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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.

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As always, thank you for reading wombwithaviewblog.com!

Elective 3D Ultrasound Businesses

What You Get With Elective 3D Ultrasound Businesses

The answer might surprise you. They sure aren’t going to tell you, so I will! This post calls out to all the expectant moms looking for early gender ultrasounds from elective 3D ultrasound, privately-owned, non-medical businesses. Regardless of what they advertise, please read this first before scheduling your visit! Moms, do your homework. You have a right to know before you go!

3D ultrasound, 3D fetal face, 33 WeeksJust look at this shot! It’s so precious, isn’t it? Who couldn’t fall in love with their little one more and more with every great sweep of the probe? Heck, I fall in love with your baby with every image like this that I take.

We, in OB/GYN healthcare, understand expectant parents’ desire for images like this or early gender determination ASAP, but the safety of you and your baby is the greatest concern for all of us in the field. And because I know your baby’s safety is of utmost importance to you, there are a few important factors to take into consideration before having your scan performed by a non-medical facility.

They are not required to meet the same standards of care as those who practice medicine. Their staff may not be properly educated, and they take your money for promises of gender guarantees WAY too early in pregnancy … when they know it may not be accurate. You have a right to understand that you may not be paying for the quality and expertise you may think you are receiving. Please read on for your own awareness, and pass the message!

Why I Cannot Endorse Most Elective, Non-Medical Ultrasound Businesses

Uneducated Staff

The biggest issue I have with these business is something that may surprise you. They are not required to employ certified staff. Anyone can buy a machine, start a business, and charge you to scan your baby, but they don’t have to be a formally-educated or certified sonographer themselves or hire them.😲😤

Scary, isn’t it??

Some years back, I was mailed a flyer from an elective 3D ultrasound business. The goal? To sell you your own entertainment ultrasound business by offering a franchise and ultrasound education in a matter of days–for anyone off the street with no prior ultrasound knowledge or training. Before this, I had no idea such a business was even legal.

As a certified OB sonographer for 25 years, I can vouch for the level of knowledge and skill we learn initially and acquire over time, through clinical experience and performing diagnostic examinations. Most importantly, our education and experience also applies to the equipment we use to scan you. Anyone performing OB ultrasound should be utilizing the ALARA principle–and any formally educated sonographer knows what this is. Basically, we learn how to optimize power settings in order to use the lowest level needed to obtain a good image. This is recommended by the medical community because long-term effects of ultrasound are still being researched. Someone who is not formally-trained likely has no knowledge of how to do this or even know it exists.

Ask about RDMS credentials (or DMS, meaning they have recently graduated).

Unrealistic Promises for Gender

Now, let’s address fetal sex. After all, most of you who are super anxious to find out if you can shop for pink or blue want to know as early as possible! Most of these places advertise 100% accuracy of fetal sex guesses from 12 or 14 Weeks. This is irresponsible and something they actually cannot do.

They can’t guarantee a gender guess is 100% accurate.
They can only guarantee you a refund if they’re wrong.

I’m sure you many of you wouldn’t consider handing over your money if you knew this is what they meant by their “guarantee.” A guess too early in pregnancy is a toss-up. You are paying good money, and in some cases, a lot of it. More on early gender determination here.

Furthermore, how qualified is the guess if the person scanning you isn’t certified with a level of OB ultrasound experience? Any obstetrician or radiologist will tell you that no ultrasound can be considered 100% accurate. As a matter of fact, even DNA blood tests for first-trimester genetics or amniocentesis cannot boast of 100% accuracy–these tests are 99+% accurate. Ultrasound cannot come close to this degree of accuracy in the first trimester.

My advice to a mom- or family-to-be is to keep an open mind regarding a sex guess too early and to wait for your anatomy screen before investing in paint! Many women talk about the guilt and loss they (and spouses and children) feel when true gender is later determined. Read what one mom had to say here!

That said, anyone can guess incorrectly! But when far enough along and with truly experienced OB sonographers who know when the circumstances are ripe for guessing (and when they’re not!), the chances for an accurate guess rise dramatically!

Equipment Maintenance and Safety

They are not required to maintain safety standards for their equipment. Machines need maintenance to ensure they are performing properly and safely. Cracked probes and cords that are worn, old, and/or not properly cleaned or maintained can be an electrical hazard to their customers. Maintenance is costly, and I just have to wonder how many of these businesses elect to bypass it because they can. You may not necessarily know whether their equipment is safe.

