Posted on August 25th, 2017 by

What’s the purpose of ultrasound gel?

ultrasound gel

Ah…that amazing blue stuff…sometimes shockingly cold, oftentimes warm like a comfy blanket (if they’re nice and keep it in a warmer!). If you’ve ever had a sonogram, you know it’s pretty messy, and Moms usually hate it!

The best I’ve used for most of my career, pictured above, is made by Parker Laboratories and provides the perfect viscosity. In other words, it doesn’t run down the side of your belly when we squirt it. Ultrasound gel is made up mostly of water, gets everywhere, and feels tacky until it dries. However, no one can have an ultrasound without it!

Why do we use it?

The role of gel is two-fold. Most importantly, it’s acoustic transmission gel. This means it helps to conduct the sound waves. No gel, no view! Ultrasound cannot travel through air or gas. Without the gel, there exists a bit of air between the probe and skin which produces no image on the monitor!

Second, it allows the probe to move smoothly over Mom’s belly. Some wonder why we use so much. If we used it sparingly, it dries out. The probe won’t glide over your kin, and the dried gel forms little balls of stickiness. Gross. Better to use a bunch and extra tissue to wipe it off after! Usually, it dries like a fine powder on your skin.

I performed this little experiment one time for a patient who asked, much to her amazement. It’s really cool, actually…touch the probe to the skin with no gel and all you see is black. Add a little gel and Voila’! Baby.

So, there you go. Another lesson in Ultrasound 101.

Have a great day and a healthy pregnancy 🙂

Email me at with your questions!


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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 2nd, 2015 by

How Ultrasound Works

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

What is Ultrasound?

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

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

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

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

Most importantly, Ultrasound is not radiation!

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

How Ultrasound Works

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

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

9 Weeks pregnant, ultrasound, 9 Week Embryo

9 Week Embryo in 2D

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

how ultrasound works

9 Week Embryo in 3D

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

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

Subscribe for more information about how ultrasound works!


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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 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 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 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 17th, 2014 by

Ultrasound – One Mom’s Opinion

I love receiving uplifting emails from readers! Your positive feedback inspires me to continue blogging and to look for more ways to inform you about your fetus and you! Accurate ultrasound information and the safety facts that you need to know for the health of mom and baby make up my highest priority for my blog!

facial profile, 18 Weeks pregnant, ultrasound

Additionally, your questions offer great content to share with other readers. I encourage all my readers (subscribers or not) to share your ultrasound stories, comments, images, photos of your fetus, and ultrasound questions at Furthermore, your experience may even help another mom-to-be with her search. I hope you’ll read, enjoy, and subscribe to my blog to find answers for all your ultrasound questions!

An Ultrasound Opinion from One Fellow Healthcare Worker to Another

nurse and mom-to-be:  Hello!! I must say I love your blog and wit!! Patients are so lucky to have such a skilled sonographer like you. I must say I’ve experienced both. My last one we met  (18 Week ultrasound) was great, 20+ years experience and worked with higher-acuity patients, too. She respected our wishes and wrote down the sex with a picture for us to open later. She asked us to leave the room so she could analyze the image. We also asked her track record and she says she does not reveal if not sure. She labeled every body part for us and thoroughly educated us, as I’m sure you do, too!! I’ve been a nurse for 10 years so I can only imagine the questions you get!  Love the idea of your site – you really utilize your talent and help us crazy pregnant ladies!!

Best wishes and I’m now a subscriber (and huge fan), yay!

wwavb:  Hi! Thank you so much for reading and your kind words! AWESOME!! I’ve worked two years on content, and I would love to make my site into a book one day!!  I think it would be an entertaining read for anyone and a great shower gift for new moms:) Your great feedback was a great Mother’s Day gift, by the way!

Subscribe for more accurate, reliable ultrasound facts and information for moms to be!


