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The Value of Diagnostic Ultrasound–To Have or To Decline?

Just in case this season finds you mid-pregnancy and debating the question above, this post is dedicated to you. Despite what you’ve read in your favorite pregnancy book or online, please take into consideration some food for thought below. You be the one to determine the value of diagnostic ultrasound in your pregnancy.

But before we dive in, let me extend a Happy Holidays to everyone. I’m sure you’re as busy as me, filling stockings with cheer and a little fa la la to boot. It’s the most fun time of year with your babies! And the response for the canvas photo ornaments has been incredible! Hope your holiday is merry and bright!

What’s It Worth?

I’ve heard it said and seen it in black and white. Diagnostic ultrasound has not been shown to improve the outcome of pregnancy. This statement may hold truth in the grand scheme of pregnancies in the history of ultrasound and its application to obstetrics, but only where it’s applied to normal pregnancies and normal outcomes.

Everyone’s the expert, right? Books, parenting sites–they all want to be your pregnancy bible. What I find interesting, however, is that many of these authors have no medical background whatsoever. How much input did they really take from obstetricians and truly knowledgeable resources? If little to none, how can they counsel the expectant parent on anything … including ultrasound? Those who know so little about the technology shouldn’t be advising anyone on its safety or value.

Let’s present both sides of this coin so that you can make an informed decision regarding what you value most. Just ask the parent whose child enjoys life today because of an ultrasound diagnosis. Below are three ways in which ultrasound can benefit your pregnancy and three questions you can ask your doc. Let’s explore them.

Detecting an Abnormality

Sure, everyone wants a healthy baby, right? None of us ever takes the plunge into parenthood expecting the worst. And when it happens, the result is a devastating blow. No one knows this better than a woman or family who’s been through it. These are the couples who truly value the technology but who fear it the most–afraid of history repeating itself. Needless to say, they leave the entourage of family and friends at home. Or, at least, in the waiting room.

Alas, finding abnormalities represents the initial sole purpose of medical ultrasound’s contribution to obstetrics. It’s a mechanism for diagnosing a structural problem early on and clarifying a plan to manage mom’s and baby’s care to ensure the healthiest delivery possible. True–ultrasound with even the most skilled of eyes at the helm cannot detect every problem. No diagnostic test on the planet can boast that ability. But when sonography can ring the alarm, it serves as a vehicle toward a path of knowledge and understanding–a necessary preparation for what’s to come.

When an expectant couple does receive the unanticipated and unwelcome news of a problem, they may feel overwhelmed with information. Rocked by shock, you may confusion over what questions to ask. Everything else aside, you want to understand the severity of the issue.

A question for your doc might be:
“What does this mean for the health and safety of myself and my baby?”

Education and Preparedness

What’s the old saying? With knowledge comes power? I do believe in this. Yes, there do exist the moms who complain that something was detected by ultrasound, it was mercilessly followed, and she worried for nothing. Baby was just fine after all. To that I say GREAT! Someone did their job by finding a potential problem. Lucky for mom, the problem never progressed to the extent that intervention was required. Of course, I hate that any mom was fraught with worry an entire pregnancy, but imagine the opposite scenario. Discovering a serious problem after birth when you thought all was well is also crushing.

So, where’s the silver lining in all this? With a sobering diagnosis, hopefully, comes the education to plan for a little one with special needs. Whether those needs are short-term or long, the following weeks and months give way to arrangements of a different kind. You’ll take this time to mentally and emotionally prepare, connect with support groups, and learn all the ways in which the family will need to physically prepare for Baby.

A question for your doc might be:
“I’m on the fence. What happens if I decline a diagnostic ultrasound?”

Life-Saving Measures

If mom elects to forgo a diagnostic ultrasound, she also can’t take preventative measures to repair a problem that could save her baby’s life. I’ll give two examples here.

My former co-worker provides the perfect example. She found her own baby’s problem. Yes, we all do it! All sonographers scan themselves at some point. It’s a perk of the business! However, the ability then becomes a liability because we know just a little too much. This means we worry more than the average joe.

She opted for genetic testing which came with normal results. Thank goodness! But we still knew there was a problem. Her baby was developing an abnormal collection of fluid behind his head which is called a cystic hygroma. The beginning of an early hygroma might look like this:

diagnostic ultrasound, thickened nuchal translucency

Thickened NT

diagnostic ultrasound, NT measurement, Nuchal Translucency

Normal NT

NT stands for nuchal translucency. You may recognize this term from part of the genetic testing performed with ultrasound around 12 Weeks. The image below demonstrates the top of a fetal head at about 13 Weeks. The large black area with a webbed appearance inside and surrounded by arrows represents the back of Baby’s head where the hygroma is seen.

diagnostic ultrasound, cystic hygroma

Cystic Hygroma

Many conditions can cause this development, but in the absence of a chromosomal abnormality, we knew the problem must be a structural one–some organ was not developing properly, probably the heart. Baby was too small yet to determine the cause. But over the following weeks, sure enough, we were able to detect her son’s serious heart defect.

FYI:

You may already know that most of us are born with four chambers within the heart. This little love was born with barely two. It was a long and grueling pregnancy filled with Maternal Fetal Medicine and perinatal cardiology visits on a routine basis. No one could make promises for the future. No one held a magical crystal ball.

What a Difference a Test Makes!

The difference ultrasound made in the lives of my co-worker and her baby was the fact that discovering such a problem so early allowed many advantages. She needed to plan for a c-section so that his fragile heart would not have to experience the stress of labor. Secondly, there was no way she could safely deliver locally. Even though the largest local hospital was equipped with a NICU, they could not offer him what he needed immediately after birth–major heart surgery.

The above revelation meant she would need to travel six hours away from her home for delivery … well in advance of her due date. She couldn’t take the chance of delivering anywhere else. This baby had to be delivered in a hospital with neonatal cardiac surgeons and equipment to treat severe heart malformations like his. They were his only fighting chance.

Fast-forward to today. He’s a very healthy kid with more energy than you could ever imagine! He needed a couple of surgeries but has done so well. What a rocky start to life!

Maybe you can guess his fate if his mom elected to never have a diagnostic ultrasound? They would have never known about the problem, she would have delivered locally, and–most tragically–he would have never survived.

A Second Story

But this one is much shorter (I promise!). A fellow employee was pregnant with twins. They developed Twin-to-Twin Transfusion Syndrome. In other words, one baby was stealing blood flow from the other. This condition (in this particular patient) would have resulted in the potential demise of one baby. She traveled several hours away for intrauterine surgery. It was successful, and all three spent the remaining months of pregnancy thriving!