No Physician on Site

Though not a diagnostic exam, a physician is not on site in case a problem is detected. And detecting an obvious problem is much less likely for someone not formally trained.

They Do Not Perform a Diagnostic Exam 

But sometimes they say or advertise that they do. Some of them even call themselves a diagnostic imaging center. They’ll tell you that they’ll scan a little to make sure Baby is okay. I believe this gives the expectant parent a false sense of security. No sonographer can legally tell you your baby appears normal by ultrasound.

Please be aware that no one can call an elective ultrasound scan “diagnostic” in any way! Your healthcare professional must order a diagnostic exam. You must be scanned by a certified sonographer in a medical facility where at least one physician is on site. Finally, an official report must be generated for a physician’s interpretation and signature.

No one scanning in an elective 3D ultrasound business can promise a diagnostic test!

Undisclosed Information

Finally, they don’t have to advertise any of the above! They have no requirements to inform you of any of the issues above. If you ask, they have to answer honestly. So, be sure to ask!

A Message To Those Who Are Not Qualified to Scan!

Make no mistake about it. Waiver or not, if you scan a pregnant woman for fun and miss a problem, you are still liable. You are not trained to recognize these problems or how to handle them. How would you handle seeing something you feel is abnormal or that you cannot explain? What would you say? If you cannot call yourself a formally-educated sonograper, you have no business picking up a probe. Most of us who practice OB every day only get slightly better at breaking terrible news. This unfortunate experience will inevitably be yours at some point.

Moreover, you don’t know how to use the equipment safely or optimally. It takes a bit of artistry, (again) proper training, and experience to be able to create good 2D images–also needed in order to create good 3D images. Providing sub-standard images takes advantage of the customer paying for it, especially when they assume you know what you are doing.

Anyone can set up a 60″ monitor and some comfy seating. Anyone can show you how to press a few buttons. It doesn’t mean you can call yourself a sonographer. If this is your goal, go to school and learn how to do it the right way. Also, it doesn’t mean you are providing a fair service for the money.

Parents, Please Do Your Research on These Businesses!

My best advice for all expectant parents who want to pay for an early gender ultrasound is, first and foremost, to ask yourself if you can truly remain open-minded regarding a gender guess. If you hold a strong preference for one sex over the other, you may want to wait until your diagnostic anatomy screen at 18-20 Weeks for a better chance at accuracy.

Know before you go, people! Call in advance to ask if the person scanning you is a certified sonographer with OB experience and not a former used-car salesman. Don’t assume he or she is qualified to scan you. If not, you would be better off with this elective scan at your doctor’s office instead. A sonographer there is far more likely to detect an obvious problem. And your doctor or another physician would be in-house to discuss it with you and answer your questions.

I’ve made it no secret in my past posts that I’m not a fan of these cash cows. I believe that non-medical personnel should not be scanning pregnant women or utilizing medical equipment.

For the safety of the expectant parent, ACOG, ACR, and AIUM do not recommend elective scans at these sites. 

These businesses were borne of the expectant parents’ desire to see their baby at will, to bond with their baby, and to share with their families a special event. We understand this movie theater experience isn’t something you can receive at your doctor’s office, but the first and foremost concern is the health of you and your baby. I think any parent would agree.

Even though this can be a fun experience for the family, the potential for serious issues is real. We can’t tell you not to go, but please do your homework first! If nothing else, ensure the person scanning you is qualified to do so! Educate yourself, and make an informed decision.

Best wishes for happy and healthy!

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The Yolk Sac–What to Expect on Ultrasound

What is the Yolk Sac?

the yolk sac

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

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

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

What’s the Role of the Yolk Sac?

The job of the yolk sac provides nutrients for the embryo until the placenta develops. No yolk sac, no baby. Your baby cannot develop without it! When this happens, we’ll often see only a gestational sac with no yolk sac or embryo. This is called a blighted ovum. Of course, this is not a good pregnancy and must end. Though many women have said they felt so much better knowing this–it can be much more difficult to accept knowing a heartbeat started, then stopped.

So, if your doctor said all looks good and you see a heartbeat, there has to be a yolk sac in there somewhere.

When Can We See a Yolk Sac?

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

What Will You Expect to See on Ultrasound?