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Posted on May 10th, 2014 by

Another Male Fetal Gender Pic

It’s a Boy! Male fetal gender on ultrasound is pretty obvious here, wouldn’t you say? Little boys are an easy guess when they pose like this! Not much question here. I love it when your babies cooperate!

male fetal gender, 20 Weeks pregnant


This baby was about 20 Weeks. He was positioned perfectly to obtain a great underside view with part of his thighs in the pic. We’re not really seeing Baby’s butt here. Can you guess what the small black oval is just behind the scrotal sac? If you guessed his bladder, you’d be perfectly correct:)

How about more great images of fetal sex? Check out the links below for male and female images:

You can email any time!

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Posted on May 8th, 2014 by

I LOVE IT!  What a breath of fresh air I received from a reader – someone who actually wants to avoid fetal sex determination! Now, don’t get me wrong. Though I held off on the potty shot for my first, I was a full-time certified sonographer working several years by the time the second came along. I personally couldn’t wait to see for myself. I even scanned myself in the process (we all do this, by the way)!

This post comes from someone who definitely fits into Club Minority. She wanted to wait for The Stork, but that was just not good enough for everyone else in her family!

distressed mama:  Hello, I’ve really enjoyed reading your blog. From everyone’s posts, I can see that I am in the minority — my husband and I want to be surprised with the sex of the baby on the day I deliver.
We got the anatomy scan a few weeks ago, and the tech was very respectful of our wishes. She didn’t reveal the sex to us, and we left with the attached pictures.
We sent my sister the top picture in a text message. Upon seeing it, she immediately said, “I think I know what it is…,” and blurted out her guess. That really bothers me because it seems that the rest of my family believes her and is taking her opinion as fact. I still don’t want to find out, but I don’t want anyone else to be so certain that they know, either!
Based upon the first picture in the set of 3 I’m sending, is the sex of the baby obvious to you? I figure that if you can’t tell, then my sister who is NOT a trained ultrasound tech can’t tell, either!
Thanks for your blog, it’s always fun to hear what you think about these ultrasounds from “the other side” of the wand!
fetal sex determination

wwavblogger:  I LOVE IT!!  First things first. Absolutely, positively NO genitalia in that shot whatsoever! The black oval in the pelvis is baby’s bladder and I’m guessing she thinks she sees something just above that which is a very small section of umbilical cord at abdominal insertion. Either way, you are totally correct in that if I can’t see parts, neither can anyone else! Tell your fam they have a 50/50 shot at guessing;)


Everyone the expert, right? And, yes, the desire is overwhelming for patients to know gender as soon as the pee stick shows +. However, sometimes the desire comes more from the family than the patient!

From the other side of the wand, I can tell you people often believe what they want to see, not what’s really there. Distressed Mom, be sure to let us know what The Stork drops at your door!
Thanks for reading!
Have a similar story? Do you desperately want a surprise?
Is your family driving you nuts with constant harrassment to find out?
If so, email me with your experience at!

For your most reliable ultrasound information, subscribe here.


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Posted on May 1st, 2014 by

Early Sex Determination

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

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

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

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

12 Week Fetus, early sex determination

12 Week Fetus

12 Week Fetus, early sex determination

12 Week Fetus


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

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

Best wishes for a healthy grandbaby!

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

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

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

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

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Posted on April 22nd, 2014 by

Mistaken Fetal Gender Guesses

It’s possible. We’ve all heard a story or two, right? Being too early in gestational age is one way to ensure mistaken fetal gender guesses. Baby insisting on keeping still in a difficult position doesn’t help, either. There’s more at stake here than just being “wrong.” Parents start to identify with being a mom or dad to a new baby girl as soon as you speak the words. Thoughts jumpstart to dance recitals and her wedding day. Dads immediately daydream of the fishing partner they always wanted, or they run out to buy his first tiny baseball glove.

These are strong emotional ties that often get broken when someone casually throws out the gender card on ultrasound. Beyond the need to return some beloved items, comes the sometimes feelings of guilt or loss when the true gender is identified.

How “Mistaken Identity” Affected One Mom:

reader:   This is my second pregnancy and I am 18 Weeks. At my 20 Week ultrasound of my first pregnancy, I was told by the head ultrasound doctor (radiologist?) that it was definitely a girl, and I picked out a girl’s name. I ended up going into labor early at 30 weeks.

