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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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 27th, 2017 by

General Ultrasound Facts


Patients have asked me these questions on a regular basis for years. Let’s get some ultrasound facts straight, shall we? I hope it’s helpful!

What’s the difference between ultrasound and sonogram?

Technically speaking, ultrasound is the study of the subject (the field of ultrasound) and a sonogram refers to the examination itself. Although we’re really not picky about what you call it.


Is ultrasound safe?

Biohazard testing over the past forty years reveals no ill effects of ultrasound on the fetus, mother, or sonographer. However, increasing levels of heat after scanning for several hours in one area can cause cavitation or the creation of bubbles. This is much longer than the time required for performing a diagnostic test. Since no one can predict the long-term effects, only the prudent and diagnostic use of the technology is recommended by ACOG, AIUM, and ACR. The benefits of the information from diagnostic exams for patient and physician currently outweigh any known risk.


Is Ultrasound radiation?

Ultrasound technology uses sound waves, NOT radio waves. I dedicate an entire post to just that subject in the link above. No radiation is emitted by ultrasound equipment or Dopplers utilized by your physician to detect Baby’s heartbeat. X-Ray emits radiation which is why, for example, your pregnant belly would be covered with a protective shield at your dentist’s office for X-Rays on your teeth.


Can my baby hear ultrasound? 

Nope, Baby cannot hear the sound waves:) Ultrasound is just that…sound waves that operate at a frequency far beyond human hearing. Human hearing ranges from 20Hz to 20,000Hz. Diagnostic ultrasound operates in the millions of Hertz. Ultrasound probes range from about 2 – 13MHz.

True story ~ I became a little distressed once when a patient asked me if ultrasound sounded like a jet to a fetus. She had just read this in a pregnancy magazine in our waiting room! I reassured her this was inaccurate. This experience marked one of the many reasons I wanted to start my blog–to get reliable info to new moms like you!


What’s the difference between 2D, 3D, and 4D?

Almost everyone has seen the gray clouds of 2D ultrasound at one time or another. 2D allows us to see through organs and inside your baby.

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 early in the 3rd. Baby’s skin has developed more fat at this point which makes for chubbier cheeks! 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.

4D can be described as 3D in motion or a live 3D image. So, where 3D is a still image, a 3D video of Baby moving is actually 4D.


ultrasound facts, 3D, 9 Weeks pregnant

3D 9-Week Embryo

Ultrasound Credentials for Sonographers


What’s your title? Are you a nurse or in X-Ray?

We’re not nurses, though some of us do cross over from RT (X-Ray) or other areas of Radiology. Sonographer, Ultrasonographer, or Ultrasound Technologist are a few of our titles. We are specifically and formally educated in the field of Ultrasound.

RDMS stands for Registered Diagnostic Medical Sonographer. A sonographer earns these credentials through ARDMS when he or she has passed a registry examination in Ultrasound Physics as well as his/her ultrasound specialty. A certified sonographer typically has at least two years of experience under his/her belt.

DMS refers to someone who has completed some sort of formal or on-the-job ultrasound training but has not yet taken/passed the registry examination.


What do you think of those 3D places?

Having posted on this often, I understand a patient’s desire to go, but I’m not a fan. 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! I know you may be surprised by this little-known fact, and so was I.

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! Do your research and at least ensure your sonographer possesses RDMS or, at least, DMS credentials. Please read the post in the link above!


Performing Your Exam


When can I expect to have sonograms in my pregnancy?

Every practice is different. Most physician’s order a first-trimester ultrasound examination to date the pregnancy. This is usually performed with a transvaginal probe. If no other problems necessitate another scan, you’ll receive your next exam 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!* However, most sonographers will happily provide the info if at all possible (as long as policy allows)! Also, important to note here is that determining sex is never a guarantee nor should it be an expectation. Sometimes, those Little Sweet Peas just won’t cooperate! You can read more here about those limitations. Note of advice for moms: Don’t pre-plan your Gender Reveal party for the same day as your ultrasound! The health of your pregnancy determines whether you will receive more ultrasound scans later in your pregnancy.


Can you predict how much my baby will weigh at birth?

While we can measure your baby’s head, belly, and femur for an educated (called EFW or Estimated Fetal Weight) guess for weight at the time of your scan, a large discrepancy for weight determination exists due to fetal position and sonographer 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. 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! Read more about why here.

However, most of us are more than happy to educate you about what you see on the monitor (minus a diagnosis!). I loved sharing how we measure and pointing out all your Baby’s parts for any inquisitive parents or family.


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Posted on February 12th, 2015 by

One of the strangest enigmas of my job is the development of my warped sense of time.  I rarely remember patient names but I do remember certain exams and images and I most definitely know faces! I might see a vaguely familiar name on my schedule, then see the patient in the waiting room and immediately put the face with the name. What always blows me away is, in fact, the length of time which has passed since they last delivered!

Case in point.. I recognized a name today, entered it into my machine and was stunned as to why the name did not pop up in the search. After all, she JUST delivered (last year, I was thinking). So, I call her back and begin my usual “so good to see you” gab and asked how old Baby is now.  “Baby”, she informed me, is FIVE! And no, not in months.  I seriously needed a few minutes to gather my composure and I’m sure she could tell by the look of sheer dumbfoundedness on my face.  It was quite amusing to her, I must say.  We both laughed and discussed how incredibly fast time flies when we are moms.

No matter whether someone is coming to see me for their second pregnancy or their fifth, it seems that almost no time has passed since their last visit.  It’s sort of like judging age; I’m getting to be terrible at that anymore, too!

Did I never overcome pregnancy brain or do our kids that make us this crazy?! Hmm..