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

 

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

Embryo – 9 Weeks

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

Yolk Sac, twins, twin yolk sacs

Twins’ Yolk Sacs – Week 6

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

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

Twins – Week 6

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

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

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

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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!

 

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 🙂

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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!

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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.

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The Ultrasound Bladder Prep

Why do I have to drink a sea of water?

ultrasound bladder prep

To drink or not to drink! That is the dilemma, and the facility performing your test has the answer to your ultrasound preparation questions. Being required to fill your bladder depends on a few factors…how far along you are if you’re pregnant, the type of ultrasound exam performed, and the protocols of your doc’s office, hospital, or out-patient center where the ultrasound will be conducted. The protocol or policy for how to conduct your test varies from place to place.

I know what you might be thinking. Every site says something different. You’ll find the most comprehensive info here. Why? Because I performed these tests for years. The info here is accurate, and reflects most all scenarios. However, at the end of the day, the facility where the exam will be performed should be able to tell you exactly what ultrasound preparation they want you to follow. And only what they say matters!

The Prep

The dreaded bladder prep may vary a little from one place to the next, but goes something like this:

  • Empty your bladder 1.5 hours prior to your exam
  • Drink 32ozs of fluid (preferably nothing carbonated) within 30 minutes
  • Have all fluid down 1 hour prior to your exam
  • Do not pee until exam is complete! 😩😵

To clarify, let’s say your appointment is 10am. You will pee at 8:30am, drink from 8:30 to 9am, and have all the water down by 9. Most bladders require the full hour to fill completely. Do not pee before your appointment time! This action, of course, defeats the whole purpose for drinking, but you would be suprised at how many do.

Will you feel like you have to pee before this hour is up? Oh, yes ma’am! Not many people allow their bladders to fill to this capacity before they feel the urge to tinkle. It might very well feel like the L O N G E S T hour of your life.

Don’t even look at one of these: ultrasound bladder prep

Or listen to this:

ultrasound bladder prep

And you’ll definitely want to steer clear of one of these:

ultrasound bladder prep

I promise. You won’t be happy if you don’t!

There is a bit of good news to all this. Once full, the exam (for a very experienced sonographer) is pretty quick . . . 5-10 minutes in most easy-to-see negative cases.

But Why a Full Bladder?

ultrasound preparation

Full bladder pelvic ultrasound

Blame the laws of Ultrasound Physics for this one. Sound waves travel more easily through fluid than tissue. Think of your pelvic anatomy from front to back. First is skin, then fat, then muscle, then intestines or bowel, then your bladder. Your uterus sits behind your bladder. So, if you drink lots of water and fully distend your bladder, it provides a window to the uterus. Also, your bowel contains air and gas which can limit what we see. Filling your bladder pushes the intestines aside. It’s actually kinda cool, but not so much if you’re the one doing the drinking.

Additionally, the uterus of most women tilts forward (anteverted) or toward the front of your belly. Filling the bladder aids in pushing the uterus backward a little–not up or higher, as I’ve read in some pregnancy books or sites, though that phrasing is really just a technicality. When the top of the uterus tilts back a little, a better angle is created to see more clearly. Occasionally, a uterus decides to go rogue and tilts too far backward instead (retroverted). Sometimes it tilts so far back that it folds over on itself (retroflexed). This is a totally normal variant. Often, however, the full bladder only helps minimally in these circumstances.

Transvaginal Ultrasound (Endovaginal) Approach

TV probe, how much water to drink for your ultrasound

Whether you are pregnant or not, the rules are the same for a transvaginal ultrasound exam. An empty bladder is required. The TV provides a more magnified view, so a full bladder just gets in the way. Inside the vagina, the probe is closer to your organs allowing us to see them more clearly. AND we don’t have to fight to see past your bowel like we do with the belly approach.

If you’re early in your first trimester, usually less than 11 or 12 Weeks, you will (9 times out of 10) have a TV. This is, BY FAR, the best way to see so early because Baby is so tiny. If your uterus is enlarged with fibroids (very common muscle tumors), your sonographer may try to scan you with TV first. However, if your uterus is too large to see well with the TV probe, she may end up attempting the abdominal approach. If this happens, you may or may not need to drink. Quite often, we can see what we need without making you drink an ocean of fluids.

I can’t speak for all private practices, but we only required a bladder prep for some GYN studies. Only those who were not sexually active or refused the TV exam needed to fill!

