of leaders is no small task! And a pretty exhausting one, too.

To carry them (or not!), raise them, care for them, discipline them, and love them defines us as Mothers. Any woman who puts her all into this job deserves to spend this day any way she pleases! Enjoy it! And for those first time moms-to-be…relish the peace and quiet now – while you still can 😉

If you want to see a post about our embryos at Weeks 7 and 8, just click the link.

Thank you to all moms for reading and subscribing! Feel free to email me at with your questions or comments!

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Posted on March 26th, 2015 by

What Can We See on Your 8 Week Ultrasound?

First, a Peek at Week 7

In the last post, two babies were finally seen, both measuring about the same at 6 Weeks with great cardiac activity! So let’s check out a few changes. The images below are of the twin embryos on a 7 week ultrasound and 8 week ultrasound.

7 Week embryos, 7 Weeks pregnant, 7 Week ultrasound

You don’t really need a measurement here to see how much bigger they look compared to just one week prior! You’ll notice that the gestational sacs are bigger, too. The yolk sacs keep the same general size and appearance, although they are not pictured here.


Since I didn’t have much to post about Week 7, let’s skip ahead a little and look at your embryo at the 8 week ultrasound, also!

8 Week ultrasound

8 Week Fetus

Can you believe the difference in just 13 days? Baby A is a whole 12mm bigger! The more round area on the right-hand side is Baby’s head. We can even make out little arm buds, and the little white lines you see on each side of Baby represents part of the developing amnion (or sac of fluid around Baby).


Now check out Baby B below!

8 week fetus, 8 Weeks pregnant, 8 Week ultrasound

Baby B is now a whopping 13mm bigger! What an animal!


8 Week twins, 8 Week ultrasound, 8 Weeks pregnant

The changes seen every week of the first trimester are really quite unbelievable and it truly is one of the most favorite aspects of my job. I love it! It makes me realize what a privilege and honor it is to be able to catch a glimpse into this incredible universe on a regular basis.

One day they’re 3mm; you blink, and they’re driving! Our kids just grow up so fast! (sniff, sniff)

Shoot me an email with your questions or comments to!

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Posted on March 4th, 2015 by

Continuing from the last post about our 4 Week gestational sacs? Great! Keep reading to see what changed…

Will I See My 5 Week Twin Gestational Sacs?

Let’s repeat some important info here! It’s important to say here that very few women are scanned with ultrasound at Week 5. Why? Because there is relatively little information your doctor can tell you at Week 5. Unless you experience problems such as pain or bleeding, your healthcare provider will want to wait until you are further along, probably Week 7 or 8, to order your first scan. Hopefully, your doc can send you home at this gestational age with a confirmation that your pregnancy appears off to a good start. Week 6 can prove hard to see in some patients. Unless you are experiencing unusual problems like pain or bleeding, don’t expect to be scanned this early.

What Can Be Seen At Week 5?

One of our nurses, whose doc was actually one we both worked for, found out pretty early she was pregnant. Yay! Our doc didn’t mind that we scanned her very early – she knew that her nurse understood what we could and could not see at this point!

TWINS! We were both shocked! One sac was appreciably smaller than the other. Our nurse and new mom-to-be had resigned herself to the idea that she may have just one baby here eventually…if she was lucky. But she was quite early, and who knew what we would see in another couple of weeks? No one can predict.

Even though the dimensions are a bit blurry, you can see that the gestational sacs differed by about 3/10 of a millimeter. SO tiny! Regardless, you can truly appreciate this difference with the magnitude of transvaginal sonography! The larger sac measures 8.8mm and the smaller about 5.1mm. Check out her images below:

5 Week twin gestational sacs


Two days later, we scanned again. The biggest variable here that continued to give us hope was how we could visibly appreciate what we thought was a very tiny yolk sac within each sac! These are the little circles outlined in white along the bottom wall of each gestational sac. The yolk sac provides nutrients for the growing embryo until the placenta is developed enough to take over the job.

How Far Along Was She Really?

At this point, we knew there were some good changes going on. But how far along was she, really? There’s a general rule of thumb we use when measuring a gestational sac. We take the one biggest dimension and add 4 to determine gestational age. Applying that rule here, the smaller sac measured 4.5 Weeks. The larger sac measured 4.9 Weeks. Considering all these measurements are only general estimates until we can see and measure an embryo, we had to assume 5+ Weeks GA (gestational age) based on the presence of the developing yolk sacs.