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Posted on January 24th, 2015 by

I’ve written it a hundred times..or seems like it! Someone sends me an image and wants to know if I can confirm gender. Sometimes I can tell, sometimes it’s clear as mud. I usually have to write back and give my spiel about unclear gender on ultrasound and how, because I wasn’t the one who scanned, I can’t see the whole uterus. Some images are just bad!

In ultrasound, we have either images that are beautiful which belong in a textbook and anyone with an eye for the modality can tell you what is pictured. Then there are terrible images where we just shrug our shoulders and wonder what someone was thinking when she snapped the image.

I’ll share this email from a reader and her image and attempt to give you an example here of clear vs not.

unsure mama:  Hello! I’m on my 4th pregnancy and my first 3 were clear as day regarding genders, all done after 20 weeks. But this one, however, my sonographer seemed like she was struggling to get a potty shot. I’m not sure of real fetal age due to bleeding the entire time until 14 weeks. My sonographer said the baby was breech and sunny side up? Baby was also measuring at 17weeks 4days. She hesitated but then said girl. I didn’t ask questions but I didn’t see lines or a turtle. Here’s the pic she gave me. What would you say? Any information will be greatly appreciated. I have one girl who is oldest and two sons.


wwavblogger:  Thanks for reading and I hope you’ll subscribe! So, like I typically say, if it’s not a perfect picture, I just can’t sign off on gender. That being said, it could very well be a girl and this just isn’t a great image. It looks like the view is one of baby crawling away from you, if you can put your imagination to work. Right above the arrow is where you would see the 3 dots, however, the dots can blur together if the image is not entirely clear.

I’ll include a link below where I show a baby girl in a similar position, just a little more to the side. Idea is the same. This one is clear and you can clearly see 3 dots here. You can also compare it to the twin brother shot in the same post, too!

I don’t see obvious boy stuff hanging down like I would expect to see here!

Good Luck!


So, girl? Maybe! Boy? Sure can’t say it’s not!

My image in the link above that I sent her of girly parts you’ll find below. Which can you see better?

female gender

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Posted on January 23rd, 2015 by

One thing Moms wonder about most while waiting for the big day is how much Baby she is actually going to have to push outta there!  If it’s not your quasi-friends telling you you’re huge or a perfect random stranger asking if there are two in tow, then it’s your bathroom scale not-so-gently reminding you of your ever-changing shape. You see the numbers creepin’ up like your too-tight fave pair o’ jeans. If you’re really lucky, you just failed your two-hour glucose. Just when you thought pregnancy was going to be your temporary ticket to Oreotown, your doc is telling you to find a new love for wheatgrass shakes and to hang it up on the Beautiful Bavarian you have a date with for breakfast every day…your husband should be jealous the way you eye those things. I know, I know. I could eat half a dozen of them myself and I can’t use the excuse of growing a human or “Baby wants it; he told me”. Of course, you could use the disclaimer my old Italian mother swears by..if you crave something and you don’t let yourself have it, your baby will be born with a birthmark in the shape of that food somewhere on its body. I kid you not; she really believes it. All I can say is it’s a good thing it’s only an old wives’ tale or there would be an awful lot of gestational diabetes babies out there born looking like pizza and french fries.  Hmm, I wonder what an ice cream birthmark would look like? A dripping cone? The whole carton?

I guess one of the favorite pastimes of Moms today in this age of quickly-changing technology is consulting the highly-revered but often-times inconsistent daily app. You want to know if your weight gain is normal, if it’s too high or too low. Was quasi-friend right to tell you not to have that second piece of cake? Personally, she’d be no friend of mine after that. Let them eat cake! Or it’s “Aw, my baby is an eggplant today.”

So, knowing we have this insatiable appetite (no pun intended) for knowing everything everyday or at least being able to look it up and get some sort of answer, is it any wonder we wonder at all about the weight of our babies, too? This is where one role of ultrasound is important. Even though very subjective (as ALL ultrasound is), knowing how to take good measurements of your baby provides your doctor with some really important information about fetal well-being.  Read on from One Confused Momma who was originally confused about gender then more confused about Baby’s size!

ocm:  Okay so new question!! How accurate are ultrasound measurements as far as baby’s weight?? I had my last one today and she measured him at about 4lbs and I’m only 29 weeks and 3 days.

wwavb:  Hi, again! It varies and it’s not an exact science. Generally speaking, the measurements we take of the head, belly and femur are subjective but have a standard deviation of 3wks in the 3rd trimester. The total weight estimation will probably be somewhere around +/- a half pound or so at this gestational age. If we get a measurement that is a couple of weeks ahead, it can still be very much within normal limits for size. We also see that babies can grow in spurts so if the belly measures big now, it doesn’t mean it will nearer your due date. We can also determine through serial scans if a baby is trending large or small and your physician will follow fetal growth accordingly. So! All that being said, if your doctor feels baby will be big, he or she will likely keep an eye on size. This is a good question for your doc at your next visit!


I don’t have one with me now but I’ll print a report of a 3rd trimester biometry (fetal measurements) with an EFW, or estimated fetal weight, and share it with you next week, if not tomorrow!

I’ll also add here that your doctor uses the fundal height or the measurement in centimeters to the top of your uterus he/she obtains when you go in for visits to determine growth in generalities. If your uterus measures really large, your doc may order a sonogram to see if Baby is big or if you have too much fluid, polyhydramnios. We see a lot of this, by the way, and don’t always have an explanation for why it’s there. Conversely, if you measure pretty small, your doc may want to find out if Baby is not growing appropriately and to ensure you have enough fluid. Mom’s body type can also influence how your belly looks, too! You can spend all day downloading apps but, as always, questions pertaining to you and your pregnancy and baby specifically can only be answered by your doctor! (And not Dr. Google)

At the end of the day, our shapes during pregnancy are as different as we all are different from one another. We have to quit comparing our bellies to those highly polished on the cover of Vanity Fair and even one another and know we are doing what is right as long as we are adhering to our doctor’s guidelines! Sometimes it’s out of our control and our babies end up too big or not thriving well. Either way, that’s why you have people like me around!