Final Thoughts

The value of anything is much like beauty, isn’t it? It’s the eye of the beholder, the love of heart, or the presence of mind which determines a given worth. How will a particular event impact your own life? We can’t necessarily know what we haven’t experienced.

So, my advice is as follows. Every parent has the right to decline any testing she doesn’t wish to have performed. But a parent needs to only understand what she won’t know when choosing to decline a sonogram. That’s a conversation to be had with one’s obstetrician or other healthcare provider managing her pregnancy. Weigh the pros and cons and make an informed decision–whatever suits your family best.

It’s not up to me that you have a diagnostic ultrasound. Especially, your decision not to have one  shouldn’t come from a less-than-credible source. As a matter of fact, the advice should never come from someone with no medical background to support such a recommendation, who’s likely never suffered the diagnosis of a sick child where ultrasound made a difference between life and death.

Your life. Your pregnancy. Your baby. Talk to your doctor. Ask the important questions. Make an informed decision. You deserve to have all the answers up front!

Final question for your doc:
“What are the pros and cons for having a diagnostic ultrasound. What do you recommend?”

Thanks for reading

Merry Christmas and love to all!

Placental Location

Is Placental Location Important?

You bet. We always evaluate placental location in the 2nd Trimester. We need to ensure your placenta is not too close or covering the cervix, aka Baby’s exit. But is it important that you know where your placenta is positioned? Most of the time, your doctor will not discuss it with you unless its position is a problem.

Why Isn’t Placental Location Always Discussed?

Like so many other variables about your pregnancy, your doctor will consider this a strictly need-to-know basis. In other words, it just isn’t important if your placenta appears entirely unremarkable (appearing normal). You’re juggling SO much info as it is already, right? No sense in adding one more thing to the memory pile.

How Do We Describe Placental Location?

placental location

Check out my handy-dandy graphics!

The Anterior Placenta

An anterior placenta is one located on the front or belly side of the uterus. With the placenta in this position, your chances for a great profile in the 3rd Trimester can be a challenge! If you have an anterior placenta, you’ll see it at the top of your image, like this, outlined in white:

placental location, anterior placenta

The Posterior Placenta

A posterior placenta is located on the backside of your uterus. In this position, Baby has a nice pillow when lying on your back. This fetus has a nice little cushion for her little bottom here. You might see a placenta here on the bottom of your image, like so:

placental location, posterior placenta

The Fundal Placenta

A fundal placenta is located at the top of your uterus. We can also see any number of combos with respect to your placental position like fundal/posterior or fundal/anterior. The image below might be classified as fundal/anterior.

placental location, fundal/anterior placenta

The above images depict some very basics with respect to where your placenta decided to implant!

When Do You Need to Know?

Only if your placenta is very low or covering your cervix do you really need to know about it. Oftentimes, we’ll note a low placenta on your anatomy screen exam. This is not a big deal most of the time. About 9/10 exams where we see it a little low at this point in pregnancy, the placenta will “move” up on a follow-up exam a month or so later.

Wait, isn’t the placenta is attached to our uterine wall? Yep. So, it doesn’t actually “move” despite our calling it such. It’s more that as the uterus grows bigger, the placenta will move with the uterus and grow further away from the cervix . . . most of the time. Sometimes, our placenta can be as stubborn as our children!

If this is your case, don’t worry! There’s not a doggone thing anyone can do about it. It’s just one of life’s little curve balls, like parenting and so many other facets of this thing we call life that we just can’t control. We’ll continue to follow a low placenta until it’s out of the way or until your doc decides it’s there to stay. In these cases, C-Section will be the topic of conversation, but not until later in your pregnancy! Your healthcare provider will want to give the stubborn placenta every opportunity to get the heck out of the way!

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I hope this post helped you understand placental location a little better!
If so, feel free to comment below.

Got your own question or comment for me? Great!
You can email me here.

Got images you want me to review? Even better!
Just subscribe here, and I’ll respond ASAP.

~

As always, thank you for reading wombwithaviewblog.com!

Fetal Breathing Movements

Babies do not actually breathe in utero. They do, however, practice breathing movements.

But what are fetal breathing movements?

Fetal breathing movements is a phrase we use when we see your baby’s diaphragm involuntarily move back and forth intermittently. Now for Diaphragm 101 in case you didn’t already know! The diaphragm is essentially a sheath of muscle that separate our chest from our abdomen.

Also, it plays a key role in respiration as soon as breathing air is a necessity. When we want to take in a deep breath, our diaphragm pushes our abdominal organs down to make room for our lungs to expand and fill with air. Incredible, right? See the image below for a cross section of Baby’s belly. The diaphragm is the faint gray line between the three arrows.

fetal breathing movements, fetal diaphragm

Very often patients notice that my probe is fixed in one spot as I watch the diaphragm move. Naturally, they want to know what I’m doing and what they see moving on the monitor. When I respond that I’m watching fetal breathing movements, they usually reply with, “I didn’t know babies can breathe in there!”

And then I explain that Baby’s lungs are the last organs to mature, so a fetus cannot actually use their lungs until they’re born. Moreover, because they are surrounded by fluid, babies cannot take the fluid into their lungs. What typically follows is a sheepish, “Oh, of course. Don’t I feel dumb!” No way. Who would know if you didn’t study a fetus for a career?!

When can you see the breathing movements?

I’ve personally noticed fetal breathing movements as early as 14 Weeks, but we expect to witness them routinely from 32 Weeks. We also refer to them as respirations. These fetal breathing movements are part of the criteria to determine fetal well-being as a part of a BPP or Biophysical Profile.

Sometimes, we don’t see these movements when we expect to see them when performing a BPP. It’s often not a cause for concern. We do not expect to see continuous breathing movements while Baby lives in the warm comfort of his temporary home. Until they make their grand entrance and need to take their very first real breath, it’s only practice!

Just one more of the cool aspects of scanning your baby. We all learn something new every day, right?

If you have a video of your baby practicing respirations on ultrasound,
I’d love to attach it to this post!

Just email it by clicking here.

As always, thanks for visiting my blog!

 

 

Pregnancy Labor and Delivery–A Labor of Love

Pregnancy Labor Isn’t Loved By All

pregnancy labor and delivery

Don’t worry that you’re all alone in this boat. Pregnancy labor and delivery isn’t fun for every mother. Some conquer it like Wonder Woman while others vow to never go down that road again. It’s all personal and relative, and no feelings are wrong or right … just your own!