At the hospital while an ultrasound was being done, I kept asking if she was ok. The poor tech said, “Why do you keep saying she? Were you told it was a girl?” We said yes. She said, “Well, I see a scrotum. I’m going to get the Dr.” So, it turns out we were the first time this head doctor ever got it wrong, and now we are legend at his hospital.

We were already calling the baby by the girl’s name we picked, and I had a really hard time with the news. The only way I can describe it is like I had to grieve this little girl I had in my head that was suddenly gone. I wouldn’t change a thing about the amazing toddler boy I have now. But at the time, I was a wreck. Needless to say, I don’t want to go through that again. I was told today that the baby is a girl (again), and it is hard for me to believe. So, I just want to see what you think!

18 Weeks pregnant, female gender, mistaken fetal gender


wwavblogger:  Wow! Your story is EXACTLY the reason I implore sonographers to give careful and cautious consideration when determining gender!

I learned many years ago that even if I say I am not sure but give a “possibly,” parents are already thinking ballet slippers and pink tutus or sailboats and whales! It’s so true.  It’s just an emotional attachment you begin to develop as soon as an inkling of pink or blue is mentioned.

 Now, not having scanned you real-time myself, looking at one single image can be tricky. By this image only, it looks like dance recitals may be in your future! It does appear like the typical three lines we see in a baby girl. Just know that I can’t guarantee it, though! PLEASE, send me another image of gender every time you have another scan in this pregnancy, especially since she already has the perfect name!
Did you or someone you know experience a case of mistaken identity by ultrasound?
If so, feel free to email all about it at!

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Posted on March 15th, 2014 by

Or, rather, Estimated Fetal Weight. This is the approximate weight of the fetus after we measure the head, abdominal circumference and femur.  Our machine takes this information and plugs it into the software to estimate Baby’s weight.  I’ve posted on BPD, HC, AC and FL before so I won’t focus on HOW we get those measurements today, but instead, the accuracy of them.

I am asked several times per week, “Now how accurate is this weight?”  Are we always right on with birthweight?  No.  Are we always close?  Another no.  But MOST of the time, we are.  It is an educated guess and based only on the measurements WE take and there are many variables that play into obtaining those properly.  As baby gets closer to the EDD (Estimated Date of Confinement), Baby gets bigger, the head becomes more engaged, and the fluid can start to diminish a bit. There is only one right way to measure Baby and all of these things make her harder to see and these measurements more difficult to obtain, especially depending on Baby’s position.

Also, Baby is packing it on in the last month!  Average growth is about 1/2lb per week!  If you’re baby is trending heavier, Baby will usually gain more than the 1/2lb and if trending smaller, then less than 1/2lb per wk.  This is why when a patient comes in at 32wks and asks how much I think her baby will weigh at birth, I always say “If I could predict that, I could have retired a long time ago!” Sometimes babies grow in spurts, too.  We might see a huge head at 30wks and a few weeks later see that everything else caught up.  So, NO WAY to predict!

Technically, our software tells us at term to figure plus or minus 1.5lbs. However, IF I feel that I am getting really easy and accurate views of the head and belly (especially the belly since most of the EFW comes from the AC or abdominal circumference), then I feel pretty good to say that I may be over-estimating by about a 1/2lb.

Remember, if you get an ultrasound and an EFW at week 38 and you deliver at 39, don’t forget to add in that extra poundage!

Here’s to a fat and happy fetus!

And if you have stories you’d like to share or questions about weight, feel free to email me or comment on this post!

Thanks for reading,

wwavblogger 🙂

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Posted on March 12th, 2014 by

Several times a week after I squirt gel on a belly, I usually get a surprised “Wow, that was warm!” or “I thought that was going to be freezing!” Most doc’s don’t have gel warmers in their exam rooms so most people are pretty surprised when I point to the electric warmer plugged into the wall.

I’m pretty amazed when people say they’ve never heard of such a thing or that it’s such a great idea.  Yes, it is, as a matter of fact! But the truth is they have been around for longer than I’ve been a sonographer, so new they are not.

Gel, at room temperature, does feel like ice. Aquasonic 100 is the brand that practically monopolizes the gel industry. It possesses just the right degree of viscosity that it pretty well stays where you squirt it without running down the sides of mom’s belly, the way mineral oil used to do before gel’s inception.

