Posted on August 15th, 2017 by

Whether one baby or more, we have great expectations for your ultrasound at 6 Weeks! 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 6 Weeks 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!


Embryo measurement at 6wks

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

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:

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 confindently 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!

Please email comment below if you found this post helpful!

And, as always, you can email me at
Feel free to leave your suggestions for topics you’d like me to address!

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Posted on July 1st, 2017 by

Pregnancy Wives’ Tales – Are They True?

We’ve all heard them – pregnancy wives’ tales. As a result, maybe you’ve googled your fingers to the bone researching them. What wives’ tales do you have to share? I’ve heard them all and can say that NO one tale is consistently true! However, you can’t make your grandmother believe it.

So, let’s address a few of the old wives’ tales patients asked me about the most!

The ring or needle test can determine gender and/or the number of kids you will have

FALSE, but it is still fun to play. If you’re not familiar, you string a thread through the eye of a needle or your wedding ring and hang it over your belly, holding it by the string end. If the ring or needle moves back and forth in a line, you are carrying a boy. A circular motion means your baby is a girl. The number of different patterns of movement is supposed to define the number of kids you’ll have. Mine was wrong and right. It determined I would have two kids, the first a boy and second a girl. I had two girls:)

So, I wonder. How is a destiny of seven daughters determined? Does the needle just make an infinite circle pattern for seven minutes? Hmm…

The Drano test can determine sex

FALSE! I have no idea where this originated, and I can’t even recall what means boy or girl. It just seems the Drano was supposed to change color for one sex and stay the same for the other. What I do know is this. Don’t do it! This drain unclogger should not come in contact with your skin and can also cause some caustic fumes which could be harmful to you and your baby.

Experiencing heartburn determines whether your baby will have hair

FALSE! Lots of patients with heartburn have bald babies and vice versa. Women often times begin to feel the effects of some serious heartburn later in the 3rd trimester. This is typically because your uterus is growing up as well as out! This puts pressure on your poor stomach, so it has much less space than normal. You feel full sooner when eating, and that pressure causes our much-dreaded indigestion. I remember all too well that Tums turned into a staple of my daily diet with both my girls.

With ultrasound, hair can be easily seen at the nape of your baby’s neck as long as there is a good pocket of fluid there. If so, it’s pretty funny to watch it float when pushing on Mom’s belly, especially if it is long and thick! Ask your sonographer if your baby’s head is in a good position to see if your baby will have a wig full of hair at birth!

How you “carry” tells whether you will have a boy or girl

TRIPLE FALSE! Most noteworthy, I’ve encountered this one most often. I don’t know whoever decided to link these two things together, but they could not be more unrelated. How you carry has more to do with your stature, torso length, belly size, and whether you’ve done this before. The more pregnancies you carry, the weaker the muscle tone becomes. Of course, everyone is different, but Baby may feel a little lower with each pregnancy. And last time I checked, the lucky little swimmer who made it to your egg first still has final say!

You can determine Baby’s sex by which side your placenta is implanted, left vs right

Hmm, this is something I started getting questions about within the past couple of years. AKA The Ramzi Theory after the guy who discovered it. However, it’s been disproven. The placenta can implant anywhere in the uterus. The most common position is posterior, or along the back side of the uterus. But what about the placenta on the front side of the uterus (anterior)? Or along the top (fundal)? What about the complete previa (covering the cervix and bottom of the uterus)? And there are all sorts of variations of placental location in between, meaning they can be a combo of two or more locations. My advice is not to rely on this one!

The Nub Theory


12 Week Female Fetus

While this one is not so much a wives’ tale, it has been getting lots of hype lately, so I’ll address it. Basically, at about 12 Weeks, external genitalia either sticks up, if a boy, or out, if a girl. The angles and skill of the sonographer as well as Baby’s position all factor into this appearance and guess. (Read more about the Nub Theory)
At the end of the day, this theory is only about 73% accurate. Personally, I wouldn’t paint a nursery based on 70ish percent…but that’s just me.

A Local Favorite Pregnancy Myth

My mother always swore by this one, and her deep Sicilian roots tell her it’s true. Her little old Sicilian friend down the street, Mrs. Camilla, predicted every one of her children’s and grandchildren’s sexes…by the moon. She didn’t know a thing about her methods,  just that she got it right every time. There’s simply no arguing with a sixth sense, right? Or a Sicilian mother. Take my word for it. Don’t waste your breath. Don’t even try.;)

Right, wrong, or indifferent…share your own experiences with pregnancy wives’ tales and funny stories here! I’d love to read about them and, so would other moms. Just email me at!