I ran into a patient of mine who recently delivered her first baby. She couldn’t wait to show her off. “She’s finally here!” She was so sweet and told me how much she loved having me as her sonographer every week. I love it! And, of course, her baby was absolutely beautiful.

She took a minute to vent about her L&D experience, of which she was NOT a fan. She said, “Nobody told me what it was REALLY going to be like. I’m never doing this again!” I laughed and expressed I was not a fan of mine, either, but that it’s different for everyone. Some people actually call it easy or loved the experience. I guess this is why some beloved souls do the pregnancy thing over and over! Well, that and they must either have really good babies or the patience of a saint. God bless the fruitful mothers, but my personal limit was two.

Moreover, our kids are incredibly expensive, right? After diapers, extra-curricular activities, cars, insurance, and college, it all adds up to a luxury house in the end!

pregnancy labor and deliveryBut I digress … I love motherhood, love my kids, and I wouldn’t trade them for a thing in this world. Change that. Between the ages of two and four, I did consider either selling my younger daughter on the black market or investing in duct tape for her mouth. Alas, I opted for the duct tape, and (what do ya know?!) she became a hard-working, compassionate, and loving young woman.

You can read her blog post here!

And for those of you who don’t know me, said daughter would be laughing hysterically at this last comment. She can attest to the absence of duct tape for discipline–though it would have been effective. If what goes around comes around, I have no doubt she’ll need it for her own kids one day!

We go through pregnancy for ourselves, our spouses, and to create that family unit for ourselves. It’s the love we put in and the love we get back that makes it worthwhile. And when our kids are bad, we stick them in a corner because we sure can’t shove them back where they came from … not that we’d want that, either.

I sometimes say I’ve made my contribution to Mother Earth with my twice-inhabited uterus. For my patient and many like her, it’s one and done! So many of my 3rd Tri patients begin to express anxiety at the thought of labor. It’s understandable. Every labor can be entirely different from your prior experiences, and we always fear the unknown. My advice to them?

Nature has a unique way of preparing us to take on the unknowns of labor ~
the complete exhaustion of pregnancy!

Well, that and finally seeing our babies in living color.

EDD, labor and delivery

Happy and healthy labor and delivery, Everyone!

You can email your ultrasound and L&D stories to wombviewerblog@gmail.com!

 

Keeping Baby’s Name Secret – When Patients Vent!

Keeping Baby’s Name Secret

Is this a parent’s right? You bet it is. An anxious and anticipating grandma though you may be, you don’t have to like it. But a couple’s decision to withhold such prized personal information is theirs and theirs alone. Your presence wasn’t necessary to make this baby then; your two-cents isn’t necessary now, either.

Some of my patients have gotten fired up about this topic and rightly so. In the routine of scanning a few weekly “regulars,” the natural flow of conversation usually turns to all the beloved options in the baby-name hat. These patients often declare “mums the word” and take off on a tirade, venting about fights between sides or an overbearing mother. After such heated debate, parents simply decide to remain tight-lipped. Who can blame them?

keeping baby's name secret

We know how it is. Names run deep in some families, and parents find themselves caught in the middle when traditional expectations rank lofty on both sides. Some opinionated family members don’t mind chiming in or expressing discontent with a name or its spelling. But why should parents concern themselves with hurt feelings because the middle name of Uncle Joseph remains in every generation for a century? Of course, parents would love to share their joy, but not at the risk of negative feedback.

Can We Really Blame Parents?

After all, they receive all kinds of unsolicited advice regarding everything from colic to college. Parents pore themselves over volumes of baby names, picking apart thousands of meanings one by one. Let’s not forget spelling, pronunciation, what it says to the world, and how his or her initials might read in all the ways. The effort can prove exhaustive, only to have to double down in defense.

keeping baby's name secretChoose a popular name, and she’ll share it with five other Ashlyn’s in her Pre-K class. Choose an obscure one, and she might curse you forever. Ysatis. Beautiful, French–and she’s doomed to repeating herself to every teacher, classmate, mom, camp leader, and doctor’s office for the rest of her life. I can’t speak for other countries, but this certainly rings true in the U.S., at least (where most folks don’t even try beyond Kimberly or Susan). It’s not my experience, just my observation. By the way, it’s EE-suh-tees. She was a patient whose name I researched in advance, sending her into shock when I pronounced it correctly! Oh, it’s the little things in life, right? We owe it to our patients to make an effort. And to many of you, that effort means a lot.

On the contrary, maybe Mom dreamed her whole life of naming her little boy Darrin. Dad made a solemn vow to Grandpa Isaac on his death bed. But with Kelley for a surname, see the dilemma? No one wants her son to be a DIK. Names are a big deal. When parents finally agree, they don’t need someone to point out it also belongs to a murdering dictator or family nemesis. Don’t parents worry about enough?

The baby-name backlash can be fierce. And parents reserve the right to exercise caution if they gauge potential ill-effects from the fam! The real argument is why anyone argues over entitlement at all for what should only be considered a joyous occasion. And who really cares after the chubby-cheeked, long-awaited addition finally makes his or her grand entrance? When Baby’s health and preparing for the little prince’s or princess’ arrival becomes all-consuming for parents, only the same should matter to everyone else. The chosen name bestowed on your grandchild marks only the beginning of the millions of decisions parents must make on behalf of their children–don’t let your secret name become PITA. No grandma really wants to be a Pain In The Ass.

So, comment below if you have an opinion or experience with this subject or email me here.

To share or not to share . . . that is the question!

Thanks for reading!

 

Gelly Belly – The Role of Ultrasound Gel

What’s the purpose of ultrasound gel?

ultrasound gel

Ah . . . that amazing blue stuff–sometimes shockingly cold, oftentimes warm (if they’re nice and keep it in an electric warmer!). If you’ve ever had a sonogram, you know it’s pretty messy. Moms usually hate it, but we sonographers just can’t live without it!

The best I’ve used for most of my career, pictured above, is Aquasonic 100 made by Parker Laboratories. It 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 would dry out. The probe won’t glide over your skin, and the dried gel forms little balls of stickiness. Gross. Better to use a bunch and extra tissue to wipe it off after!

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 here with your questions!