We go through a gallon or so per week!

Funny gel story:  We sonographers typically hold the bottle upside down and shake, like attempting to coax out that last ounce of ketchup for your fries. I once did this with a bottle directly over mom’s belly…and the cap wasn’t screwed on entirely! Yep, you guessed it. The cap catapulted onto mom’s belly along with a half bottle of gel. Oops! :/ Fortunately, she wasn’t hurt, and we ended up laughing about it!



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Posted on March 1st, 2014 by

What exactly do I do? Let’s break it down. This information will definitely be helpful to anyone interested in training for a career as a sonographer. Many are fascinated by ultrasound! So, this may also be an interesting read for those who are merely curious about what we do. This may also be a little long, so hunker down with a good cup o’ joe.

Ultrasound is very technical, so attention to detail is of great importance. We work in the millimeters, so spacial concepts and 3-dimensional thinking are necessary. We can visualize mentally what we are only partially seeing on the monitor. For new sonographers, this gets easier with improved scanning ability over time. None of us were great sonographers right out the gate!

So, what am I? I have many names…sonographer, ultrasound technologist, ultrasound tech or technician. A certified sonographer is someone with a couple of years of experience who has passed a Physics exam and one specialty examination (like OB/GYN). You then earn the credentials of RDMS, Registered Diagnostic Medical Sonographer. There are many other examinations for which one can earn more credentials.

We start off with some book knowledge. We learn medical terminology, A&P, pathology (disease) and how it presents, ultrasound physics, biology, and examination protocol, for example. In my particular training, we started clinical rotations where we visited different clinical settings for a period of time. We would follow other more experienced sonographers to observe examinations. I learned a little about the technologist/patient relationship like what to say and (most importantly!) what not to say.

We also learned how to present our examinations to the Radiologist, the reading physician. You better have all your ducks in a row here, people! They are tough. They can and will ask you a hundred questions, and you better have the right answer waiting. Like any other profession, some are easier to work with and offer more guidance. Some, well..don’t. After you are more experienced and have proven yourself time after time, the tough ones let up a little:) They know when a sonographer knows her stuff, and they know when they can trust your skill and ability. It just takes time.

We learned how to handle patients in hospital beds, how to transport them, and how to handle their catheters. Learning to keep urine, vomit, or blood off your person was a good time, too! We also learned what to do if it happened anyway and how to not get sick yourself. It doesn’t help your patient! If you have a good teacher, you also learn how to handle patients with dignity and respect. It’s hard for someone to feel that when they lie in a hospital bed. In an outpatient setting, you learn that patients are the lifeblood of a practice. When dealing with the general public, you can’t always say what you want, and you have to learn to filter.  This is sometimes VERY HARD to do!

A sonographer learns scanning ability with hands-on training with a machine and an experienced sonographer at the helm. Ultrasound machines are very much like most computers. They all have the same basic functions, but some have a few more bells and whistles than others. We learn what something looks like by watching someone else.  S…l…o…w…l…y over time we begin to be able to recognize parts ourselves. Then we take over the probe. We have to learn how to hold it and find the parts ourselves. We learn how to properly measure organs and how to adjust 40 knobs so that the image looks the way it should. Additionally, we have to learn image protocol which includes what images to take and how many.

Eventually, after a few months of scanning, these technical details become second nature. As soon as the probe touches the skin, we set about making our image look as needed without much thought. It is only then that we start to recognize pathology. Sometimes, disease processes present exactly as one learned from the book, sometimes not. Oftentimes, we see something we know is NOT normal, but we can’t exactly put a name to the process. What students need to know is that one of the most important things they’ll learn about ultrasound is to first learn what “normal” is.  Once one scans many normal exams, it is much easier to recognize when something is wrong.

We learn all the above for many different parts of the body! Some aspects of ultrasound include Intracranial and Peripheral Vascular (vessels of the arms and legs), Echo (the heart), Small Parts (breast, testicle and thyroid), Abdominal (all abdominal organs and vessels), OB or Obstetric (maternal and fetal), GYN or Gynecology (pelvic organs in a non-pregnant female), and many others. Ultrasound is also performed on the eyes and in more recent years, muscles and nerves. We also spent a bit of time learning about biohazard waste management and HIPAA regulations that keep patient information private.