What Does the Future Hold?

That’s a good question! But it’s one your doc cannot answer at 5 Weeks. We both were hopeful; still, the differences were a little worrisome for us both. Would the smaller sac catch up? Would we see embryos the same size at the same time? The next scan would reveal a little more info;)

Be sure to email to ask your ultrasound questions!

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Posted on February 1st, 2015 by

Most OB patients today get an endovaginal ultrasound for 1st Trimester dating when they establish care for a new pregnancy. Most offices maintain requirements for when this first visit should be scheduled. There is good reason for this! Most patients want to see their docs AS SOON as the pee stick demonstrates that little plus sign. However, the problem here is that very little can be determined by your doctor too early in the first trimester. Except, of course, that you’re pregnant!

Some home pregnancy tests like to brag that you can know you’re pregnant as early as your first missed day. But this isn’t always a good thing, especially for those overly-anxious mamas. Naturally, the next question they all have is “Is everything okay?” If you are less than 6 Weeks (from your LMP or last menstrual period), your healthcare provide just cannot confirm this. If you ovulated even one week later, it means we still aren’t going to see much on your endovaginal examination. The earliest we can measure an embryo and detect cardiac activity is about 6 Weeks gestational age.

Even then, it can be quite difficult to see well or measure depending on position of the embryo and uterus. If you are even a few days earlier than this, we would only see a gestational sac and possibly a yolk sac. It’s not feasible to scan you every day and your insurance company will not allow it, anyway!  All the above reasons are why some docs specify a confirmation visit no earlier than 8wks for a 1st trimester dating scan, when we should be able to confirm a fetal pole and a heartbeat.  Coming in too early if your dates are off means your doctor will then have to order a follow-up visit for you in a week or two to confirm a normal early pregnancy.  Trust me!  This will feel like the LONGEST one or two weeks of your life!

Sometimes the dates conflict. Your LMP may say you are 10wks but we see a fetal pole that measures 6wks. This just means you really became pregnant a month later. When these numbers are discrepant by more than just a few days, your doctor will typically use the gestational age we obtain by ultrasound.  See the fetal pole and report images below.

10w2d Fetus


Note that on the report, the patient should have been 11w3d by her LMP of November 10 but Baby measured 10w2d instead.  With dates = 8d off at this point, her doctor will likely go with the due date of 8/25/2015 instead of 8/17.

So, take my word for it.  The only thing worse than waiting to see your doctor for your first OB visit is going to see her and then leaving without answers.  Trust your doctor’s office when you call to make this appointment and they say it’s too early!  They know what’s better for you than you do;)

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Posted on January 2nd, 2015 by

How Ultrasound Works

Let’s explain ultrasound, how ultrasound works, and why we call this technology ultrasound!

What is Ultrasound?

Ultrasound is just that…ULTRAsound, or sound waves that operate at a frequency far beyond human hearing.

*Human hearing ranges from about 20Hz (Hertz) to 20,000Hz (or 20kHz)*
*Ultrasound operates in the megahertz (MHz) or millions of Hertz!*

Fetal ultrasound probes operate at a frequency range of about 2-13MHz. Also, the use of Doppler technology is another form of ultrasound. Your healthcare provider may use a hand-held Doppler transducer to detect your baby’s heartbeat starting at about 10 Weeks. The frequency of these dopplers range from 2-5MHz. These dopplers require special training. Only those educated on how to distinguish maternal blood flow from fetal heart tones should use them.

Additionally, Doppler technology can also play a role in conjunction with an ultrasound machine, but only formally-educated sonographers should utilize it. This feature emits a higher energy, therefore, power settings should be set very low. An example of this type of Doppler is when your sonographer is scanning your baby and uses doppler to hear the heartbeat while it’s also shown on a graph below the image. We like to use this very sparingly early in the first trimester!

Most importantly, Ultrasound is not radiation!

X-Ray is ionizing radiation; ultrasound is like sonar or a fish-finder!

How Ultrasound Works

Sound waves penetrate skin and the tissues below it with the help of gel which aids in conducting the waves. Remember the goopy stuff we squirt on your belly? Once the sound waves hit the target of interest, they bounce back and result as an image on the monitor. It’s up to the operator to efficiently and properly adjust many settings to optimize for the best image. Credentialed sonographers know how to do this best! After all, Knobs and Buttons 101 is a large part of our training and education:)

The image produced is a 2D image (the gray-scale image) which allows us to see in two planes only at one time. An example of a 2D image is seen below. Baby is shown upside down here!