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Twins at 6 Weeks–What You’ll See on Ultrasound

Twins, 6 weeks, 6 weeks pregnant

Ah, twins–are these babies precious or what? SURPRISE! Man, I just love seeing the look on people’s faces when I give them this news. It’s the best! The shock. The disbelief. The fainting spells. It’s so funny when we have to call a code for smelling salts for Dad! 😂

Whether we see one embryo or more, we have great expectations for what we expect to see during your ultrasound at Week 6. Not everyone can expect to have a sonogram at this early gestational age. If you do, however, the first thing you can expect is a transvaginal ultrasound. Yep. Babies are just too tiny as you’ll see below, so we need the magnification and better resolution of the vaginal probe. Hopefully, you won’t be required to float into your ultrasound exam with a full bladder. They’ll likely end up letting you hit the restroom and performing the vaginal scan anyway.

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

Twins at 6 Weeks

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

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

6 Weeks, 6 Weeks pregnant, twins 6 Weeks

Baby A Embryo

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

 

6 week ultrasound

Baby B Embryo

Baby B measured about the same at 3.4mm.

Now check out the heart rates!

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

Baby A Heart Rate

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

 

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

Baby B Heart Rate

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

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

I know you might be feeling overwhelmed right now, but you’ve got to always look for the positive, the silver lining. Two at once is a lot to take in, but just keep two healthy babies your focus. Remember, siblings have been coming into this world together for a long time … if their parents can do it, so can you!

Just look at how much fun this will be in a couple of years!6 weeks pregnant, 6 Weeks, 6 week twins

~*~

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

~You can email me here with your question~

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Ectopic Pregnancy–Understanding What We Look For

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!
Please email comment below if you found this post helpful!

Want to share a story about your experience with ectopic pregnancy?
You can email me at wombviewerblog@gmail.com.

Also, feel free to leave your comments and suggestions,
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Baby Gender Misconceptions

How Do We Determine Baby’s Gender?

baby gender misconceptions, fetal gender

Sometimes, there are just so many shades of gray between pink and blue. Determining Baby’s gender by ultrasound is not as easy a task as most think. Actually, gender misconceptions pertaining to ultrasound are so common that I thought it worthy of yet another post.

Making a male vs female determination requires far more expertise than just sticking a probe to a belly. And babies do not just automatically cooperate! Baby’s legs need to be wide open and other parts cannot be covering over external genitalia. If so, the chances of holding that “reveal” party are slim to none.

Another common misconception is that we can force Baby to move. I promise you that every sonographer on earth would use a magical “make Baby flip” button. A girl can a dream, but I think this technology lies only in our very distant future. Unfortunately, babies get comfy and only move into another position if they get the urge. And not a moment sooner!

Determining sex accurately is all about angles. Being far enough along with Baby in the right position is only part of the task! Most of my emails come from people who want a second opinion. However, most of the time, it’s one I regretfully cannot give. Either Baby is too early or the image is just plain, well . . . terrible. In these scenarios, the truth is I just can’t commit.

Most sonographers don’t mind telling you your baby’s sex, by the way! The problem for us comes when we can’t see what our patients want to know. Even if we explain all the reasons, patients sometimes become upset or angry. I have scanned tens of thousands of babies. And anyone who has, too, can recognize when gender is obtainable and when it isn’t.

Tips For Your Baby Gender Ultrasound

So, here are a few recommendations for you to follow before your next ultrasound. No guarantees! But if you are busting at the seams to find out what you’re having, these tips just might work!

baby gender misconceptions, making baby move

Try eating or drinking something about 30 minutes prior to the exam. Baby typically becomes more active after eating. Now, I’m not condoning a double espresso and Snickers combo (yummy, yes; smart, no). We don’t want your fetus launching into orbit. Instead, try enjoying a hearty and healthy lunch or breakfast prior to your scan.

 

baby gender misconceptions, fetal genderKeep an open mind! Understand that not seeing the sex is definitely a real possibility. Whatever you do, not planning a gender reveal party for the same day is a smart idea.

 

 

 

breech fetus, prone fetus, ultrasound picturesDon’t shoot the messenger! In other words, your sonographer can only tell you what she sees. If that is an uncooperative fetus or if visualization is poor, she may not want to risk a guess. You can read more about a breech fetus here–it’s merely one of many potential problems with fetal position that can hinder a guess. Remember, that you want an accurate guess, not just any guess. Most importantly, an experienced sonographer knows when not to guess. Neither one of us wants me to guess the wrong sex . . .

Believe me! We would love to do our part to help you plan your party, shop for baby clothes, or decorate a nursery. It’s the most fun when we can! And when we cannot, it’s a real bummer–for you, because you leave disappointed and for us, because we’re (sometimes) blamed as the party poopers. Poop–I hate when that happens!

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Pregnancy Wives’ Tales for Gender

Are all these old wives’ tales really true?

Well, it depends on who you ask, and if that who happens to be my mom (more on that shortly). We’ve all heard them, haven’t we? The pregnancy wives’ tales for gender which everyone wants to share with you as soon as they know you’re expecting. As a result, maybe you’ve Googled your fingers to the bone researching them.

What wives’ tales do you have to share? I’ve heard them all and can say that NO one tale is consistently true! However, you can’t make your grandmother believe it. So, let’s address a few of the old wives’ tales patients asked me about the most!

The Chinese Birth Chart

Nope, not even this.

pregnancy wives' tales

The Chinese are responsible for some really delicious egg rolls, but I’m afraid their birth chart is not 100% accurate. What I do believe, however, is that I could probably eat fried rice every day of my life.

The Ring or Needle Test

Apparently, this one can determine gender and number of kids you will have . . .

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

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

The Drano Test

FALSE! I have no idea where this originated, and I can’t even recall what means boy or girl. I do seem to recall that this clog-clearing liquid was supposed to change color for one sex and stay the same for the other. What I do know is this–you shouldn’t try it! This stuff should not come in contact with your skin and can also cause some caustic fumes which could be harmful to you and your baby.

Heartburn Determines Hair

pregnancy wives' tales

FALSE! Lots of patients with heartburn have bald babies and vice versa. Women often begin to feel the effects of some serious heartburn later in the 3rd Trimester. This is typically because your uterus is growing up as well as out! This puts pressure on your poor stomach, so it has much less space than normal. You feel full sooner when eating, and that pressure causes our much-dreaded indigestion. I remember all too well that Tums turned into a staple of my daily diet with both my girls. Unfortunately, the egg rolls didn’t work.