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Posted on April 29th, 2017 by

Diagnostic Ultrasound In a Nutshell

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. However, first and foremost, it 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 I Really Do When I Scan?

In a nutshell, my job requires me to see what’s in there 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, in other words, 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 any 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 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 that is beyond human hearing.  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.  Things 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.

Many other diagnostic ultrasound examinations are performed on many 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 is precisely why fetal sex is still incorrectly guessed! If the observer, or person holding the probe, is not very experienced at looking at fetal sex..oops!..wrong sex. And we’ve ALL heard those stories, haven’t we?!

Subscribe for more great information on subjects like diagnostic ultrasound and updates for the release of my new book on 1st Tri Ultrasound!

~ Coming Soon! ~

It’s all about ultrasound every week, dispels the myths, provides accurate information, answers lots
of questions for all you new moms out there as well as provides info that even the most
popular pregnancy books today just don’t!

Stay Tuned!

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Posted on April 27th, 2017 by

General Ultrasound Facts

  • Technically speaking, ultrasound is the study of the subject (the field of ultrasound) and a sonogram refers to the examination itself.
  • Current biohazard testing reveals no ill effects of ultrasound on the fetus, mother, or sonographer. However, ongoing tests show increasing levels of heat after scanning for several hours in one area. Over-scanning for long periods can cause cavitation or the creation of bubbles. This is much longer than the time required for performing a diagnostic test. Additionally, for this reason, only the prudent and diagnostic use of the technology is recommended by ACOG, ARDMS, and any other professional medical organization. The benefits of the information from diagnostic exams for patient and physician currently outweigh any known risk.
  • Ultrasound is just that…sound waves that operate at a frequency far beyond human hearing. Nope, Baby cannot hear the sound waves! Human hearing ranges from 20Hz to 20,000Hz. Diagnostic ultrasound operates in the millions of Hertz. Ultrasound probes range from about 2 – 13MHz.
  • Ultrasound is sound waves, NOT radio waves. No radiation is emitted by ultrasound equipment or Dopplers utilized by your physician to detect Baby’s heartbeat.
  • 4D is 3D in motion or a live 3D image.
  • Most people are familiar with 3D imaging as a fun way to see the outside of their baby. Additionally, the best and cutest 3D images are obtained later in the 2nd trimester or very early in the 3rd. Baby’s skin has developed more fat at this point which makes for chubbier cheeks!


ultrasound facts

3D 9 Week Embryo

Ultrasound Credentials for Sonographers

  • Someone newly trained in the field earns the credentials of DMS or Diagnostic Medical Sonographer. He or she has completed some sort of formal or on-the-job ultrasound training. This person is usually relatively inexperienced and has not yet passed the registry examination. This person should have direct supervision in performing your examination.
  • RDMS stands for Registered Diagnostic Medical Sonographer. A sonographer earns these credentials when he or she has passed a registry examination in his/her ultrasound specialty. Moreover, a certified sonographer will typically have at least two years of experience.
  • Not everyone who scans an expectant mom in a 3D non-medical business is a certified OB sonographer. Some have no formal ultrasound training whatsoever! These businesses are not regulated like medical practices. They may not be knowledgeable of or follow guidelines for equipment maintenance. Ultrasound equipment that is not properly maintained can be an electrical hazard for mother and/or fetus!!!


Performing Your Exam

  • Every practice is different. Most physician’s order a first-trimester ultrasound examination to date the pregnancy. This is usually performed with a vaginal probe. If no other problems necessitate another scan, the next is performed around 18-20 Weeks. Most women know this scan as the anatomy screen where we evaluate fetal and maternal parts for abnormalities. *Your doc does not order this exam to determine fetal sex!* Also, important to note here is that determining sex is never a guarantee, nor should it be an expectation. However, most sonographers will happily provide the info if at all possible!
  • The health of your pregnancy determines whether you will receive more ultrasound scans later in your pregnancy.
  • 2D ultrasounds are the grey-scale images you might recognize during your diagnostic examinations. Occasionally, a high-risk practice (MFM or Maternal Fetal Medicine) will usually also use 3D to assist in visualizing a fetal abnormality. We also frequently use the technology for GYN scans to attempt a better look at uterine shape and/or IUD placement.
  • Ultrasound cannot predict how much your baby will weigh at birth. While we can measure your baby’s head, belly, and femur for an educated guess for weight at the time of your scan, a large discrepancy for weight determination exists due to fetal position and sonographer inexperience or skill. We can typically track a trend for large or small babies. We know the average gained weight in the last few weeks is about 1/2 lb per week. However, every baby is different!