Trans-Abdominal Approach

In most hospitals and out-patient imaging centers, you’re going to be drinking, sister! Your exam is typically read by a radiologist in these facilities.

Most of the time, radiologists are of the mindset that certain anatomy will be better seen with a full bladder EVERY time and on EVERY patient. This isn’t necessarily true, but most of these docs want to start with a full bladder first. Commonly, they’ll have you empty for a vaginal scan if they want a better look. To be fair, I haven’t worked in the hospital setting in 15 years. Maybe they’ve adopted more modern policies! If they haven’t, they should.

Filling the bladder has long been the standard practice, and radiologists are set in their ways (sorry, guys, you know you are!). They like to start with a full bladder, but the experienced sonographer knows how best to scan to obtain the images needed. I think the protocol should be opposite . . . TV first and only make the patient fill if absolutely needed! Unfortunately, I don’t make their rules.

Many of these places will also still require you to fill for your anatomy scan at 18-20 Weeks or even for ultrasound exams in the 3rd Trimester. In my opinion, that’s just pure evil. Expectant moms have enough pressure on their bladders as it is! A little fluid in the bladder may help us to evaluate the cervix. But most patients have a little fluid in there anyway. In cases where the cervix isn’t seen well, our friend, the TV probe, is called to action.

Cons to Filling the Bladder

  • Elderly patients (for GYN exams) have a hard time holding their urine
  • Most OB patients have a problem holding it due to pressure from Baby
  • Drinking the water too fast often causes the patient to vomit it right back up!
  • Many do not follow the ultrasound preparation properly. They either do not drink enough water, they don’t have it down in time, they drink more than they needed which results in over-filling the bladder, or they drink all the water then pee right before the exam
  • Not following the prep usually results in drinking more fluid or being rescheduled
  • Some say they weren’t given a prep
  • Sometimes schedulers really do forget to provide the instructions
  • Some patients are dehydrated, so the fluid tends to go where it’s needed and not the bladder
  • But most importantly, it’s MISERABLY painful for the patient!!

In my opinion, the cons far outweigh the pros for drinking water for an ultrasound exam. However, your facility could care less what I think and dictates what ultrasound preparation they want you to do for your test! Being able to pee when you want is a luxury. You just don’t realize it until somebody tells you that you can’t! When in doubt, ask if you’re free to pee!

Best wishes for a healthy sonogram (with no bladder prep🤞)!

As always, thanks for reading and feel free to comment or email me with
your questions here.

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Ultrasound Safety–Is It Radiation?

Ultrasound Misconceptions!

ultrasound safety

Ah . . . one of my favorite things on this beautiful planet of ours is a beautiful sunny day at the beach. I love almost nothing more than that warmth on my skin and my toes buried in sugar-white sand. How about this shot, huh? Taken by yours truly on just such a day! However, because there is no good without its constant bad companion, our basking near the shore also leaves us susceptible to waves of radiation. Shoulder burns. Skin cancer. But let’s not confuse these waves with the sound waves of your diagnostic ultrasound! This post is dedicated to ultrasound safety, what ultrasound is, and what it isn’t.

First, let me help some of you moms out there relax right off the bat. The idea that ultrasound is a form of radiation is a complete untruth, rumor, or misconception. The technology behind ultrasound has long been documented–since its inception for medicine in the early 1900s. Anyone who has studied ultrasound, as well as every physician, engineer, and manufacturing company in relation to the technology can attest that ultrasound emits sound waves, not radiation waves. Those who have conducted biohazard testing in the field over the past forty years can do the same.

Despite what you may have read or heard, regardless of where, please do not believe this garbage! I hope you’ll read more about it here below. And please do not let this scare you away from your diagnostic scans. Your obstetrician is in the business of taking care of you and your baby–not to willingly subject you to radiation . . .

What Exactly is Ultrasound?

Ultrasound is just that. Ultra Sound, or sound waves that work at a frequency far beyond human hearing.  Like a fish-finder one might use on a boat. Or sonar used by the military. Human hearing ranges from about 20Hz (Hertz) to 20,000Hz (or 20kHz). When it comes to creating an ultrasound image, we work in the MHz range or millions of Hertz. An OB probe ranges from about 2MHz – 13MHz.

Ultrasound is a department of Radiology within a hospital, but it does not emit radiation.