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

How You “Carry” Signifies Boy or Girl

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

Placental Location Can Determine Baby’s Sex

placental location

Understanding Placental Location

Hmm, this is something patients started asking me within the past couple of years–the Ramzi Theory, named after the guy behind the theory. However, it’s been disproven. Furthermore, the placenta can implant anywhere in the uterus. The most common position is posterior, or along the back side of the uterus.

But what about the placenta on the front side of the uterus (anterior)? Or along the top (fundal)? What about the complete previa (covering the cervix and bottom of the uterus)? And there are all sorts of variations of placental location in between–meaning they can be a combo of two or more locations. My advice is not to rely on this one!

The Nub Theory

pregnancy

12 Week Female Fetus

While this one is not so much a wives’ tale, it has been getting lots of hype lately, so I’ll address it. Basically, at about 12 Weeks, external genitalia either sticks up, if a boy, or out, if a girl. The angles and skill of the sonographer as well as Baby’s position all factor into this appearance and guess. You can read more about the Nub Theory here.

At the end of the day, this theory is only about 73% accurate. Personally, I wouldn’t paint a nursery based on 70ish percent…but that’s just me.

A Local Favorite Pregnancy Myth

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

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

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Ultrasound Images–If You Got ‘Em, Share ‘Em!

Email Your Ultrasound Images!

ultrasound images

3rd Trimester Feet!

Got Some Precious Ultrasound Images?

Okay, so what do all you moms-to-be out there do before Baby gets here? Show off your great ultrasound images, right?!

Well, I’d love to see them, too. Email me those shots near and dear to your heart, and show off your little punkin’ to the world at the same time. Baby’s face, profile, 2D, 3D, hands, feet, or even your 4D video clips would all be perfect to post. And if you also have great shots of male or female fetal sex, send those, too!

I’ve personally taken some really great pics over the years. Baby yawning, sticking out the tongue, puckering those lips, and even flipping the bird! Who doesn’t love a cute set of baby toes? How about a ton of hair? If you got it, flaunt it! We moms like to brag on our cute kids, so it may as well start before they even get here.

(Full disclosure! Uploading your images means you consent to my using them for promotion of my blog or future books. As always, I keep your privacy private omitting all identifying info. Can’t wait to see them!)

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Ultrasound Gender Determination

Ultrasound Gender Determination ~
Pink or Blue?

Ultrasound gender determination can be tricky! Especially too early in pregnancy. Or any time they just won’t cooperate!

gender determination

Female Gender 16 Weeks

male gender, 16 Weeks pregnant

Male Gender 16 Weeks

How many times have all you moms out there, young and old, heard the story that goes, “They told her it was a ‘this,’ and they decorated an entire nursery, and it came out a ‘that’! Those ultrasounds are wrong sometimes, ya know!”

A dollar for every one of those comments would buy me my dream cottage on the Amalfi coast! However, I understand why this happens, and sonographers everywhere need to apply more discretion. First of all, you may already know that it’s not the machine that’s wrong. The sonographer or observer scanning you evaluates what she (or he) sees and determines Baby’s sex. The whole process is entirely subjective! And inexperience sometimes causes sonographers to excitedly guess or, otherwise, cave to the pressure from anxious parents. Unfortunately, sometimes guess incorrectly.

Advice Regarding Gender Determination for the New Sonographer

First rule of thumb for any newbie sonographer out there . . . don’t guess! Don’t put a percentage on your guess, and don’t say “I think.” Also, don’t say “It kinda looks like ‘this,’ but let’s wait until next time.” Parents may want you to guess, but they also want you to be right! Just a word of caution here–some patients may become upset with you if you don’t guess. But if you’ve exhausted your bag of tricks and you still are not sure of what you are seeing, you owe it to the patient to explain this. It’s something you have no control to change, and you would rather they not become attached to the wrong sex. Hopefully, they will understand!

Psychologically and emotionally speaking, most parents start to really become attached to one sex or the other. They begin to envision the first dance recital or baseball game by the time the next ultrasound exam rolls around. On more than a few occasions in my career, someone else guessed incorrectly (usually, too early!), and I had to be the bearer of bad news. After witnessing the affects of “mistaken identity” (shock, anger, tears, sadness, guilt), I adopted a personal policy long ago to only offer a guess when parts were obvious. In other words, Baby had to be in a great position to easily see a penis and scrotum or labia/clitoris. Even though my policy upset a number of my patients in the past, I truly believe refraining from tossing out any old guess is in their best interest and can save them some heartache later.

True Story!

One grandmother, so excited by the doctor’s early guess, flew right out and bought thirty-two dresses! Yep, 32. She did so despite the doc’s warning about his level of confidence and told her to wait for the sonogram with me. Fortunately, he got lucky with his baby girl guess, and grandma was a very happy woman (and a little less rich)! However, you can imagine the disappointment in returning all those frilly frocks if doc was wrong. I always hated giving such news!

Please, all you excited moms-to-be, remember your sonographer doesn’t withhold information about fetal sex just because! We’d actually really rather all our babies cooperate quickly and easily! It’s such a bummer for us both when they won’t. You can’t plan all the fun things you imagined you could. Shopping, party planning… And believe me, I always preferred when my patients left my room hugging me instead of cursing my existence. A magic trick to make Baby flip on command? It’s too bad we aren’t bestowed with super powers upon certification!

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Early Fetal Sex Determination

The Myth of Early Fetal Sex Determination

early fetal sex determination

As a sonographer of many years, I know that ultrasound is subjective. But expectant moms seem to continue to be surprised by incorrect early fetal sex determination. And I seem to be receiving more and more emails about this ever-growing problem. Nothing makes me angrier than when another sonographer tries too early to hand out a sex guess! I get angrier still when some businesses make this promise as a marketing ploy.

It just isn’t fair to the patient or customer. I feel these facilities take advantage of pregnant anxious moms who have a desire to know the sex of their baby as soon as possible. After all, it is one of the most anticipated events in pregnancy! However, these mothers-to-be wouldn’t spend their money on an ultrasound if 3D non-medical businesses didn’t exploit that desire. They advertise a promise or guarantee for early fetal sex determination at 12+ Weeks! So, what is the public to believe except that they can deliver on that promise? The truth is they know it’s only a guess. If they guess right, they got lucky. If they guess wrong . . . oh, well. Here’s some of your money back.

Too Ambitious?