Ultrasound Facts About Fetal Sex

Most expectant moms today already know this little fact. The ultrasound machine is never “wrong” in determining fetal sex. Actually, it is the observer who is incorrect!

Guessing the wrong sex can be due to one or a combination of many factors. It is possible your baby was in a difficult position to see well. Maybe you were too early in your pregnancy for an accurate guess or your sonographer is inexperienced. In addition, an overall poor view can also limit fetal sex determination!

Facts About Your Results

Yes, the sonographer can read your examination. However, your OB/GYN physician or radiologist must ultimately interpret the images and report we create. Consequently, only your physician can legally give you results!

Patients ask me these questions on a very regular basis. I hope it was helpful! Feel free to email me at with your comments or questions!

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Posted on January 20th, 2016 by

In the 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 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!

9 Weeks pregnant, 9 Weeks, 9 Week embryo


Now, below is a video 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!

You can email me at to ask your ultrasound questions!

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Posted on November 19th, 2015 by

“How sure are you?” I’ve heard this question probably more than any other in my career! Sometimes, guessing fetal sex is a big risk and a real guess. Patients want percentages; I just want to be right!

Every sonographer is different. One’s sure is another’s iffy. I’ve seen images where a person was told one sex and the sonographer had “no doubts” only for me to scan later, confirming the opposite gender. The fact is that as long as expectant parents remain interested in guessing fetal sex by ultrasound, there will always be challenges surrounding the task.

How Sure Are We When Guessing Fetal Sex?

Are we sure or is it a guess? Honestly, they are all guesses. No sonographer should tell you her guess is 100% accurate. Even genetic tests like 1st Trimester DNA and amniocentesis can brag of 99+% accuracy! We, as humans, sure can’t surpass those odds!

Who we have making all those guesses are new sonographers right out of training, observers with little training, and those who are not formally trained in ultrasound at all (some of the keepsake video places). And because ultrasound is so subjective, there will be always be incorrect guesses. Even all us experienced sonographers practice a little differently. There will always be those who feel more confident to guess earlier than me. Others are more cautious, examining from every angle but still hesitant to commit if Baby’s legs are partially closed.

I’m more of the latter persuasion. I want to be VERY sure, super-duper sure before delivering a guess to my patients! I need great views in more than one angle and textbook imaging. After all, moms and grandmas want to shop! I would crawl under a rock to know I guessed incorrectly. Mostly, I would feel simply horrible for my patient, knowing it was because of me that she invested (both emotionally and financially!) in one sex vs the other! 😵😣

What’s the Answer?

Those who are new graduates or with limited experience could consult a more-experienced sonographer for a second opinion. And if a patient decides to visit an elective ultrasound business, make sure your sonographer has had formal training!

Patients should not pressure their sonographers for a percentage but also be understanding if she says she cannot determine their baby’s gender. I know! It sure stinks when this happens, but guessing fetal sex is something we can do if we have time and if Baby cooperates! Last but not least, Moms, don’t trust a fetal sex guess from anyone in a non-medical ultrasound facility that does not carry sonographer credentials! RDMS for those who are certified and DMS for those with formal training but who have not yet passed a registry examination. Experience in OB is preferable!

*And a final word of caution! Save your money during Weeks 14-16! Waiting until 17-18 Weeks is always better!*

And if you haven’t yet seen them, check out the links below for my images of fetal sex! They depict perfect examples of textbook, classic, no-guesswork-needed images of both male and female sex.

Here’s hoping you get pics like this for your next scan!

wwavblogger, RDMS

wwavblogger, RDMS

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Posted on October 5th, 2015 by

Fetal gender determination is not always a walk in the park for us sonographers. Ultrasound, like many technologies, have their limitations. There exist many factors which can make fetal gender determination mission impossible! Your OB docs understand there are a number of variables that prevent good visualization in every ultrasound we perform. Unfortunately, many patients do not.