Someone Is Spreading the Wealth

The heading is meant to be facetious. Unfortunately, someone is spreading only fear and proliferating ultrasound misinformation. Apparently, she is also someone who hasn’t done her homework. I was floored recently while doing research for my book when I came across a very popular pregnancy book (which will remain nameless) who actually wrote that ultrasound is radiation. If you have read this book, you know who I am referencing here.

She also claims that the Doppler used by physicians to obtain heart tones emits more radiation than scanning equipment! Wrong again, Doppler is ultrasound.

How does this happen? After all, she supposedly had the help of “knowledgeable” medical resources to write the book. Are they the only healthcare providers on the planet who don’t know Ultrasound is not X-Ray? And if not, why not?

I am unaware if this author has since recanted her falsehood. If she did, I give her credit. If not, she owes an explanation and apology to her faithful readers and social media followers. She is incorrectly influencing millions of parents-to-be with this misinformation, and it’s not okay. She is adding needless fuel to the fire, and moms worry about enough as it is.

Additionally, she then goes on to advise moms to only have an ultrasound if they really want one but to not have more than they need. To me, this begs the question…is it radiation or is it okay?

I would like to think she did not intentionally mislead her readership. But as a published author, ignorance is no excuse.

What is Radiation?

It is a transfer of energy that also travels in waves. As I mentioned at the start, radiation is found in light from the sun, microwaves, and X-Rays. But not sound waves. And, yes, exposure to radiation can cause cancer. One example is skin cancer from too much sun exposure.

Consider this. When you go to the dentist, what is the first thing asked of any woman? “Is it possible you might be pregnant?” If the answer is “Yes” or “I’m not sure,” they shield your belly to protect Baby from the minuscule dose of radiation from the super quick X-Ray of your teeth.

If an obstetrician’s job is to manage the health and care of Mother and Baby, and it is, why then would docs expose their patients directly to radiation? And what about sonographers? We all would be directly exposed numerous times a day, every week for the duration of our careers. None of us, patients nor sonographers times decades, have died from cancer due to ultrasound exposure.

Is Ultrasound Safe?

So far, with the prudent use of commercial technology, there have been no known bioeffects on the fetus, mother, or sonographer. Biohazard testing over decades has demonstrated the creation of heat in fetal tissues during higher than recommended settings and extended scanning times. The long-term effects are still being studied. Therefore, it is the feeling of ACOG (the American College of Obstetricians and Gynecologists, ACR (American College of Radiology), and the AIUM (American Institute of Ultrasound in Medicine) that the benefits outweigh the risk, and they justify the use of ultrasound only for diagnostic purposes.

They do not endorse the private entertainment ultrasound scan in the strip mall near you. These facilities are not regulated to maintain the same standards as medical practices for patient safety. They are not required to hire formally-trained and credentialled sonographers or to properly clean or maintain ultrasound probes or equipment. Be sure to do your research prior to scheduling your appointment in one of these facilities!

My Two Cents

One of the reasons I started this blog five years ago is because patients were misinformed – by Dr. Google, family, or friends. I expect as much from a random non-medical blogger, and I became even more enraged to find misinformation doled out on popular pregnancy sites. But in a published book? Unforgivable!

It’s one thing to express one’s opinion. But when you’re making tons of money by persuading expectant moms to adopt your line of thinking, you have the responsibility to get your info right. No one says anyone has to be a fan of ultrasound. And as a mom, you have the right to decline. Before you do so, speak with your provider. You need only to understand your choice. Any mom who ever delivered a baby with serious problems was happy to know about it in advance for planning and educational, emotional, and delivery purposes. This, in fact, is the purpose of obstetric ultrasound.

And if you’re all about moms and choices, and those choices are power? The power only comes from a parent who makes an informed choice, not one based on misinformation. It is my wish and goal to simply and accurately explain ultrasound for moms-to-be and stamp out the misconceptions. Understanding is also power. 🙂 I hope this helps you expectant mamas-to-be sleep a little better tonight.

Here’s to a happy, healthy, and informed pregnancy!

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Gender Determination–Is It Listed on My Report?

Gender Determination in an
Ultrasound Report?

I’ve received questions lately regarding where to find fetal sex or gender determination in an ultrasound report. Can you always find this information in a report?

The short answer? No, not always.