I think developments in the technology have yielded a little too much ambitious guessing in the fetal sex department. Resolution has improved so greatly over the years that we see better than ever with the most modern equipment. But just because we can see “a little something” sticking out, in no way or shape or form, means you’ll be investing in blue paint.

I want to educate every fertile, human-growing woman or parent-to-be out there that even the best
ultrasound equipment on the planet cannot differentiate a boy from a girl.

To this day, determination of sex is still dependent on the experience and skill of the person holding that probe to your belly. But also know that a sonographer’s skill doesn’t mean squat when external genitalia has just begun to grow. It’s anyone’s guess!

We have all heard a similar story. A customer pays for an early scan and is told one sex. “Congratulations! I’m 100% sure!” Lo and behold! At the mid-pregnancy anatomy screen (or later), the penis has magically fallen off and now all the sailboat motif and cute suspenders have to go back. Or vice versa. The question I always get is, “How did this happen???”

Loads of Room for Error

So, just how DID this happen?

Easy. It’s the scanning observer’s opinion, but it’s still just a guess. You assume he or she is experienced in making this determination…maybe, maybe not. Especially when this person displays such confidence in his/her guess, you feel sure that they must be correct in their guess. But it doesn’t mean they are; they can still be very confidently and entirely . . . wrong.

This is why!

External genitalia is just starting to develop later in the first trimester, and it will continue to morph and change in appearance over the next several weeks. All babies have a little something sticking out at 12 Weeks. But if Baby is a girl, that tissue will shrink and become recognized as a clitoris later on, with labia seen on each side. If a boy, this part grows a little larger and becomes a penis. The scrotal sac develops over the next few weeks but is still quite small. And we cannot see testicles until somewhere around 28 Weeks (or maybe slightly earlier).

The Nub Theory

early fetal sex determination

12 Week Fetus

Most readers ask if this test has any validity. The answer is “some.” If (and, again, subjectivity comes into play here), if an observer knows what fetal angle to obtain and how to read the angle of the nub, you might have a 70% accurate guess. But that’s a few IFs. The observer also has to know when the angle is equivocal, meaning the protruding part is not one way or the other but somewhere in-between. In these cases, a guess cannot be made. Keep in mind here that even if the angle is perfect, there is still a ~30% chance of an incorrect guess! In other words, it’s not a hugely reliable predictor.

So, What’s the Best Advice?

Later is better! Wait for your mid-pregnancy anatomy screen at 18 – 20 Weeks. Below are great images of typical and normal-appearing external genitalia of each sex at this age:

male gender, 2nd Trimester

Male Fetus

female gender, 2nd Trimester

Female Fetus

If Baby isn’t cooperating, don’t put the heat on your sonographer to guess anyway. Part of a good sonographer’s job is also to know when NOT to guess.

The truth is that no one should be providing a guess for sex determination much earlier than this in pregnancy, especially for a fee. And certainly not with a 100% positivity attached.

Just because someone says she is 100% sure, doesn’t mean she is right.

Business is business. As long as parents will pay for it, someone will take your money and offer a guess. This is the unfortunate bottom line in the non-medical ultrasound business. I’m not saying you shouldn’t go to one of these places. Maybe you just want to see a heartbeat and bond. This is understandable. But I caution you to pay for fetal sex determination earlier than 18 Weeks.

Advice Regarding Early Fetal Sex Determination

All you moms who are thinking about paying for an early scan at a strip mall near you (or anywhere!), please first consider the above info. It might just save you a few bucks and some disappointment later. Alternatively, if you are the kind of person who can remain entirely neutral about any sex guess and just want to have some fun watching Baby move, go for it. Have a blast.

The biggest issue here is our own nagging, relentless, compelling need to know as soon as possible. But more of the same will keep happening. Businesses won’t quit selling early fetal sex determination as long as pregnant moms are buying. Let’s pass the word around, ladies. Just don’t buy what they’re selling!

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Diagnostic Ultrasound–What Is It?

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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Ultrasound Facts–What’s True vs What’s Not

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.

~*~

Feel free to email me at wombviewerblog@gmail.com with your comments or questions!

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Amniocentesis–The Amniotic Fluid Test

Amniocentesis

 Do All Women Need One?

amniocentesis, amniotic fluid

  • Who needs an amniocentesis?
  • When should an expectant mother consider an amniocentesis?
  • What factors help a patient decide if an amniocentesis is right for her?

Some women may need one of these tests to determine fetal lung maturity if your doctor feels you need to deliver early. However, only your doctor can help you make this decision when it comes to first-trimester genetic testing. You can find out a little more about an amnio performed during this stage of pregnancy (some very basic information) here.

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

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

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

Things to Consider Prior to Amniocentesis

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

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

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

What’s Included in Genetic Testing?

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

amniocentesis

NT test

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

What Do the Results Mean?

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

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

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

How Is an Amniocentesis Performed?

Basically, a sonographer will scan you to look for an adequate pocket of fluid. The doctor performing the amnio will determine whether you have a pocket with sufficient fluid in an area she/he feels is safe to attempt the procedure. Typically, they like to stay away from Baby’s head and your placenta, depending on where it is located. A nice pocket of fluid might look like the image below.

amniotic fluid test

Pocket of Amniotic Fluid

The sonographer will measure your baby’s heart rate and anything else the physician requires. The physician will then clean off the area of your skin with betadine over the desired pocket of fluid (as long as you’re not allergic to it!). You might know it as the orange stuff that stains your skin, but it takes care of the germs. This is a good thing.

amniocentesis

Sometimes she may use a numbing agent for the skin, sometimes not. If not, it’s because she can only numb the skin and not down deep. The numbing agent feels very similar to the needle used to withdraw the fluid, like a stick and a burn and a lot like a bee sting. Since this is the case, some docs would rather stick you only once and elect not to numb the skin.

If you have an aversion to needles, you may want to look away. The needle is long because it has to reach the fluid. Sometimes, your physician will use ultrasound guidance to insert the needle into the pocket of fluid. Once there, the doc will attach a syringe to withdraw the fluid.

This is an example of a syringe.

amniocentesis

Once she has enough fluid, she’ll remove the needle and push the fluid into a vial. The vial goes off to the lab for testing. If all goes according to plan, the whole procedure of performing the amnio will take about ten minutes or so. Pretty quick!

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

What If I Really Don’t Want an Amniocentesis?