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Posted on January 21st, 2015 by

When you bring family for your sonogram, your smallest ultrasound exam guests sometimes provide the best entertainment for us sonographers! I have posted some “kids say the funniest things” in the past. Most of the time when parents bring small children, especially for a lengthy ultrasound exam like the anatomy screen, it truly can be very distracting and disconcerting. Every once in a while, however, we have a child in the room who is simply entertaining…like the one who thought his baby sister looked “weally weird” from one of my most recent posts. He said, he was NOT making the mistake of going to another sonogram. Hilarious.

A totally precious little girl was in today with her Latino family. She must have asked me a million questions. The exam I had to do was pretty short and sweet, so it didn’t require too much brain power. Fortunately, I could indulge her a little. Every time Grandma thought she was talking too much, she would tell her in Spanish to stop and pay attention. That would work for about thirty solid seconds before the onslaught of more questioning. She was so cute and smart and SO well-spoken for only four!

For those of you who have had a sonogram later in the third trimester, you know how big Baby looks on the monitor. My little guest sees the baby’s abdominal circumference fill the image. Out of total quiet she exclaims, “My baby cousin has a really big head…and her butt is GRANDE!”

Any kid who can make me laugh out loud can visit me any day of the week! 😉

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Posted on August 12th, 2014 by

On July 25 I posted images of twin gender at 16+wks, one a boy and one a girl! A confident guess. Babies are 18+ Weeks now…and still looking the same. Enjoy!



This, of course, is a side-by-side of each baby with Baby Boy on the left and Baby Girl on the right.  It’s an underneath view so all we are seeing are babies’ butts and legs to the knees essentially.  All parts labeled for better understanding.  The “three white lines” for the baby girl are a little harder to see in this image but you’ll see it more clearly in the one of her below.



This is the same view and very obviously a proud baby boy!



You can see how much different this baby girl looks compared to her brother.  No wee wee here!


These are GREAT images of gender, people!  Clear potty shot and no question..just how I like to scan them! Below is the link for the first images at 16+wks.

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Posted on August 6th, 2014 by

Young kids are always accompanying their parents to the ultrasound to see their new sibling on the monitor. Honestly, unless they are over the age of four, interest steadily declines and sometimes rather quickly as soon as the lights shut off. Mom and Dad want them to be more interested than they truly are.  At 2 and 3 they simply are in the age of “me” and actually could care less about whether their new baby sister or brother, the one they’ll torment for years to come, can be seen on the “TV”.  Furthermore, if they do comprehend what a baby really is, the one on the monitor sure doesn’t look like any baby they’ve ever seen!

Parents try to come as prepared as possible with iPads in hand, games and snacks. Sometimes none of it matters and they scream and carry on until it’s over or grandma hauls him out. Every once in a while I’ll have a little visitor who is so cute, I just want to keep him with me all day. Today I had one such little guy. He was 3, barely understandable and so stinking cute. The kids who are quiet are usually intimidated by the surroundings and are fearful Mom is going to be hurt. I usually break the ice by offering them to feel the gel. I hold out a gloved finger with a big glob on it. I’ll make a game out of it and even if they are grossed out initially, very soon they are asking for a squirt.

Little man did just the same today. After a bit he got comfortable with me and asked what his baby sister was doing in there. I replied she was swimming. I didn’t understand most of anything he said…except that his baby sister was a fish. He said it over and over and over again. And the more we laughed, the more he said it. Of course, he knew he had a baby sister in there before anyone else did.  I swear I just think they have a connection with one another! We confirmed it was a sister and he kept reiterating “Baby sister a fish.”

I gave him his very own picture of Baby Sister to keep for himself. Kids just love that and I made a new little friend. He walked out of my room and looking up at me with a big smile kept repeating all the way down the hall that his baby sister was still indeed a fish. Too darned cute!

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Posted on August 1st, 2014 by

You’ve been ticking off days for months. God forbid if you have to put a big fat X on your EDD (the anxiously-awaited Estimated Due Date) as you watch this day come…and go. It’s just wrong!

We know pregnancy is different for everyone. Some people feel great while others…well, just don’t. Every mom watches the calendar in anticipation of Baby’s arrival. However, the days seem to get slower the worse you feel, and slower, and  s  l  o  w  e  r. Sometimes, you wonder how you can possibly go another day without splitting in two. You’re not alone.

You’re over it, and that’s okay. Toss any thoughts of guilt right into that Diaper Genie you just unboxed. I still remember the misery of pressure from standing too long. My piggie toes swelled like little sausages, and that vista had long disappeared below the horizon of that foreign belly in front of me. The full waddle was on, and 90% of my diet consisted of Tums. At least they were fruit-flavored. I was sick. of. being. pregnant. Consequently, I could so appreciate this sentiment in my weekly patients.


Weekly Scans Before My Due Date (EDD)?


After all my years in ultrasound, I discovered there exists an understandable progression of waning interest in the technology as a pregnancy advances. You might ask, “Is this really a thing?” Oh, yes. It’s especially true of those moms who are forced to visit us every single week after 32 Weeks. For those moms, there are other medical conditions that warrant routine observation of Baby. The culprit might be high blood pressure, gestational diabetes, multiples, or any number of potential complications.

This exam is called the BPP or Biophysical Profile, a way to observe and evaluate fetal well-being. It’s a great way for your doc to decide if she/he needs to intervene before that infamous EDD.