Actually, we mostly do not record fetal sex, and it’s mostly not important to your doc. Typically, fetal sex is not pertinent information to the examination. Though parents may desire it, physicians don’t need the gender determination to manage your care and that of your baby if both are healthy. The above is true for most general OB practitioners in the US. However, every physician practices a little differently, and one can certainly dictate if he or she wants this info on all patient reports (if possible to determine). The case may be different if you are seeing a high-risk OB doc, aka a perinatologist. Their reports consist of much greater detail and may possibly include a fetal sex/gender guess.

Example of a Blank Report

gender determination, ultrasound report
In the images of a sample report taken from a monitor, you’ll notice there is a whole host of blanks to fill, but fetal sex is not one of them. On the first page where you see Sex: Other, this refers to the patient. Patient demographics were not entered here, so the Sex option defaulted to Other. We always include your LMP or EDC/EDD – aka baby due date. The larger blue space would be filled with fetal measurements, estimates of gestational age, and fetal weight as they are obtained.

OB ultrasound report, gender determination, ultrasound report

OB ultrasound report, gender determination, ultrasound report
In the pages above, you’ll note the list of fetal organs and structures we attempt to document on a mid-pregnancy anatomy screen. We only fill out the section called BPP in the third trimester when your doc orders this particular examination. And the CVP is usually only filled out when performing a Fetal Echo or detailed heart examination.

Exception to the Gender Determination Rule

There always seems to be at least one exception to every rule. Because the responsibility of a sonographer is to search out structural malformations, we also have to report suspicions of abnormal external genitalia. In other circumstances, we may see particular abnormalities that we might group together, as in the case of certain syndromes. Sometimes, knowing fetal sex helps physicians either support or rule out a particular chromosomal or structural problem. Some of these are gender specific. In the pic below, we have a designated space on a Comments page to expound on our findings. We can add fetal sex here if we feel it is pertinent information to the findings.
OB ultrasound report, gender determination, ultrasound report
In some countries, fetal sex is neither reported nor discussed with parents due to the cultural preference of one sex over another. And some facilities are beginning to incorporate policies against providing parents with this news due to litigious reasons. Unfortunately, such is life in the good ol’ US. Facilities want to limit their liability for guessing incorrectly by simply not allowing their sonographers to guess at all.
So, if you don’t want to know your baby’s sex (or even if you do!), don’t expect your ultrasound report to disclose that information. Your sonographer creates the images and report. We only include what we need and leave out anything we don’t!
Best wishes for happy and healthy!

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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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“Sound” Ultrasound Information

Reliable Ultrasound Information
for Expectant Moms

Factual ultrasound information can be hard to find. No one knows that better than a newly-expectant mom with loads of questions! How do you know what’s accurate and what’s not? With so much info at our fingertips, too much Googling just seems to lead to more unanswered questions, doesn’t it?

As a sonographer (ultrasound technologist) with formal training and twenty-five years experience in OB/GYN, I am amazed by what I read on other sites about ultrasound. And it’s not just from blogs and forums filled with personal opinion. Misinformation also comes from parent/child sites and even some of the most popular pregnancy books that the general public would expect to be reliable. These articles or posts or books, I realize, are written by authors with no obvious medical training or experience. But their information should be coming from reliable sources. If they interviewed someone in the medical field, facts can become a little lost in translation from interviewee to print.

Five years ago, I ran across a blog about ultrasound…the uses, technical details, what we can see, and how we can see it. The level of wrong in this post left me dumbfounded! It was clear to me that this person had absolutely no medical knowledge whatsoever. It’s not too hard to spot when they use the terminology incorrectly in nearly every sentence. What bothered me the most was that someone left a comment thanking this so-called author for the “valuable” information. It struck me then that many people actually do believe anything they read on this crazy web thing.

So, Where Can You Find Accurate Ultrasound Information?

If you have a curious knack for researching ultrasound on the internet, just be sure to check out someone’s bio. Look at the author’s credentials. Do they reference their experience and knowledge in the field? You can determine whether that individual’s level of experience with a particular subject before taking the information at face value. If an author is not a sonographer, physician, or medical professional with ultrasound knowledge, just know that what you are reading may not be entirely accurate. And if you have questions about what you read relative to your pregnancy, ask your doctor! She or he is always going to be your most reliable source for credible advice on your health and that of your baby.

ultrasound information

9 Week Embryo

My Pledge to My Readers

My desire to create a platform where an excited new mom can find accurate info about ultrasound drove me to create this blog. Hopefully, expectant couples with curiosity about their scans can find a little general info here.