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

What to Ask Your Doctor about an Amniocentesis

It’s hard for us to ask questions about something if we don’t fully understand it. We can’t know what we don’t know, right? Some questions you can ask your doctor are:

  1. Why is the testing recommended?
  2. What kind of genetic testing do you offer?
  3. What will the results tell me?
  4. Will my insurance cover this testing?
  5. Who will perform these tests? (Your doc or a perinatologist)
  6. Where is testing performed?
  7. When will I get results?
  8. What are my options after receiving results?
  9. What are my options if I choose not to have an amnio?

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

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

Here’s to your happy and healthy pregnancy. 🙂

***

You can email me at wombviewerblog@gmail.com with your questions or comments.

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A Male Baby Gender Guess

What Makes a Male Baby Gender Guess Easy?

The male fetus on ultrasound can be a pretty easy baby gender guess sometimes! As I’ve said before, trying to guess too early can be difficult because Baby is too small. This is true no matter whether you are having a girl or boy. It can be a lot like trying to determine whether a tiny moving bug has six legs or eight without a magnifying glass. You can guess, but you may very well be wrong. However, at 18 Weeks and later, very obvious male external genitalia can be very easy to see and also a pretty funny addition to your scan.

At 18 Weeks and later, obvious male external genitalia can be very easy to see and even add a bit of laughter to your scan, especially when he’s showing off! Poor guy . . . he has no idea just how much we’re invading his privacy!

A mom-to-be wrote me a while back asking me for a second opinion on her images. No problem! I love it when it’s this easy. Check out her images below.

male fetus, male ultrasound, male gender male fetus, male ultrasound, male gender

Can you easily see this baby gender is male?

I wrote her back and annotated the first image like you see below.

baby gender guess, male fetus, male ultrasound, male gender

Even though most people may be able to easily pick out boy parts on their images, it sometimes just doesn’t look like other boy images you’ve seen. Or maybe they look nothing like your other son’s images. This is understandable to me because it’s a different baby and a different angle. No two images are going to look exactly alike! Part of the reason for this is because we all look a little different, boy or girl, right?

As far as angle goes, your sonographer might obtain a total underside view where both femurs appear in the image. Maybe Baby bent a leg just when boy stuff could be seen the best, allowing only one leg in your shot. Other angles might include a shot from Baby’s front or side. All of these angles will make the image look different and maybe even unrecognizable to you.

Some sonographers don’t really explain the image and only throw up an arrow pointing out what makes your baby gender a male or female. Don’t be afraid to ask if she can explain what’s on the screen. Most of the time, we don’t mind at all helping you understand!

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The Breech Fetus

Why a Breech Fetus Is Such a Challenge

What’s the worst position a fetus can be in if you want to determine fetal sex? You guessed it! Look no further than the image below to answer this question. The breech fetus compromises most of what both you and I want to see.

What You Don’t Want to See

breech fetus, gender guess, gender ultrasound

This image is really an example of just how much position plays a part in how well we see. This baby (above) is not only lying in a breech position, or butt-down, but baby is also facing Mom’s back (prone).

The wait for your ultrasound exam between Weeks 18-20 and whether you’ll be shopping for pink or blue may have you losing sleep! The LAST thing you’ll want to see is your baby looking like the image above. It spells one word . . . disappointment. If baby stays in this position throughout the examination, the possibility of seeing anything cute is essentially nada.

Below is an example of baby flipped over and looking up.

20wk facial profile, fetal face, gender ultrasound

How much better do you see baby’s face? (Hint–it’s way better!) Here’s hoping you have more luck than this patient did for her anatomy screen ultrasound exam!

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Embryonic Movement–Watch Baby Go!

Embryonic Movement at 9 Weeks!

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

When is the Earliest Detectable Embryonic Movement?

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

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

embryonic movement at 9 weeks, 9 weeks embryonic movement, 9 weeks pregnant, 9 week embryo

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

Embryo Movement 9 Weeks

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

I hope you found this entertaining!

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Gravida, Para – What Is on My Ultrasound Report?

What Does Gravida, Para Mean?

 

Every once in a while, a reader sends me a great question that isn’t related to fetal sex. This one is related to GP or Gravida, Para as seen on her ultrasound report. See comments for this link about 1st Trimester dating.

curious mama:  Just curious on the report on the right where it says GP and Williams in that box. What does that mean? I’ve also seen it on another person’s report but in the box beside GP, it says male AB. Just confused about what this GP stands for?

wwavb:  Hi and thanks for your great question! Look for it in my next post! GP stands for Gravida and Para, meaning how many times you were pregnant and how many live babies you have given birth to at the time of the scan.

For example, G2P1 means this is your second pregnancy and you have one child. Williams stands for the program used to calculate age, named after the physician who developed the method. You are reading the two together, but they are not meant to be. GP simply was not filled out on this report. Most of the time, this is because the information is redundant; it’s already in your chart, so it’s not necessary to enter it again on the report. All machine manufacturers’ reports look different so it would not be unusual for your friend’s report to say something different. Hope this helped!

***

An EMR Pitfall

I do have to say the above scenario define part of the pitfall to EMR or Electronic Medical Records where patients can see the actual reports generated for an exam. Because they don’t understand what they read, they call in for an explanation. Hence, we experienced a multitude of patients calling in for explanations which have to be triaged by knowledgeable staff.

Patients should have all their questions answered, however, it can be costly and time-consuming for practices, to say the least. Patients should be given results, just not reports. This is just my opinion, of course.

Thanks, reader! Hopefully, others searching the same question find this post!

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Guessing Fetal Sex–Gender Ultrasound

Gender Ultrasound–Guessing Fetal Sex

baby gender ultrasound

“How sure are you?” I’ve heard this question probably more than any other in my career during the baby gender ultrasound! Sometimes, guessing fetal sex is a big risk and a real guess. Patients want percentages; I just want to be right! Nothing is ever 100%!

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

You can see a few great images of fetal gender here. 🙂

How Sure Are We When Guessing Fetal Sex?

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

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

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

What’s the Answer?

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

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

*And a final word of caution! Save your money during Weeks 12-14! Weeks 15-16 can still be “iffy.” Waiting until 18 Weeks and later is always better!*

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Fetal Gender Determination

Sometimes, it’s just Mission Impossible!

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

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

Is Fetal Gender Determination a Requirement?

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

What Factors Impair Fetal Gender Determination?

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

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

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

Can you appreciate the difference between the first two images and the third?

female gender, 2nd Trimester female gender, fetal gender determination

Great image of female gender!

female gender, 2nd trimester female gender, fetal gender determination

Great image of female fetus!

fetal gender determination

Um, not so much . . .