So, if you’ve been losing sleep in anticipation of this long-awaited news, read this first! My goal is to inform expectant moms so that you go into your ultrasound exams with realistic expectations. I sincerely hope that through understanding these limitations, you’re able to leave your experience feeling happy. If all you can see is Baby’s heartbeat, it’s an opportunity to bond with your new addition that doesn’t come everyday.

Is Fetal Gender Determination a Requirement?

Definitely not. Fetal gender determination is not a routine part of a diagnostic examination. It may be information you desire, but it’s not typically information your physician needs. The anatomy screen at about 18 – 20 Weeks or so is ordered to rule out structural fetal malformations. Most U.S. practices do not mind providing a fetal gender determination as a courtesy IF the sonographer feels she can see well. And we LOVE to give you this information, if we can!

What Factors Impair Fetal Gender Determination?

Some of these factors that can get in our way of how well we see are listed below. They are very common! Actually, some of them confront us on a daily basis.

  • a breech fetus
  • a fetus with the rear against the uterine wall
  • a foot or feet in the genital region or crossed feet
  • closed legs
  • the umbilical cord between the legs or against the fetal body
  • body habitus or too much weight around a patient’s middle
  • uterine fibroids or contraction
  • a decrease in amniotic fluid
  • genital malformations
  • early gestational age

Even one of the above factors can prevent even the most experienced sonographer from determining fetal sex. A good sonographer knows when the views are good enough to provide you with a guess. A good sonographer also knows when not to guess! What you don’t want is someone who is inexperienced but willing to guess anyway. Many times, it’s not just one but several of the above variables that limit what we see. Unfortunately, we can’t change any of them.

Another little fact I’ll add here is that a non-arguable truth of the modality is Ultrasound’s laws of physics. The farther sound has to travel, the weaker the returned signal. The more tissue the sound waves have to penetrate, the worse the image. In other words, the more tissue there is around a patient’s middle, the more fuzzy the picture. The more fuzzy our picture is, the less we can see Baby’s parts. Any not just fetal gender, any parts. All it takes is one of the above factors to ruin the party. More often than not, a combo of factors will cause a little unwanted rain on your parade.

What Can We Do to Help?

We can try a couple of variables in an attempt to see better. Jiggling your belly or turning you to each side sometimes helps. We do this in the hopes that your change in position will also change Baby’s. Alas, it doesn’t always work.

What We Can’t Do

Unfortunately, we can’t scan you indefinitely! In an effort for fairness, we always try to get our next patients in as close to their appointment times as possible. Sticking to this schedule can be tough when patients arrive late or when we find abnormalities. Most patients are allotted a 30-minute appointment for their ultrasound exam. However, not all of this time is scanning time.

Before we scan you, we need to examine your chart for your history, an order from your doc, and an indication for the exam. After the exam, we need time to type up your report and send it to the physician. Most of us are nice enough to take more time with a patient if our schedule allows. I always did. Unfortunately, some of my patients (not understanding ultrasound) didn’t think I did!

What You Shouldn’t Do!

An unreasonable action disgruntled patients take these days includes airing their rants on social media. Consider, first, that venting your frustrations reflects poorly on your physician and practice. And you could be fired. Yes, a patient can be fired! In other words, I would advise against this method of revenge. If you are unhappy, you have the right to discuss it with Administration. But just know a practice does not have to tolerate any behavior deemed irrational or unreasonable. Just like one can fire an attorney, a plumber, or doctor, a patient can find herself in the same situation.

A Modern-Day Problem

Unfortunately, our society has become one of immediate gratification, even demanding it in the face unreasonable circumstances. I’m reminded of a few former patients and a like-minded character from one of my favorite childhood movies. Anyone remember Veruca Salt of Willy Wonka fame? These patients actually got angry, yelled, cried, and ranted in a place of medical business, much like the toddlers they would have themselves in another couple of years – all because I couldn’t tell them the sex of her baby. This. Is. Unreasonable.

I realize some sonographers don’t try very hard. In most circumstances, however, most of us make a sincere attempt to obtain this information for our patients who want it. We cannot, however, change the laws of physics.