Please feel free to email me at wombviewerblog@gmail.com. Ask me your questions; tell me your ultrasound stories. Remember, no blog, no site, no forum can replace the healthcare professional! We are not your doctor, we do not manage your pregnancy, nor do we have any knowledge of the health of you and your baby. Carefully consider what you read, and direct any concerns to your doctor for the best advice you can follow. 🙂

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about first-trimester ultrasound! 

 

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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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Becoming a Sonographer–A Tough Road

Oh, the adventures of becoming a sonographer!


sonographer, ultrasound technologist

Isn’t this facial profile precious? But it’s not just any profile; it’s a technically perfect 2D ultrasound example of a simply beautiful fetal profile. It’s what we sonographers strive to obtain on every baby we scan and reminds me of how I fell in love with the technology . . . with my own first baby. I was well into my college career at the time, but nothing else had quite piqued my interest like my first exposure to ultrasound. Boy, I had no idea what challenges lay ahead!

Becoming a sonographer, aka ultrasound technologist, was one of THE biggest challenges of my entire life. The training was challenging, but finding myself in a new field and technology where I was painfully ignorant and unsure? Healthcare is not a place for the timid.

A Sonographer’s Start – Whoa! (What a Challenge)

If I was going to work with physicians, I better learn what I was doing fast or go home. It took a while for the puzzle pieces to fit . . . a good 6 months to 1 year. Thereafter, little light bulbs of realization would flicker every time I put two and two together. It was a marriage of all things unfamiliar. I was learning to read patient charts, learning about labs and correlative examinations, interaction with the physicians and with my patients. All of these things were a recipe for growing my new career as well as learning the technology. In the beginning, it was more about “How do I not screw up?” rather than “Wow, that was a great case!”

I promise you, it’s not for the squeamish. If another person’s urine, vomit, or blood bothers you, Ultrasound may not be for you. I cannot emphasize that enough! It was a hard year, and I felt like I was walking a tightrope for the vast majority of it. Brutal.

A Sonographer’s Fear

All new sonographers will miss pathology. It’s a fact of the modality. Initially, you are too concerned with getting all the right images. You’re too inexperienced to notice minor pathology. This is why it is so imperative that a newly-trained sonographer has direct supervision from someone very experienced. With lots of experience comes confidence. After a while, a newbie will start to get a feel for his/her scanning ability and stop second-guessing herself. Was I not seeing an organ because it can’t be seen or because I just couldn’t find it? It’s an awful feeling. However, it is one that can be overcome with time and, again, experience.

The more normal examinations a technologist performs, the sooner she will know when a case is not normal. Ten to fifteen scans per day over the course of a year equals a good bit of experience. After the first few months of constant supervision (if you don’t have it, ask for it!), you will start to become a little more comfortable with the examinations. You’ll then only need a supervisor’s help when confronted with abnormal cases. You may not be able to pinpoint a diagnosis, but you know it’s not what you normally see. This is very important in your early career. Eventually, you will be able to put together differentials to possibly explain what you are imaging. It’s a good feeling when you get to this point!

A Sonographer’s Advice

It was a slow learning process, at least for me, anyway. Over the years, it became easier to work with the docs. More importantly, I learned how to better communicate with my patients, which has been the most rewarding. It feels really good to correctly diagnose a case. But it feels even better to have a patient sincerely thank you for your help . . . or give you a hug in appreciation. It feels good to know I’ve made a small but, hopefully, significant difference. It’s been a good career. And for those who are going into it, hang in there because it gets better. For those who have practiced a long time and feel the flames of burnout, take a vacation! We all need to step back and take a breather once in a while.

Every case is someone’s health and life at stake, and not a week goes by still without learning something new. What a sonographer sees (or misses!) will either lead that patient to other tests or lead to a missed diagnosis. It is sometimes intimidating to think that a patient is on your table and yours alone. It’s up to you to find the problem in question.

I always say I would never want to relive those earlier years, yet they have shaped who I am. They helped me become a better sonographer. So get out there! Become a sonographer, become good at it, research and read, and ask questions of co-workers and docs alike. Make a difference in someone’s life. Make a difference in your own.