Over time and with more experience, we learn how to better manage our patients and case loads. I say it’s a process with a long learning curve, especially for anyone starting out with no medical background. At times, I cursed my choice of career, place of employment, and certain unpleasant physicians. I sometimes cried before and after a particularly hellish workday or weekend of call. It was the hardest thing I’ve ever done. BUT I did it. And slowly but surely, the puzzle pieces came together. They began to fit in a way that brought light and clarity to every exam I performed. Suddenly, it just started to make sense.

When I began to ask more questions about something I didn’t understand, I received better response from docs I admired for their extensive education, intelligence, and knowledge. You can’t be afraid to ask questions! It’s important to your docs, their practice, and patients. It’s also important to you, the sonographer, for your own developing skill and ability. This confidence grows over time! It’s a great feeling when you finally get to this point.

To this day, I still get a rush when I recognize pathology and all the puzzle pieces come together. It makes me happy when I can explain something to a patient that gives clarity to her understanding. There’s nothing like a “thank you” (or even a hug!) by a patient. And who doesn’t love positive feedback by a physician who says you did a great job? As difficult as my career was in the beginning, I’m still at it after 23 years. And year after year, post all the blood, sweat, tears and pain, I feel I’ve come a long way:)


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Posted on February 23rd, 2014 by

Okay, so we’ve talked about how some 3D pics are impossible due to fetal position. When Baby is facing Mom’s back, there is almost nothing you can do to get them to flip over! These moms (and all family who joined in for the festivities) are totally bummed that Baby wouldn’t show off.  Often times for these exams, that’s all they show…their bums.

However, SOMEtimes babies are just in a fabulous position for 3D images so that obtaining them is just effortless…and beautiful! This is one of those times! Mom and Dad were a cute young couple who were so excited to get these great shots. They had no problem with me sharing with the world:)

3D pics, third trimester3D pics, third trimester


Do you notice her tongue sticking out in the pic below?


3D pics, third trimester


She is so precious! I will add here that the reason you are not able to see the top of her head is because she had it buried in Mom’s pelvis. The only way to see anything well in 3D is if it is surrounded by fluid!

Here’s hoping your baby cooperates like this!

You can email your pics to!



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Posted on February 7th, 2014 by

Can you skip your anatomy screen?

Of course, a patient has a right to refuse any test! I’d recommend a discussion with your obstetrician, however, so your doc understands your reasoning. Your doc will want to clear up any misconceptions you may harbor and ensure you understand the consequences for your decision. However, students practicing ultrasound on your fetus does not constitute a replacement! Here are all the reasons why.

True Story…

A patient requested her anatomy screen examination be cancelled because she went to a facility where students practiced on her. She stated they already did the scan, so she didn’t need to have it done a second time.

 Students practicing on your belly is not a formal or official scan; it’s just practice;)

Your diagnostic examination was ordered by your physician and must be performed in a medical facility with a written order by your doc. No order, no exam. That examination must be performed by credentialed sonographers, must include specific documentation, and must be interpreted by a radiologist or your physician. Click on the link above for more info about what you can expect from your anatomy screen!

Can students practice?

Yes, ultrasound students routinely practice on pregnant bellies, and that’s okay — as long as it’s also okay with your doc! I always recommended they have written permission from your physician, but that isn’t carved in stone (just my opinion!) And I personally recommend waiting until after your real anatomy screen is complete — if anyone is going to question a problem, you’d want that to be your doc…not a student or instructor.

Holy cow…me as a student…you would not have wanted that to count as your official study! Actually, that goes for any student. They should have a supervising instructor guiding them, but their casual practice is no substitute for the real thing…medically, ethically, or legally. Students are still struggling to figure out what’s a head and a butt on your baby and how all the buttons work. “Hmm, where is that knob again to make the image brighter?”

Yep, there’s a L O N G learning curve to ultrasound, and no one knows that better than me! Whew,  excruciatingly painful.

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Posted on January 19th, 2014 by

Is a Male Sonogram Easier to Read?