9 Weeks pregnant, ultrasound, 9 Week Embryo

9 Week Embryo in 2D

Because a 3D image is made when the sonographer makes a sweeping motion with the probe, several 2D images are saved all at once. We then have a “box” of information to work with that allows us to see the outside of Baby instead of “through” Baby. Below is a 3D image at 9 Weeks:

how ultrasound works

9 Week Embryo in 3D

Hopefully, this post helps you understand ultrasound a little better when you go for your next scan. I wish you all uneventful pregnancies and happy, healthy babies!

I hope you keep coming back to have all your ultrasound questions answered, so email me at!

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Posted on July 12th, 2014 by

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 with your questions or comments:)


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Posted on May 1st, 2014 by

Early Sex Determination

I find it comical when people ask me my opinion about gender and then don’t believe it. Especially regarding too-early sex determination. They keep asking. And asking. But too early is just. It just leaves too much room for error!

Fetal sex is not well-developed until about 17 Weeks. In fact, too early in the pregnancy, they both have itty bitty parts that stick out and can all look the same. That said, 12 Weeks is way too soon.

Read the emails from the grandma-to-be below who didn’t want to take “it’s too early” for an answer!

g-ma:  Hi, I subscribed to your blog. I love it. These are my grandbaby at 12 weeks 2 days. Any guesses? The baby’s legs were crossed at the 16 Week ultrasound.

12 Week Fetus, early sex determination

12 Week Fetus

12 Week Fetus, early sex determination

12 Week Fetus


wwavb:  Hi! And thanks for reading and subscribing! So glad you are enjoying the info!

Okay, so if you’ve read any of my posts on the subject, you know that guessing at 12 Weeks is like flipping a coin. Just too early. An accurate guess can be made at 18 Weeks IF baby is cooperating! Any guess any earlier is simply a guess, and I just wouldn’t invest in paint!

Best wishes for a healthy grandbaby!

g-ma:  Thank you for your response! It’s just driving me crazy wondering what those two white ovals are between the legs. Doesn’t look girl or boy. Could it be fingers or an umbilical cord?

wwavb:  It’s definitely external genitalia, but boys and girls look the same at that age! Over the next several weeks, girl stuff shrinks to form labia and all her girly parts; boy parts get bigger to form the scrotal sac and penis. It’s all still developing on the outside even though chromosomally it’s already determined on the inside.

g-ma:  Thanks for being so helpful. I would think it’s a boy for sure if it’s genitalia! But, not if they look alike at 12 Weeks.

 wwavb:  Sounds like you’re not too far off from finding out. Happy shopping!
g-ma:  Really…No guesses? I know it would be a guess. I thought the pics looked pretty clear. Everyone thought boy.
This grandma earned a spot in my post for her persistence! But it doesn’t change the facts. The professional verdict was not boy or girl but too early to know. It’s just not all formed yet!
People have a tendency to believe only what they can see or understand. As long as sonographers guess too early and continue to be wrong, I will have to persistently defend my stance on “too early” until the cows come home. It’s especially difficult when someone else delivers a “beyond sure” pink or blue guess to excited expectant families.
I’ll say it again. Weeks 12 – 15 are just too early for a guess that’s accurate enought to invest in paint – unless you’re going yellow!
Email with your questions!

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Posted on January 29th, 2014 by

Early Pregnancy – Blighted Ovum

An interesting and sad outcome of an early pregnancy is the blighted ovum. Basically, it just means that a gestational sac developed but a yolk sac or embryo never did. You’re still pregnant. But all the components of pregnancy did not develop properly enough for an embryo to start growing.

Of course, we perform a transvaginal ultrasound to see best early in the 1st trimester. What we typically see is a gestational sac with nothing inside of it. We measure the sac, which is the only estimation of gestational age without an embryo, but we know that at about 5 1/2 Weeks we should see a yolk sac inside of the gestational sac, like the image below.

Blighted Ovum Ultrasound Images

gestational sac, yolk sac

5w5d Gestational Sac with a Yolk Sac Within


Or an example of an early twin pregnancy could look like this:

Yolk Sacs, dichorionic twin pregnancy

Twin Gestational and Yolk Sacs


But a blighted ovum would look something like this:

blighted ovum

Gestational Sac/Blighted Ovum

You would see the gestational sac with only the black of fluid inside. If the sac is measuring 6 Weeks or greater, we might suspect a blighted ovum.