The natural order of declining sonogram excitement goes a bit like these real comments from my patients:


  • “How soon can I have my first ultrasound?” – Asked from the + pee stick or first doctor’s visit


  • “How soon can I have my next ultrasound?” – Typical inquiry immediately after the first ultrasound


  • “When can we look again?” – Asked as soon as the gel is wiped off from the 18 – 20 Week diagnostic anatomy screen


  • “Do I get another one?” – A late 2nd trimester inquiry after the anatomy screen follow-up


  • “Oh, yay!! I get to have ultrasounds every week!” – Early 3rd trimester


  • “This is so great. I can’t wait to see her every week!” – A few weeks of excitement


  • “What?? Do I really have to come in twice a week?” – Response to bi-weekly Biophysical Profiles until delivery


  • “This was fun at first, but I’m getting tired. And my feet hurt!” – One month left


  • “Okay, poke me with a fork – I’m over it.” – The dreaded final two weeks before her EDD


It’s so funny to me how parents positively can’t wait for their ultrasounds in the beginning. Some actually argue with their physicians to have scans earlier than they need them (they have a gender party to plan!). Initially, the feeling is so surreal and powerful –  this is your baby, and you can actually see his or her heart beating. Incredible. You think it’s something you could positively never tire of watching.

But after a while, especially if Baby never cooperates with cute face shots, the family loses interest. They quit accompanying you on your ultrasound visits, and all the fun oozes right out the door. Patients start to feel as though the monitor just plays the same movie of passing gray clouds over and over. They just can’t see a thing that looks like Baby. Of course, it’s different when Baby likes to pose for the camera.

It’s okay to feel “over it.” I promise I won’t take it personally that you are sick of seeing me every week! “Oh, no, not you again.” We sonographers get it. The gel has dried up, and you can’t see below the equator anymore. I do believe the Man Upstairs or Mother Nature has a way of making pregnancy miserable for most of us toward the end. If it didn’t get tough, we might be all too content with baby inside – afraid to face the unknown of labor.

When our Due Date rolls around and we leave a puddle of sweat everywhere we go, seeing our babies in shades of gray is cool. But color is better. And peeing ourselves? Well, that’s the last straw.

Where’s that eject button?

Thanks for reading and hope your baby is right on time!

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Posted on July 30th, 2014 by

Male Gender on Ultrasound

What should you expect to see?

You’ll need to look no further than the photos I have for you below — two great images of male gender! This baby was about 19 Weeks and (no pun intended), boy, was he proud! See below:

male gender, 19 Weeks pregnant


The image above represents a bottom view if you imagine Baby sitting on a glass table as you look up from underneath. I have all the parts labeled for you. The arrows, of course, point to the wee-wee (my technical term). This pic is about as straightforward a potty shot as you will find.  No guesswork, all boy!

male gender, 19 Weeks pregnant


Now this is a side view of Baby. You can’t see his head in this picture which would be off to the left-hand side. Again, I’ve  labeled all the parts so you, hopefully, understand what you are seeing. This time it’s the legs which do not make an appearance here. Not to be graphic but for demonstrative purposes, imagine slicing the body in half lengthwise; this is the view we have right down the middle of the torso.

male gender, 19 Weeks pregnant


The penis and scrotal sac from the side resemble a turtle sticking out of his shell.  If you can appreciate the tiny dotted line, you will see it is drawn around the “turtle.”

You can see how parts look different from different angles.  These depict super great images of baby boy stuff…no question, no nonsense, no guessing. Just all boy! Now this is  what I like to see when making a guess!

Compare to the pics in the links below for other great fetal sex images!

Best wishes for a healthy baby on your next scan!

Also, you can email me at!


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Posted on July 25th, 2014 by

Male and Female Gender Ultrasound Pics!

Okay now, readers, this is a perfect example of how we can sometimes determine gender at less than 17 Weeks! The images below represent twins and their perfect images of male and female gender! It just doesn’t get better than this.

These babies dated at 16w4d and depict textbook images for boy and girl fetal sex. They make a perfect side-by-side comparison!

These were very easy potty shots. We’ve just gotta love it when not just one baby cooperates but two in the same belly. These babies hardly made me break a sweat. I’ve even labeled their parts for you. So, hopefully, they make for easy reading for you. Check them out below.

Baby girl, on the left, is showing off only her bottom. Imagine her feet pulled up over her head. Flexible little things, aren’t they?

male and female gender ultrasound, 16 Weeks pregnant

Female, left and Male, right – Twins, 16 Weeks

male and female gender ultrasound, 16 Weeks pregnant

Baby boy, on the right, is showing off his thighs and bottom.

Unfortunately, not all babies cooperate like these. Some babies don’t want to show off the goods, and there’s little we can do to make them move. I know we sure would have many more happy mamas out there if we could!

More Links for Male and Female Gender
Ultrasound Pics

Happy fun comparing these images to your own!

Email me at with any questions. 🙂

For your most reliable ultrasound information,
subscribe here!



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Posted on July 19th, 2014 by

Ultrasound Advice for New Sonographers

New sonographer ultrasound advice is a topic that needs addressing for anyone new to the field. It’s a tough place out there for you. I know, I lived it, too.

A Fine Example of Negligence

I felt a bit distressed to learn something recently. It is an important lesson for any new sonographer, especially. A recent graduate of a sonography program landed her very first job out of school with a temp agency. With essentially no work experience, her recruiter advised her to “Fake it ’til you make it.” I thought I’d faint. She lied saying her recruit had one year of experience and placed her in an OB practice to work alone. The lack of responsibility of this recruiter left me surprised and horrified. The quality of exam a patient receives was obviously of no importance. This is unfortunate.

Moreover, the horror this new sonographer experienced is another story. Even though she had a brief period of training by the sonographer going on leave, she was uncomfortable with scanning or reporting anything on her own. With no experience to call on, she did not possess the confidence to call a case normal or abnormal. Where does someone even begin to construct a report when she is unsure of what she sees on the monitor? This is unfortunate and a precarious circumstance for all involved.