Not for some moms who have always dreamed of buying pink! Here’s an email from a reader who was really hoping for some estrogen in the family after two boys! Sometimes, wishful thinking prevents us from seeing what is really there…

Email from Mom KB:

kb:  At my 17-Week ultrasound, the tech took a photo saying the baby was a boy pointing to what is clearly the foot between the legs. She also said the umbilical cord was between the legs.

male sonogram, 17 Weeks pregnant

kb’s 1st pic at 17 Weeks

At my 21-Week ultrasound, the baby was breech with cord between the legs. When asked what we thought, we saw two lines and nothing else…so, we guessed girl. In the next view, she said boy.

male sonogram, 21 Weeks pregnant

kb’s pic at 21 Weeks

Where the tech pointed as a pee looks like a foot to me. I have two boys already and you could see the scotum and tip clearly. I feel different and not even pregnant. The heart rate was 170, 171, 157. I can’t shake that it’s a girl. Am I wrong and just hoping? What do you think?

wwavb:  Thanks for reading my blog and sending your question! Hmm, what do I think…

Well, as far as “feeling” different goes, each pregnancy is a different universe in and of itself. The way you feel with one pregnancy has nothing to do with how you “feel” in another. People historically want to contribute that difference to gender, but there just is no relevance there. And Baby’s heart rate can vary quite a bit, just as ours does with respect to fetal activity. So, you can’t go by that, either.

It’s entirely possible that your sonographer could tell it was a boy, but it wasn’t clear to you because the cord was in the way. It’s also possible that you just want a girl so much that it’s hard for you to really “see” boy parts in the image.


I labeled the images she sent, and wrote her back.

wwavb:  The first image isn’t very clear. But see the labels for the second image. No foot here! Where I have the arrows of the legs, you are only seeing part of the thighs. The rest of the legs and feet are not in the image.

male sonogram, 21 Weeks pregnant

male sonogram, 21 Weeks pregnant

kb:  I don’t see the scotum because she said the cord was between the legs.

wwavb:  Holy cow, this is totally a boy! All boy! See my edited image attached below…


Congrats! 😉 I always say it takes a special woman to be a mom of all boys! Little boys love their mamas, and you have the perfect opportunity to teach them to be loving, respectful, and helpful to their future wives. Your daughters-in-law will thank you!


Patients have a really hard time believing their eyes in a male sonogram image if all they want to do is shop for frilly dresses! But I do stand by my advice to her…we women have a unique opportunity to instill great character in our little boys. Chivalry doesn’t have to be dead! You can teach them to hold open doors and show respect to the next generation of women. They’ll love you for it!!!

Not only can you teach him to respect all the future women in his life — his girlfriends, his wife, and potential daughters — but one more very important woman who is arguably the most important of all.


Best wishes to all you moms out there of all boys!

If you want to tell your all-boys story, you can email me here!


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Posted on January 18th, 2014 by

fetal hair

Yes! We can see fetal hair on ultrasound! Usually later in the 3rd Trimester, especially if it is long or thick, you might be able to see your baby’s hair floating in the amniotic fluid. It can be pretty funny to see it waving as your sonographer pushes on your belly with the probe!

We can see fetal hair easiest about the nape of the neck and back of the head. Sometimes, you may also be able to appreciate hair on top of your baby’s head with 3D imaging. Moms are often surprised! They can’t wait to show off their baby’s head full of hair when they come back for their post-partum check after delivery.

This baby below had so much thick hair! I often joke with parents that their babies will either come out with pigtails or needing his first haircut.

On ultrasound fetal hair appears a lot like white fuzz where you see the arrows pointed. Mom and I enjoyed lots of laughs during this scan, and I told her to make sure she invested in lots of bows! I can’t wait to see her in color. 🙂

Feel free to email me with your ultrasound pics, stories, questions or comments at!


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Posted on January 16th, 2014 by

A Great 3rd Trimester Female Gender Pic!

Okay, readers, if you are searching for the perfect shot of 3rd Trimester female gender, check out this photo below. This image is shouting, “Am I a girl or what?” Poor thing. We don’t even give her half a chance for modesty!