Moreover, some patients mistakenly assume that because we couldn’t make a fetal gender determination, we must not be able to skillfully perform their diagnostic examination otherwise. Please keep in mind that medical professionals never judge such as gross incompetence. Rather, ranting such on social media is reflective of the patient’s ignorance, a lack of understanding of how the technology works. So, please! Don’t do this:)

We hate when our patients leave foaming at the mouth. Remember, this scan is about Baby’s health first! Just ask any mom who didn’t have a healthy baby.

Please feel free to leave comments below or email me at with your questions!

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Posted on May 12th, 2015 by


Obtaining a great fetal profile on ultrasound can be a challenge. I’m sure many of you have received questionable images in the past. Have any of you expectant moms shared this mom’s concern, too? Read on for what goes into obtaining a great fetal profile on ultrasound.


When a Fetal Profile is Limited


nervous mama:  Hi, can you please help me?! At 37 and 39 Weeks, I had ultrasounds done, and the profile looks so bizarre to me that I am nervous something is wrong. I have asked the sonographer and physician, and they don’t see anything wrong with them. However, I can not find anything remotely similar on the internet. Can you please explain what I am looking at? The nose looks odd shaped, and I cannot make out any other features such as the lips and chin. Please email me back before I give birth on Wednesday of next week. Thank you!

fetal profile, fetal face, 2D

fetal profile, fetal face, 2D


Because I only had limited information from these images and because I didn’t personally scan this patient, all I could give her was limited information about what I could see. That said, the profile in the top image is not a good one simply because of positioning. Baby’s face is plastered against what looks like the placenta (they love to do this, by the way!). Because of this, there is no amniotic fluid between the placenta and the face. The fluid helps to outline features like the nose and lips better.

It’s the same principle in 3D imaging. No fluid in front of the face, no image. I never give images like this to patients! When I see babies in this position, I tell Mom that I just can’t see Baby’s face well to obtain a good image. You can see in the second image there is just a bit of fluid (the black) in front of Baby’s face.

Another characteristic of obtaining a great profile is for the sonographer to ensure she is taking a perfect shot directly down the center of Baby’s face.  The images here are not a representation of a “perfect” profile image, per se’.

How We Take a Great Fetal Profile

Imagine taking a marker and drawing a line right down the center of your face. Starting at your hairline, draw a line down your forehead, between your eyes, down your nose, and all the way to your chin. This line splits your face into left and right halves, correct? This makes a perfect profile, and this is where we need to place the sound beam to obtain that view.

What Doesn’t Make a Nice Fetal Profile on Ultrasound

Now imagine that same sound beam as another line which is slightly to the right or left of the center line. Maybe you can imagine how the view would appear different. If the line cuts through your nostril instead of the middle of your nose, the image would not be the same. This may also be why the lips and chin look slightly different in the images above. Additionally, you won’t find anything online about it because everyone’s babies look as different at term on ultrasound as they do in real life!

What To Do If Concerned About Your Fetal Images

All that said, only your doctor can give you peace about something you question on your ultrasound images. If the sonographer is very experienced in OB and feels confident the face was normal, all you can do is trust that all is okay! If you can’t let it go, talk to your doc about it. Perhaps, if they have 3D capabilities, maybe the technologist can attempt a front view to ease your fears. Just remember that late in pregnancy, obtaining a good view of Baby’s face can be a challenge due to fetal size and limited fluid levels. That placenta may be a comfy pillow, but it leaves virtually no chance to see that face!

At the end of the day, a perfect angle with great position and good fluid are the only things that help create a great 2D image of a fetal profile!

This reader emailed me after she delivered saying Baby was beautiful with no unusual features or facial abnormalities. Thank goodness! I’m so glad she followed up with me! Not many do:(

Great Images of a Fetal Profile

See below for three of my personal images of a great profile!

profile1jpeg profile2jpeg profile3jpeg

They say a photograph speaks a thousand words. This can be especially true in ultrasound. We sonographers all know sometimes good images are impossible for many reasons. So, sonographers, explain why if you feel a good profile is not achievable. And, patients, don’t hesitate to ask your sonographer if you think something looks weird!

We should always strive for the best. The one thing a sonographer shouldn’t do is just take any old image as a keepsake photo. We want moms to cherish them – not to lose sleep over them!

Hope this helps! Feel free to leave your comments below!

Email me at with your questions!