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

What Can We Do to Help?

We can try a couple of variables in an attempt to see better. Jiggling your belly or turning you to each side sometimes helps. We do this in the hopes that your change in position will also change Baby’s. Alas, it doesn’t always work. For some tips on how you can try to ensure Baby is a little more active during your exam, click on this link!

What We Can’t Do

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

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

What You Shouldn’t Do!

internet search of fetal abnormalities

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

A Modern-Day Problem

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

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

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

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

Good luck for a great sonogram!

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Female Gender on Ultrasound

Can We See Ovaries with Female Gender?

Patients, in general, tend to believe that determining male gender should be very easy anytime, and the only way to determine female gender is the lack of male parts. Wrong! But can we see the uterus and ovaries of a female fetus? Read an email below from a mom with this very question.

mama-to-be:  Is it possible to see Baby’s ovaries and uterus with ultrasound? I’ve read these organs are formed around 20/22 Weeks. I was thinking it was possible to see them at 22 Weeks or later?

wwavb:  This is a really great question, and I’m surprised it’s not asked more frequently! Nope, a uterus and ovaries cannot be seen in a fetus anytime in pregnancy. They are simply too small! Gender can only be determined by examining external genitalia.

***

Second Trimester

See below for great, textbook female gender images!

female gender, 16 Weeks pregnant, 2nd trimester female gender

This image is of a baby girl at about 16 Weeks. Here, you can only really see Baby’s bottom but not her legs. Imagine Baby is pulling her feet up to her nose. Looking up from the underside, only cheeks and girly parts will be seen, right?

Note the three arrows which point to three white lines representing the labia on the outside and clitoris in the center. Sometimes the lines look more like white dots depending on the angle. See the image below:

female gender, 16 Weeks pregnant, 2nd trimester female gender

This image is around the 16 Weeks, also. You can see here how the top labia looks more like a dot and the middle and bottom white echoes look more like lines.

Third Trimester

female gender, 32 Weeks pregnant, 3rd trimester female gender

Finally, we’ll end out this post with a perfect example of 3rd Trimester female gender! At about 32 Weeks, we found this baby girl lying in the best position to obtain this shot. Notice how the white lines have morphed into the labia you would expect to see on a baby girl. Notice, also, the fluid (black areas) around the labia which helps us to obtain this great shot.

As Baby approaches the late 2nd Trimester, she will start to develop some fat in her skin and the labia will plump up a bit. That’s when her little parts look like the image above, resembling the “hamburger” to which most patients refer.

***

I hope this was helpful! Have some female gender images you want to share?

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Male Gender on Ultrasound–When the Cord Gets in the Way

Sometimes, little boys just aren’t as obvious …

2nd trimester male gender, male gender on ultrasound

… inside the uterus as they are outside of it. Male gender on ultrasound can be difficult to discern if other parts are in the way. And there’s just not much room in there for the plastic Hefty superman cape of the garbage can variety.

I know my patients over the years would have been thrilled to decipher baby parts on the monitor all by themselves. If they could only read that fuzzy gray and white image, they’d feel much more assured of the whole boy or girl thing. How many times has a sonographer pointed out gender to all you moms during your sonogram and you respond back with a “Uh, where?” Well, you’re not alone in that boat. Check out this email from a mom who had the same problem:

Mama’s Email:

confused mama: Hello! I just recently paid for a gender ultrasound which I was so excited to finally get. But I had an uncomfortable experience with the ultrasound technician. The second she saw the baby she said I am 100% it is a boy. She didn’t show me, my mom, or my mother in law the penis or scrotum, and she didn’t explain at all.

I was 19 weeks and 2 days at the time of this ultrasound. I might be in denial it is a boy, but I’m honestly confused by the photo she gave that shows the penis and scrotum. There are two lines underneath it. But in all the boy ultrasounds I have seen, the penis and scrotum look more defined. It might be the butt, I’m thinking, but I don’t know. Can you please give your professional opinion? I had a friend who is also a RDMS, and she said she could not tell the gender. I am debating if I should do another gender ultrasound. Please help!

male gender on ultrasound, 19 weeks pregnant, male gender, 2nd trimester, second trimester gender

My Response Below:

wwavb: Okay, so check out the image below.

male gender on ultrasound, 19 weeks pregnant, male gender, 2nd trimester, second trimester gender

You are seeing an underside view of Baby. Encircled in yellow is the cord which lies between Baby’s legs and obscuring parts somewhat. His parts in all their glory should stand out a little better with my annotations. I wouldn’t go for another, especially if it’s one of those non-medical ultrasound drive-thru’s.

Does your friend not do OB/GYN? I felt it was pretty easy to tell, but I would have either not given this image to a patient or otherwise explained the parts.

***

I think some sonographers forget that not everyone can figure this stuff out as easily as we can. Even if a sonographer can boast of experience and certification but specializes in aspects of sonography which are not OB, a guess can still be quite a challenge for them, too. After all, experience is the teacher, right? ANY sonographer who is brave enough (or stupid enough) to call anything between the legs 100% will one day learn this the hard way. Anyone experienced in medicine, or sonography, can attest to the fact that nothing is 100% in any testing arena … even DNA and amniocentesis are only 99+% accurate for gender. As flawed as we humans are, it’s for this reason and the nature of this technology that will never guarantee better accuracy than genetic blood and amnio results.

As sonographers, if we’re going to state how sure we are about gender determination, we should always narrate for our patients when Baby is feeling a little shy that day. And patients, if you can’t tell a penis from a big toe, speak up! Most of us are more than happy to show you around.

And especially when you pay for a 3D elective scan (I’m not a fan of some of these–please read why in the link above!), you have the right to see the monitor with full explanations. After all, you paid for it!

If you have questions for me, just email them here.

And if you’d like me to review your images, just click here!

Thanks for reading, and I hope you’re enjoying the new site!

Fetal Profile Image

A Good Fetal Profile Image Can Be a Challenge

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

When a Fetal Profile Image is Limited

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

fetal profile, fetal face, 2D

fetal profile, fetal face, 2D

 

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

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

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

How We Take a Great Fetal Profile

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

What Doesn’t Make a Nice Fetal Profile on Ultrasound

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

What To Do If Concerned About Your Fetal Profile Images

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

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

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

Great Fetal Profile Images

See below for three of my personal fetal profile images!

facial profile, fetal profile image fetal profile image facial profile, fetal profile image

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

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

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

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