Usually, your doctor will ask you to come back in another week or so to confirm whether an embryo is developing. There are typically huge changes in the first few weeks as I’ve shown you in prior posts. Most of the time, the gestational sac will be bigger on your next scan, even if a blighted ovum. This is expected because the hormones of pregnancy still exist which will cause the sac to continue to grow even if there is no baby inside.

Some patients feel a little better knowing a baby never developed. For others, it is still quite painful to find that what you thought was growing doesn’t exist, especially in a desired pregnancy. For all, it is still a loss which makes trying again that much harder.

I’ll tell you as I have all my patients who have suffered a blighted ovum or other pregnancy loss – our babies come to us when THEY are ready…not necessarily when we are.

As always, thanks for reading! And please email me at with any questions or comments!

A blighted ovum is not an easy subject to talk about but knowledge is power. Subscribe to the blog to get more ultrasound information from a source you can trust.


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Posted on December 28th, 2013 by

Early Twin Pregnancy – Reader Questions Answered

Here is an email from a reader who questioned whether she may have a very early twin pregnancy. Too early, or earlier than a confirmed Week 6 of gestation, only time will tell what will develop! Read on for her emails and my responses..

Concerned Mama: I had a dating sonogram, and it was determined that I was about 5 1/2 Weeks along. I have two other children but never had a sonogram before 11 Weeks. Basically, my OB performed the sonogram, and she did not deny or confirm twins. She simply scheduled me for a repeat sonogram in two weeks. From your experience, can you tell me what exactly I’m looking at and is it two babies in the gestational sac? Thank you so much for your time and knowledge!

5 Week pregnancy, 5 weeks pregnant, 5 week gestational sac, early twin pregnancy


wwavb: Hi! Thanks for reading my blog and subscribing! By the looks of your image, I would have to agree with the 5 1/2wks estimation of dating.

So, you know the gestational sac is the bigger black area.  Your doctor scheduled another for two weeks because there’s just no way to determine right now whether you really have two babies in there yet!

The image is not a great one, but you can sort of appreciate and get the impression of two smaller circles inside of the sac. The smaller circle may very well be a second yolk sac, but it is just too small and too early to say for sure. The usual progression is that we see the gestational sac first, then a bigger gestational sac with a yolk sac within it. If two yolk sacs are questioned, two babies are questioned. However, we just cannot really see the embryo until about 6 Weeks. It’s still really tiny then. Your doctor wanted an additional week so she could feel sure about whether there are two!

Good luck and keep me posted!

wwavblogger, RDMS 🙂

Concerned Mama: So from what I understand, you’re saying that you could have an early twin pregnancy, but it’s just too early to know for sure? And if there is not twins, what possibly could be the second structure in the gestational sac? Based on your expertise, what percent chance is there that it will be twins and what kind of twins? So sorry for all the questions. But according to doctors, I shouldn’t even be pregnant right now because of the damage that Stage 4 endometriosis did to my ovaries and tubes. So I’m a little nervous and worried, and ANY information really helps ease my mind.

Thank you so much for responding! I think what you are doing is amazing, and I definitely will tell all the ladies I know about your blog! Thank you again and look out for more sonogram pictures from me!:)
Merry Christmas!!!

My Advice to Readers Regarding an Early Twin Pregnancy

So that you can “see” what I see in the image above, I outlined the yolk sacs with a circle. So, if you compare the image above to the one below, you can appreciate what her doctor saw. One larger yolk sac, one smaller yolk sac.

early twin pregnancy, 5 weeks pregnant, yolk sacs

A few years have passed, and I never heard from this reader again. I can only assume the pregnancy didn’t progress well. I always hate this part of my job – when I know how much a pregnancy is desired, and it ends in miscarriage.
Your doctor will first want to determine that your pregnancy is off to a good start. To do this, she/he will want to establish heartbeats and how many. This cannot happen until we can actually see an embryo(s) and heartbeat(s), and the earliest we can document this is about Week 6!
If indeed this turned out to be the start of a twin pregnancy, it would have been classified as monochorionic. This means both babies are growing together in the same sac, that one egg was fertilized and split, they will share a placenta, and will be the same sex.
Only a little more time will determine if they would each have their own amnion, at about 8 Weeks or so. This is important! Each baby living in its own amnion is more safe and healthy for each baby.

Please feel free to email me with your stories or questions at! I’ll be happy to share my knowledge with you!