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Posted on March 1st, 2015 by

Most women never get to witness this most amazing part of their pregnancies…the ultimate genesis of a pregnancy as can be visualized by ultrasound. No one has an ultrasound performed every single week in the first trimester, so I will share with you in the upcoming posts the astounding changes one can expect to see on a weekly basis.

How Early Can We See An Early Gestational Sac?

Between 4 and 5 Weeks of gestational age – but your doc will not order a scan this early! Why? Because there simply is no way for your doc to confirm your pregnancy is off to a good start at this point. Until we can see a yolk sac, an embryo, and a normal-appearing heartbeat (Week 6), no one can say for sure! A vast number of very early pregnancies end in miscarriage at this point…sometimes without a woman ever knowing she was pregnant at all!  I’ve heard my doctors say this is usually nature’s way of taking care of something that was genetically abnormal.  Each week a pregnancy progresses successfully, the higher the chances it will continue.

Even at Week 6, an embryo is only about 3mm. So tiny! Seeing Baby well this early can be very difficult in some people, especially if the uterus tilts backward. For this reason, most docs will wait until about Week 7 or 8 before scanning you for the very first time.


Your gestational age is determined by the first day of your last menstrual period or your LMP. For example, if you are 4 Weeks pregnant today, you would have conceived about two weeks ago if you have a normal period about every 28 days. I know it seems two weeks off, however, ultrasound software is calibrated according to gestational age, not fetal age. Very few women know when they actually conceived versus when their last period started.

Sometimes a woman’s “dates” are off meaning you are really farther along or not as far along as you thought.  Maybe you gave us the wrong LMP or maybe you ovulated very early or very late. This can change what we would see on ultrasound. Most women ovulate between days 10 and 14.

If you come in for your ultrasound too early, earlier than 6 Weeks gestational age, there’s not a whole lot we can tell you about your pregnancy. We may be able to see and measure a gestational sac, but your doc cannot tell you if everything appears normal until Week 6!

The timeline goes something like this:

  • <4 Weeks – we may see only a thickened endometrium and no gestational sac
  • 4-5Weeks – only a gestational sac
  • Just over 5 Weeks – possibly a faint yolk sac
  • about 5w2-6d – larger gestational sac including a yolk sac
  • 6 Weeks – larger gestational sac, yolk sac, and embryo with a heartbeat!

The changes we see every week are dramatic and essentially the same in every normally-progressing pregnancy.  For instance, we know that if we see a sac that measures 5 Weeks and you come back two weeks later, we should very well see an embryo that measures about 7wks. The embryo measurement is the important one for dating here! The early gestational sac can vary in size by a few days or more. Therefore, until we can actually measure an embryo at Week 6 or later, gestational age is only a guess.

Week 4

At Week 4, we begin to see the very start of a pregnancy as demonstrated by a tiny little sac of fluid called the gestational sac. Check out the image below.

4 Weeks pregnant, 4 Week gestational sac


This gestational sac measures 5.7mm or about 4 1/2wks. One criterion we note of a gsac is a brighter ring around the sac (the small black circle). This ring is called a decidual cast or reaction which is inside the single arrows. It should also be seen within the endometrium as you’ll see outlined by the double lines.

Below is a dichorionic pregnancy or TWINS!

4 Weeks pregnant, 4 Week twin gestational sacs


I am not a geneticist, so if you have twins and question identical versus fraternal, ask your doc! Twinning gets quite complicated. However, in this particular pregnancy, her babies were fraternal. This means she ovulated twice in the same month. Two eggs were released at about the same time and both were fertilized. SURPRISE! Man, I just love seeing the looks on people’s faces when I give them this news. It’s the best!!

You’ll notice the discrepant sizes of the gestational sacs. The smaller sac measured about 5mm and the larger equalled about 8mm. The proud owner of this uterus happened to be one of our nurses whom we scanned every couple of days in the beginning because she was a nervous wreck! Alas, her anxiety brings you a peek into the life of a growing pregnancy starting at <5 Weeks!

We didn’t know at this point whether the two eggs were possibly fertilized a couple of days apart or if the smaller sac would likely not progress. We both knew, however, that only time would tell. This is precisely the reason your doc will opt to not scan you so early! There is no way anyone can predict the outcome.

You can, however, follow this pregnancy! The next post, at about 5+Weeks, will demonstrate how these sacs looked just two days later!

Thanks for reading!

You can send your questions and comments to!


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