Don’t get me wrong. Everyone has to learn, and all new sonographers need the opportunity to become better. But, like so many things in life, there’s a right way and a wrong way to accomplish this task. It has to be fair to both the sonographer in training as well as the patient. Therefore, the following is a message to all sonographers who have just stepped out of the classroom and into the real world of practice.

Turn the Table…

From a slightly different perspective, please consider the following ultrasound advice. If it were you, your daughter, your mother, or your sister on the examination table, wouldn’t you want to know if it was the first exam performed by your provider? We all like to feel as though we are in good hands, competent hands when we seek medical attention or advice. Wouldn’t it be disconcerting to know the person scanning you is new, overwhelmed, and lacks the knowledge in all ways to perform your exam properly? Every patient deserves to have their examination performed by someone who is knowledgeable and properly trained. After all your hard work in school, you deserve to be properly trained!

Just in Case Your Instructors Didn’t Tell You…

You are not qualified to work alone. You need direct supervision from someone with qualified experience. You need direct supervision for all of your exams performed for at least three solid months. After that, you need to ensure you work in an environment with at least one other experienced go-to sonographer for questions..because you will have them. You will have a lot of them. We all did.

You should never lie about your experience, even if a recruiter tells you to do so. Potential employers need to ensure how much they can rely on your skill and experience outside the classroom. Your class time and clinical rotations count as experience toward taking your registry examinations, but it doesn’t go far toward real-world experience. You were in school and learning. You will still be learning volumes over the next few years. No one ever knows it all, and this is a field where you will continue to learn your entire career.

Students and new technologists, once you have scanned about twenty-five normal cases (give or take), you will be able to scan a normal exam on your own pretty easily. Tackling pathology is a whole other ball game. You will feel more comfortable you taking on the challenge of an unfamiliar process when you develop more confidence in your skill and ability. Everyone’s learning curve is different. If you learn new things quickly, you may feel more confident in your skills in less time. If you have a no-fear personality, you’ll have less problem jumping in with questions or presenting cases to physicians when you are unsure of a diagnosis.

What About a Private OB Practice?

Sonographers in a private practice need a great deal of experience. They need to be able to work independently and have enough confidence in their skills to tackle a challenging case without breaking a sweat. They should feel very comfortable scanning patients in every week of pregnancy with no question regarding the protocol of any exam. Do we still turn to our co-workers for a second eye from time to time? Of course, we do. It’s all part of continuing education and proactively learning where we have the opportunity to grow. It’s imperative. Remember, we never know it all!

In our office, we do not hire anyone who is not registered in OB/GYN with less than three years of full-time OB/GYN experience. How can a physician trust your work if you don’t trust it yourself? A physician relies heavily on the experience and ultrasound advice of his/her sonographers to provide competent and thorough examinations. How can they properly treat their patients otherwise?

Your job as a sonographer is to find pathology. You can’t diagnose what you don’t recognize, and you won’t recognize what you’ve never seen. This is just the nature of the beast.

Be Your Own Advocate!

I’m sorry if your educators failed you. They have a responsibility to not only teach you in the classroom, but what to expect outside of it. This is not your fault. It reminds me of an old adage which says that you can’t know what you don’t know. So, before you take your first job or any job thereafter, ask yourself if you are experienced enough to commit to it. Then ask if you will have supervision. Start out in a teaching hospital. Sonographers are thrilled to share their knowledge with you in such facilities! Learn what you need before you think about branching out on your own. You owe it to yourself in order to become a better sonographer. You owe it to your patient to provide a quality examination.

Patients: if this is overly concerning to you, it should be. You can always inquire as to the experience of your healthcare providers!

Subscribe to the blog for more ultrasound advice for new sonographers and expectant mothers!

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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 July 11th, 2014 by

Is Unknown Gender Still a Secret…

If your mother-in-law thinks she can read your images?

We all know that our family and friends can be quite nosy, opinionated, and even rude when it comes to all things pregnancy-related. After all, they’ve been there and done that, and they know better than you. This is your first rodeo, and you know absolutely nothing. Sound familiar?

In the course of conversation during a scan, especially with my weekly patients, we glide from the political correctness and appropriate medical office pleasantries to cutting up about life happenings. My patients take this opportunity sometimes to vent about just such personal offenses. One of my readers recently did the same! Read on about her dilemma…

irritated mama:  Hello! Firstly, I would like to say what a great blog you have, and I’ve really enjoyed reading it. Secondly, I’m wondering if you can take a look at my scan pic from my 20 Week scan. I’m now 25 Weeks. We didn’t find out the gender as my husband didn’t want to, but his family is convinced it’s a boy from the scan pic. They are even calling it a “he” which is quite annoying. I’m just wondering if there is anything on this scan pic that confirms the gender? Obviously, we didn’t get a potty shot. I hope you can help. Thanks!

unknown gender, 20 Weeks pregnant


wwavb:  This email cracks me up! You are not the first to be annoyed by in-laws who think they are ultrasound aficionados! Everyone is suddenly an expert. You’ll be happy to know gender is nowhere to be found on this image! It’s a great side shot of Baby, but when you get down to baby’s bottom, part of the hip/leg is pictured. So, it’s not a side shot between the legs. Now you can tell your in-laws to mind their own biz!

Best Wishes!
wwavblogger, RDMS

irritated mama:  Brilliant, thank you. That settles it, and I will tell them just that. Haha!


So just know, all you pregnant moms out there with in-laws who are driving you to drink…first, I can’t condone escaping your in-laws with wine in your delicate condition. Second, you have to stick up for yourself! There are nice ways to say anything. So, next time your mother-in-law (who doesn’t know what a femur is) attempts to read into your ultrasound image, kindly thank her for her oh-so-professional interpretation, and ask her if she’d like to deliver her grandchild while she’s at it.🤣

Yes, I am a smartass at times, but I blame my brother — the ultimate King of Smartassness, one-liners, and wisecracks. It’s a crown he wears proudly.