3rd Trimester female gender


This is a great image of labia as seen later in pregnancy. Baby has more fat in her skin now and looks nothing like the “3 dots or lines” you saw at halftime. Now, granted, not every baby girl looks exactly like this one. We are not all built EXACTLY the same, right? Some babies have smaller labia than others. Still others have a larger clitoris.

However, I think no one can argue that the pic above looks nothing like any little boy I’ve ever seen. This mom and dad were so excited for their second precious baby girl. Lucky for you, they were also so happy to share! 🙂 Now, THIS, expectant parents, is a GREAT shot if I do have to say so myself!

❤️I just LOVE a great ultrasound image!❤️

Wow, I’m such a geek sometimes.

If you have great shots of your baby girl, feel free to email me!



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Posted on January 10th, 2014 by

That may be a reference to the limbo, but it’s also a term used for where that head is located in the pelvis as your pregnancy is nearing its end.  Many patients say they feel as if baby has dropped and ask me if their baby’s head is low or if I can tell how low it is.  Nope.  The station of the fetal head is more of a feeling thing that your doctor assesses with a physical examination.  With ultrasound, we can sometimes see that the head is SO VERY low to the extent that we have a hard time actually measuring the head at the proper level.  When this happens, we will say that the head is so low that it is limiting the exam but we can never really “see” how low it actually is.

Either way, at this point in the pregnancy, you know that light at the end of the proverbial tunnel is in your near future.  Yippee!

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Posted on January 4th, 2014 by patient’s precocious 4 year old son said to me one day.  I wrote a post about it back then.  He was so cute and must have asked about five times to hear his little brother’s heartbeep!

So let’s talk about heart rate today, or “beeps” per minute (bpm).  People want to always believe the old wives’ tale about baby being a girl if the heart rate is high and low if it’s a boy.  I think L&D nurses could probably lend an opionion on this as they monitor the rate for long periods of time and may certainly know something I don’t.  As far as ultrasound goes, it doesn’t mean a thing.  We are only sampling a few seconds of heart motion at a time to obtain a rate and really only need three cardiac cycles to measure it.  The fetal heart rate is like our own in that when a fetus is very active it speeds up and when they rest it slows.

We can first see a heart beat at about 6wks (gestational age – that’s counting from the first day of your last period).  It can start out quite slow..about 100bpm and looks like a little flutter.  If it’s a lot slower on the initial scan, in the low 80s or less or if it’s very irregular, we get a little worried.  It can be an indication that maybe the pregnancy may not progress.  There’s no way to ever know for sure and my docs will usually have their patient come back in a week or two in these cases.  After about 6wks, the heart rate should only get stronger and more easily visible by ultrasound.  In the next couple of weeks after that, it gets really much as 180bpm or so.  After that, it starts to hang out around 120 – 160bpm which is what we call within a normal range.  It can be a tad higher or lower but we wouldn’t expect it to remain there.  Either way, we can’t link it to gender.

Regardless, it’s usually the first thing a patient wants to see or hear.  Siblings get a kick out of it if they’re older.  The younger ones (maybe <2?) get scared by it.  Otherwise, the heartbeep is a pretty cool thing to watch!

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Posted on December 28th, 2013 by

Early Twin Pregnancy – Reader Questions Answered

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

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

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


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

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

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

Good luck and keep me posted!

wwavblogger, RDMS 🙂

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

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

My Advice to Readers Regarding an Early Twin Pregnancy

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

early twin pregnancy, 5 weeks pregnant, yolk sacs

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

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

Subscribe for automatic updates and more info on early twin pregnancy!

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Posted on December 11th, 2013 by

How Often Do I Get the Gender Question?

A lot! If I’ve heard it once, it’s been a million times. How sure am I? Or “Can you confirm my guess?” For the images below? I’d love to say it’s a definite. But without scanning myself, there is just no way to be sure these images are of a baby boy! And I can’t be completely convinced by these pics alone. Below is an email from one mom and her follow-up response!