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Posted on February 21st, 2013 by

The Amnion – What is It?

The amnion is another name for your fetus’ amniotic sac or amniotic membrane. Two great ultrasound images are seen below!

amnion, amniotic membrane, amniotic sac

In this first image, we can see the membrane (or the wall) of the amnion around Baby who is 9 Weeks. The fluid inside of this sac is black, as is all fluid in sonography. The amniotic membrane appears white.


amnion, amniotic sac, amniotic membrane

Above is another image of the amniotic membrane without Baby in the pic.

This is the thin line that kinda looks like a little bubble around your fetus. If you are having diamniotic twins, you will see this around each fetus. This simply means that each baby has its own protective sac of fluid. This is what we want to see!

Thanks for reading!

Please email me with your comments and questions at and subscribe for more reliable ultrasound information!


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Posted on January 27th, 2013 by

Pregnancy Week by Week – 6 Week Twins

In my pregnancy week-by-week posts, our 6-Week twins are growing like a weed! Check out the image below to see just how much.

pregnancy week by week, 6 Weeks pregnant

Week 6 Twins

 How Big Are They Now?

At 6w5d gestation, you can see that each embryo = 8mm each. Just measure that out on a ruler. Crazy, huh? So tiny yet we can see these embryos so easily with the magnification and high frequency of a transvaginal probe. We can also see their heartbeats very easily at this point, too! Steady, strong, and rhythmic…just what we want to see.

This image represents a split screen so as not to confuse — you can see that each fetus, labeled “A” and “B” are each in their own sacs. This type of pregnancy is called dichorionic/diamniotic. These babies each have their own main sac as well as their own sac of amniotic fluid.

Now, genetics tends to get a little complicated. Fraternal vs identical depends on when that egg split! Ultrasound cannot determine this right now and sometimes not at all. But in this particular pregnancy, we later determined that these babies each had their own placenta. This means they each came from a separate egg. In other words, mom ovulated twice, and they are fraternal twins!

Aren’t they so cute?

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Posted on October 13th, 2012 by

Why do parents want to hear a fetal heartbeat?

All the obvious reasons! There’s nothing like a parent connecting with their baby via an audible fetal heartbeat. During an ultrasound exam, it’s called a doppler. It doesn’t matter whether baby is as tiny as a gummy bear at 8 Weeks or a fully-formed fetus at the anatomy screen at Week 18, hearing the heartbeat is something most all patients ask of us sonographers.

6 Weeks, 6 Weeks pregnant, fetal heartbeat


I have also found hearing a fetal heartbeat provides a bonding experience for siblings, as well. Big brothers and sisters are awed by the sound of a fetal heartbeat, especially when they realize they have one of their own and it sounds the same! Many times the siblings ask over and over to hear it again. It’s really cute and, of course, I oblige in an older fetus.

A Word of Caution

I don’t like to use the doppler very early in the first trimester. Even though no form of ultrasound utilizes radiation, the sonographer must use caution to ensure certain power settings do not exceed recommendations for use. Early in the first trimester, doppler use for a fraction of a second versus none at all is preferable.

A Little Needed Reassurance

Even though parents appear greatly relieved by seeing a fetal heartbeat, hearing it also provides some reassurance for the concerned parent. Expectant parents who have previously miscarried are expectedly quite anxious during subsequent pregnancies. Seeing and hearing their baby’s heartbeat garnishes instant relief. It is a bonding experience for all involved and remains a blessing for me to be able to provide and be a part of — no matter how many scans I perform!

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Posted on May 23rd, 2012 by

When can you expect to see the earliest heartbeat on ultrasound?

When can an expectant mom expect to see the earliest ultrasound heartbeat? About 6 Weeks! Earlier than this, and you may not even identify an embryo! For 6 Week twins, the expectation is the same.

earliest heartbeat on ultrasound, 6 week ultrasound, 6 weeks pregnant


6 week ultrasound, 6 weeks pregnant

About 6 Weeks of pregnancy or on your 6 Week ultrasound! This is about four weeks from conception which equates to 6 Weeks GA (gestational age). Best seen with transvaginal imaging, baby is about 3.5mm at this point, and cardiac activity should be visible with the naked eye. Yay, this is a big, big milestone!

Just know that not everyone receives an ultrasound this early in pregnancy. Your doc may want to wait until Week 7 or 8 for the best views…Baby will be bigger and better seen!

Best wishes for a healthy pregnancy!

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