You can email me at with any ultrasound questions you have!

Interested in subscribing? You can do that here🙂

Thanks for reading!


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Posted on July 4th, 2014 by

Early gender pics can be deceiving. Many of you who want to know your Baby’s sex as early as possible with ultrasound may be tempted to believe the tempting promises of your street corner 3D ultrasound business. Before you pay your money to one of these places, I encourage you to first read the above link!

The early fetal parts of external genitalia look nothing like they do later on, just as an embryo doesn’t look like a baby or an embryonic chick look like a chicken! It’s also the  reason we do not perform the screening of anatomy until 18 Weeks. Structures like the brain are ever-changing until about that time. Even at 17 Weeks, the brain looks a little different. The same applies to external genitalia – later is most always better.

Because these parts are just starting to develop at 12 Weeks, boys and girls can look alike. Over the next month, your baby’s external genitalia are still developing and changing in appearance. That is to say, boy tissue starts to get bigger and girl parts shrink. Eventually, the scrotal sac and penis take a more recognizable shape, and the labia and clitoris take on the appearance of three tiny white dots or lines. Fetal boy parts can appear different from other boys, just as girls can appear different from other girls. We’re all different!

Please take my word for it. Any guess at 12 – 14 Weeks is simply a guess. You may as well flip a coin. At 15 – 16 Weeks, it’s still a guess. Now, have I guessed gender at 16 Weeks? Definitely! But it had to be someone I was scanning personally, baby had to be lying butt-up in a perfect position with legs wide open, and I had to have a clear image otherwise. There are many factors that play into how well we can see at any point in a pregnancy. It just all has to be textbook perfect and not every patient/fetus is a textbook scan. I might feel confident enough to provide a second opinion of your baby’s gender if you are 17 Weeks with a perfect potty shot!

Links for Great Images of Fetal Sex/Gender

The Nub Theory and Genetic Testing

Even if the parts appear very straight-forward based on the nub theory, it’s only a theory and only about 73% accurate. That’s a lot of room for error. So, just because a girl might look like a girl based on the nub, don’t be surprised to find a penis at your anatomy screen! Only genetic tests like first-trimester blood tests for DNA or amniocentesis are 99+% accurate for fetal sex.


All that said, you are welcome to email me with questions at any time in your pregnancy. However, sending me pics with a request for gender confirmation earlier than 17 Weeks will probably get an “it’s just too early” response. As much as I would love to, I just can’t provide you with helpful information in most of those cases. I can never be more confident than the person who scanned you! Especially if your sonographer said she couldn’t get a great shot, I likely won’t be able to tell, either.

If you’re greater than 17 Weeks and your sonographer has given you a potty shot where she’s annotated boy or girl, subscribe and email me your pic. I’ll be happy to try and provide a second opinion!

Good luck at your next scan!

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Posted on July 2nd, 2014 by

Sometimes my patients crack me up with their need to vent and their stories that follow. Whether it’s family, work, kids, friends, or strangers ruffling their feathers, it brings a bit of humor to my otherwise medically-infused day.

I called back my next patient – a late third-trimester mama who was about 37 Weeks. She huffed and puffed the entire exam about how tired she was, how she couldn’t be more ready to have this baby, and how frustrated she was with her spouse’s lack of help – with everything from kids, to cleaning, to dinner. It was last call at this pregnancy party for her, and she had had enough.

“Ya know, husbands just SUCK! The first time around, it was all ‘Let me rub your toes.’ Now I look over, and he’s snoring!” She was so disgusted with her husband and so funny. I literally laughed from the moment she climbed onto my table. It’s a good thing I could perform her exam in my sleep. I always loved the patients who made me laugh!

All I can say is don’t mess with a mama laden with full-term hormones! You’re simply on the losing end of that battle. Spouses, you better make her happy, give her what she wants, and pamper her in any way you can!

We all know that when mama is happy, everybody is happy;)  And don’t let your spouses forget it!


You can email with your questions and suggestions!


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Posted on June 29th, 2014 by

Internet Pregnancy Advice Isn’t Always So Reliable!

I know it’s such a difficult temptation to resist, but Dr. Google really isn’t the best doc to consult when you’re experiencing questionable symptoms. Especially, not when it comes to pregnancy, and practices across the country see it every week. Relying on Dr. Google for internet pregnancy advice only opens a can of worms causing more fear and worry…and more questions.

We’ve probably all done it at one time or another. Isn’t it just so easy to click on a Symptoms Checker or post your question onto your pregnancy group’s community forum? Maybe someone else has experienced the same thing, it turned out to be nothing, and your fears can be put to rest? The problem is that no one else in the world is you — or your baby.

We would see this quite a bit in the practice I worked for — a patient is given ultrasound results by her doctor, she goes home to Google the information, and then calls back to the office in a complete panic over what she’s read. The internet is filled with more information than we need and more than applies to you in your pregnancy. You are likely causing yourself more worry than necessary.


What you’re getting in your internet searches is the whole spectrum of findings and worse-case scenarios. This is also the case on almost every blog and site, no matter how credible. In your forums, you have other pregnant moms with no medical background, all discussing their results with only partial knowledge of her case and missing links. At the end of the day, twenty people experiencing pain may yield seven different outcomes. And because people gauge their symptoms differently, there’s no way for you to compare their level of pain to your own.

You know, as humans, we’re a bit flawed in our thinking. We tend to convince ourselves of what we believe to be true, whether that information holds water or not. The last thing you want is to read something which convinces you that you don’t need to call your doctor when you really should have. Don’t convince yourself a problem isn’t real; let her staff ask the important questions and determine whether you need to be seen!

The Best Advice!