Mom’s Email

Mama K:  Stumbled upon your site looking for answers of why I had “3 white dots” and was told boy when other moms I knew were told girl. Here are images taken at 15 weeks 1 day. I was told boy, and I believed it until I saw others with similar images who said they were having a girl. None of my other two boys looked like this, so I’m just curious! 🙂 Thank you!



wwavb:  First, 15 Weeks is still a bit early.  Not that I’ve never been able to determine gender at 15 Weeks, but sometimes parts can still look a bit equivocal. And since I didn’t scan you real-time, I just cannot confirm based on these images! Therein lies the problem with trying to guess sex too early, and this is where mistakes are made. I’ve seen the tip of a penis appear similar early on, and I’ve also seen the clitoris (middle white dot) still appear a little prominent in females at this gestational age.

My best recommendation is time! Your anatomy screen which is usually performed between 18 and 20 Weeks should reveal much more information PROVIDING baby is in a great position to see between the legs. I hope this helped somewhat, and please upload images of that scan to keep me posted!

“His Pee Pee” may turn out to be “Her Hoo Hoo”…Hoo writes this stuff anyway?

Mama K’s Update!

Drumroll, please…

male gender, gender question

Mama K: Hello! Just wanted to update you with my recent scan. It’s a boy! Super happy to be having our third boy 🙂
 wwavb:  Congrats! Now THAT looks like a boy! 🙂 Merry Christmas and enjoy your baby boy!
Wow, what a difference a few weeks makes!
Email your ultrasound pics to

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Posted on December 9th, 2013 by

Expectant parents who pay for elective ultrasounds at a nearby drive-through may not get exactly what they are seeking – a definite on the fetal gender front. Take my reader in today’s post, for example. She was 16 Weeks pregnant. Even though guessing sex proves not the impossible task on every 16-Weeker, it is difficult on most that age. My best advice comes down to waiting for the sake of accuracy – the exact opposite of what any anxious mom wants to do. Elective ultrasounds – is it really worth the money? Here’s one reader’s experience who probably will beg to differ.

One Mom’s Email About Elective Ultrasounds

Mom:  Got this elective ultrasound done at 16w2d – sonographer said she was 80% sure girl but had a hard time finding this shot. Just felt like she was throwing something out there for us to go on. She also reminded us that it was early, and I should wait until my 20 Week scan to be sure before buying pink. Well, because of the holidays, I can’t get in until after the New Year to do my scan at 22+ Weeks, and it’s driving me crazy now. I spent $100 on this for her to tell me 80%. I’ve been looking at other pictures and reading and just wondering what you think.  THANK YOU SO MUCH!

elective ultrasounds, 16 weeks pregnant

wwavb:  Thanks for reading my blog and for your question! First of all, and this is just my professional opinion, no one should be offering gender determination scans at 16 Weeks. She’s absolutely right…it is early, so it would have been better to explain this first and then recommend you wait a couple of weeks more for the best chance of determination.

No one can guarantee gender 100% at any gestational age (NOTHING in medicine is 100%), especially not at 16 Weeks. It’s not that you can’t ever make a determination at 16 Weeks. But it’s definitely harder than at 20 or 22 Weeks (providing Baby cooperates!). Also, I never give percentages. Either I can tell or I can’t. No guessing! When a patient asks me to guess I always say, “Do you want me to guess or do you want me to be right?”

I can tell you that ultrasound is tricky! Trying to determine sex from someone else’s frozen shot without scanning you real-time is only a guess. Your sonographer should not have added the annotation of girl then tell you to wait for the next scan. She probably felt it was a girl and just didn’t want to commit due to your gestational age. What the image demonstrates where the arrow is pointed LOOKS like three little white lines. I would say this appearance resembles female genitalia. So, based solely on the image, I would have to say Team Pink has it.


The best advice I can give anyone in these circumstances is to buy pink if you really want to start shopping. However, keep the receipts and hold off on painting a nursery until your diagnostic scan can confidently confirm! I personally don’t want to guess incorrectly. Furthermore, I don’t want to cause anyone the distress moms feel when someone guesses incorrectly.

It’s too bad these guys don’t feel the same. If they did, they wouldn’t scan their customers at 12 Weeks. In the whole baby game, is it fair to charge someone any price for something you can’t guarantee? Or is it highway robbery because you advertise that you can?


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