Your doctor is your best resource for managing your pregnancy and any potential problems which may be associated. Only she/he holds your chart full of pertinent medical information about you and your baby. Your obstetrician can examine you and listen properly for your Baby’s heart tones or perform an ultrasound. Only your doc can advise you on what the next step should be or determine if ordering further testing is warranted. Whatever your concern, discuss it with your obstetrician or other healthcare professional managing your care.

And in case you’re more concerned with bothering your doctor after hours, this is precisely the reason for on-call staff around the clock! Your physician is your best advocate. He would rather you ask him (or his qualified staff) than your friends or family.

If you begin to experience your symptoms early in the day, don’t wait to call until midnight!
(To clarify, this doesn’t mean not to call because it’s midnight — just not to wait!)
 Don’t wait to see if your problem will go away. They’ll want to know about it sooner than later!
Also, you don’t want to put off treatment if you need it.

Remember this. Dr. Google cannot lay hands on you, examine you with his handy-dandy speculum, advise you, console you, or discuss test results. This is why you have an obstetrician. Moreover, Dr. Google didn’t attend so many years of medical school and surely won’t be the one to catch your precious bundle of joy on his or her birthday.

Direct all your concerns to one who will be — that’s why she’s in the baby business!👶

You can email me at with any questions!


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Posted on June 28th, 2014 by

As a kid, I used to go swimming at a friend’s house and I’ll never forget the sign posted on their cabana.


This is our swimming ool.

Notice there’s no p in it.

Let’s keep it that way.


I always thought it was so funny and clever! And her mother meant it, with all her Italian beauty and ferocity, threatening us that we better not do it! I have to laugh at that memory.

That brings me to a pool that most definitely contains some “p” and lots of it. I’m, of course, referring to the amnion.

For people who don’t already know this, you may be grossed out. However, this function proved necessary in order for us all to get here! Since we’ve all had to drink a little pee in the past, let’s talk some physiology. The amnion is predominantly made up of fetal urine, and it is one of the things we evaluate on ultrasound. Baby starts to swallow amniotic fluid later in the first trimester. During the anatomy screen, we look for fluid in the fetal bladder and stomach so that we know baby is swallowing and the kidneys are functioning properly. We also evaluate the amniotic fluid level.

Anything fluid on ultrasound appears black, so the stomach, bladder, and amniotic fluid are black.  Patients will typically ask, “What is that hole?,” when really it is a fully-distended stomach or urinary bladder they are seeing. Below you’ll see an image of a full fetal bladder.



So, there ya go, Mrs. Pat. Pee in the pool is a good thing;)



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Posted on June 28th, 2014 by

One of my favorite sayings of all time, from some of my favorite patients of all time! The phrase was new to me until this week when two different patients used it in the same week. The first was from a new patient and the second from one of my favorite couples ever. The phrase? Soup coolers! And soup coolers refers to…wait for it…Baby’s lips! Let me clarify. I’m talkin’ about big beautiful perfect lips, ripe for lots of sugar after Baby’s grand entrance. Or exit. However you’d like to look at it!

With a really great profile, we can obtain great images of the soft tissue of your baby’s face like the tip of the nose and lips. And that’s just what we got on my patient’s scan today. I called them luscious! Daddy called them soup coolers. Hilarious!

Most of you know that ultrasound images can be quite magnified, so sometimes parts can appear a little generous in size. I think there’s no doubt that this baby has some of the most precious soup coolers around! And Mom was happy to share them:)

This precious little pumpkin below is about 33 Weeks. The first two are 2D images, and the other three are 3D. Love ’em! Loved this couple, and miss them so much! They simply made my day each and every visit. And if they ever see this post, they’ll know exactly who they are:)






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Posted on June 18th, 2014 by

I would love to share this really funny experience with one very over-protective Dad.

A couple of years ago, I had a patient who was coming in every week for BPPs or Biophysical Profiles as they are called. I explain this exam in greater detail in the link above, but it is simply a way to determine the well-being of a fetus by scoring the baby on his/her movements. We also measure Baby’s amniotic fluid and monitor Baby’s weight, as well.

During these scans, babies are sometimes napping…or maybe lazy. Sometimes we have to “force” a little movement by nudging baby which we accomplish by poking at mom’s tummy. If Baby is REALLY asleep, we sometimes have to poke quite a bit. I, of course, always ask Mom if I am hurting her. And I’m surely not hurting Baby. Your Little Love Bug is well protected by the amnion and fluid and mom’s uterus which is, essentially, one big muscle. But Dad, on this particular day while joining Mom for the visit, felt that I was — and he let it be known.

I start poking around on Baby and Dad pipes up saying, “You need to stop that. You’re pushing too hard.” I assured him that I wasn’t and asked Mom again if I was hurting her. She actually laughed a bit, stated she was fine and instructed me all to just continue doing what I needed. She also tried to calm Dad, but he wasn’t having it. After a little more vigorous poking, Dad said, “You’re gonna cause Shaken Baby Syndrome!” Some Dads joke about this, but this one was serious. Mom laughed out loud, and I reassured Dad that Baby was well-protected in there. We certainly would never do anything to, intentionally or otherwise, cause harm to his little one.

He eased up but wasn’t happy about it. He was starting his job early…over-protective of his baby girl before she ever even arrived.

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Posted on June 15th, 2014 by

First, I’d like to extend a huge congratulations to a reader who recently delivered!👶 I love answering your ultrasound questions. I love it more when I actually help a reader. This is what she had to say…

Hi! I hope you had a lovely time on your holidays. Just had to say I had a little boy at 38+5, and he was a MASSIVE 8lb 7oz :)  Not half as bad as I imagined. Many thanks for your help to me!

Feedback and Your Ultrasound Questions…

I’m always excited to get your feedback! The whole point of my blog is to answer questions you have about ultrasound accurately. Considering the vast forums on pregnancy where everyone chimes in on their personal experiences, taking to heart unreliable information has the potential to do harm to you or your baby. Everyone is an expert; everyone has an opinion. Though I believe most genuinely care and try to help, I have found much about ultrasound to be misleading or incorrect in some way.

I have loved breaking the news to expectant parents about whether they would be shopping for pink or blue! And I’ll still be happy to try to decipher someone else’s images for my readers. In my effort to bring to you factual and truthful information about your ultrasound examinations, part of that truth is doing my best to help you understand your exam. Ultrasound will always be, first and foremost, a medical examination of mother and child. Your sonographer needs enough quiet and concentration to ensure your baby appears healthy! Afterwards, break out the party hats, and let’s have some fun!🎉 Of course, the level of fun completely depends on how photogenic your new addition is feeling that day. Poo, sometimes, it just isn’t what you expected, even when you lost sleep in anticipation😫

That said, the highlight of many workdays revolved around very happy couples who were mindful of why they were there, so happy to be expecting, and loaded with ultrasound questions! I love to impart  ultrasound knowledge to anyone willing to learn it. If I could also deliver a few awesome keepsake images of their future addition and enjoy a few laughs in the process, all the better. I still feel honored to have been a third objective party who was privileged to orchestrate it all!

Best wishes for a beautiful experience!

Email with your comments, questions, pics and suggestions!

I’ll do my best to answer them for you!


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Posted on May 24th, 2014 by

Today’s post is all about ribs but not the kind we love to bathe in barbecue sauce. It’s all about fetal ribs today.

Bone on ultrasound shows up white because it is very dense. Water, on the other hand, is the opposite and shows up black. Ultrasound cannot travel through bone, so as your baby’s bones become more dense, they cast a shadow behind them. Viewing certain parts behind them become a challenge, like the heart.

Next time you have a scan, notice the appearance of  baby’s bones. Look for the perfect black lines of the shadow behind the bone. Notice we cannot see anything in that shadow. Therefore, anything that lies behind bone is not well seen.

Take a look at the image of this baby’s ribcage below. Notice the arrows pointing to the white dots which represent the fetal ribs and the black shadow that follows each one. Ultrasound 101. You’re quite welcome!




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Posted on May 22nd, 2014 by

EFW or Estimated Fetal Weight

Here’s an email I received from a UK reader asking about determining Baby’s estimated fetal weight or EFW. Read on for my response!

reader:  Hi, I was just wondering how accurate scans are at estimating weight? I’m 36 weeks +1, and I had a growth and reassurance ultrasound today. Baby was perfect :), and they estimated 7 lbs. This is my 4th child, and the only full-term baby I’ve had was my last. He was 7 lb 10 ozs. I am a little worried this baby is going to be a 9-pounder and that I’m going to have a difficult labour. This is my last baby, so I really don’t want to spend these last weeks worrying over nothing. Any info would be gratefully appreciated. Thanks in advance. I love reading your blog!

wwavb:  I love my UK readers! First, let me say I am happy you found my blog and are enjoying it. Thank you so much for saying so! I hope you’ll spread the word!

Now on to your question. I’m unsure what the discrepancy is in the UK for fetal weight. Our machines may be calibrated slightly differently here in the states. That said, 1 lb +/-  is not unheard of and sometimes can be greater depending on the level of skill of your sonographer and fetal position. These factors can make measuring baby more difficult and less accurate, which is precisely why it’s called “estimated.”

If your baby is at 50% or thereabouts, it means he is average in size and will gain, on average, about
1/2 lb/wk until delivery. If your baby is measuring bigger then average (which I wouldn’t know without seeing the individual % for each measurement), it’s feasible Chunky Monkey could gain a little more each week.

Just know that if this baby ends up being larger doesn’t mean you’ll have problems delivering!



It’s also important to note that if your baby is measuring smaller than average, his or her weight gain will likely equal less than that 1/2 lb/wk estimate. Everyone wants to mentally prepare for what they are going to have to push out which is totally understandable!

Best wishes for a quick and easy labor and delivery! for your questions and pics:)


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Posted on May 21st, 2014 by

What’s in a Fetal Umbilical Cord?

The fetal umbilical cord is made up of two arteries and one vein. This is one of the important bits of information we obtain during your anatomy screen or the scan most get at 18 – 20 Weeks. A great image of the cord is seen below. Many patients will ask if those are bubbles floating in the amniotic fluid. Nope! No air in there, remember?!

fetal umbilical cord


Notice the fetal umbilical cord circled in yellow below (along with boy stuff!):

fetal umbilical cord


You may sometimes see your sonographer add “color” to Baby’s cord (except that this one is black & white):fetal umbilical cord

Typically, we apply blue to the vein and red to the arteries. This color flow capability just allows us to see the vessels better and to evaluate the flow within them. This is mostly performed in the 3rd Trimester.

SUA or Single Umbilical Artery

Sometimes, only one artery develops; babies can grow just fine in those cases. Usually, if your baby has a two-vessel cord or SUA, single umbilical artery (as they are commonly referred to), your doctor may request serial ultrasounds to follow Baby’s growth over the course of your pregnancy. Often, your doc may request you schedule serial BPPs from 32 Weeks until delivery.


We can never see all the cord from placental to fetal insertion later in the pregnancy. Baby gets to be too big, and we see only segments of the cord here and there. One question I’m routinely asked of patients is if the cord can be seen around the baby’s neck. Called a nuchal cord, sometimes we do see this, but it just isn’t something your doctors necessarily need to know. For more on the nuchal cord, click the link above.

Did this post strike the right chord with you?
(Okay, I’m really sorry — there’s just no excuse for a bad joke.)

Here’s to your healthy babies, Ladies!

Email if you have any other questions!


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