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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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Week 10 Ultrasound

How Big Is Baby at Your Week 10 Ultrasound?

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

10 Week Fetus

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

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

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

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

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

Got more questions about fetal ultrasound?

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Fraternal Twins Question

Fraternal Twins on Ultrasound

Let’s talk about twins today, how we see them early on, and when we diagnose them. I’ll answer a reader’s email about her fraternal twins and their placentas.

Merry Christmas or whatever you celebrate this holiday season! I know it means something different to every person but, for our family, this is a time to spike the egg nog, decorate the “Griswold Family Christmas Tree,” and recite too frequently from our favorite movies. “He’s an ANGRY elf!” 😂 Most importantly, we count our blessings.

For all of you expecting a new addition, and especially for those of you planning to hang up more than one extra stocking, this post is dedicated to you. It’s a question from a reader about first-trimester fraternal twins.

mamax2: Hello there! I am having twins, and I’m currently 13 Weeks! This ultrasound was transvaginal at 11 Weeks when we found out we were having twins. I had an earlier ultrasound where we only found one baby (8 Weeks and 3 Days). I’m shocked and amazed that my body has done this. I’m now concerned that my babies could be sharing a placenta or a sac (I really shouldn’t Google!). I see the white line between them, but what does that actually indicate? Also, the lighter line (bubble) around the top baby, what is that? I guess I just need clarification on what I’m looking at.

11 week twin sacs, fraternal twins

My OB has yet to tell me if we have one or two placentas, but said he thought they were fraternal.

I should mention I had a miscarriage at 20 weeks of a singleton boy in Feb 2016. After genetic and placenta testing, it was deemed an unexplained loss. I’m very anxious about this pregnancy as I know the risks are higher with a twin pregnancy.

Thank you for your time! Have a blessed day!

wwavb: CONGRATS x 2!! Wow, so much to cover here … I’ll try to answer all your questions!

First of all, yes! It’s an amazing thing our bodies can do! You had two babies who decided to go along on this amazing journey together! I always told my patients with a history of miscarriage that it’s quite possible your last baby decided he is ready to start on this journey again and just wanted a companion! Our babies have to be ready for this big old world, too, right? They have to come when they are ready–not always when we are!

So, that said, I am so sorry for your previous loss because it is such a terrible and painful experience. I know it will make you a lot more anxious in this pregnancy, but just try to remain positive. It’s a good thing nothing terrible was found, even if it doesn’t provide you a physical reason. Maybe these babies will give one another strength!

Only one baby was seen at 8 Weeks because whoever scanned you missed the other one! We have to scan entirely though the uterus from one side to the other or we can miss multiples–i.e. your experience!

And, no, you should not be consulting Dr. Google. Mistake! You’ll never find the answers to your questions, only anxiety and more questions.

To address your question, your babies are not sharing a placenta or a sac! Yay! This is the safest scenario for twins. Dichorionic/diamniotic.

11 week twins

The white line between them is the wall between the two main sacs (yellow arrow). The very thin line you question is the amnion, the sac immediately around Baby (five straight yellow lines). (Please note, readers, the baby in the top sac is not well seen–this is a better image of the bottom baby). Later in the pregnancy the amnion adheres to the chorion and you won’t see it separately.

Because each baby lies within its own separate main sac, you likely ovulated twice, each baby will have its own placenta, and they can be opposite sexes! This is why your doc said your babies are fraternal. He knows they have their own placentas, and I’m sure he would have told you if you asked him. I recommend keeping a running list of all your questions for your doc and next visit!

As a high risk pregnancy, please keep in mind that billions of women have had normal twins forever, and you can, too. See your doc regularly, and follow all advice–basically, take care of yourself!

I’m so happy for you three, and I wish you a multitude of blessings and all things uneventful in this pregnancy! I have a number of posts on twins, so please look them up! I hope I helped:)

mamax2: Oh, my goodness! Thank you so much for your quick response! I appreciate it far more than you know! I feel relieved knowing they are not sharing a placenta or sac! That first ultrasound just really made me wonder!

You’re such a sweetie, and I appreciate your uplifting words towards my pregnancy and my loss. I’ve struggled with fertility and never imagined my body would/could release 2 eggs without fertility meds!

Again, THANK YOU! I can breathe a little easier now! ❤️️

In summary…

I was so happy to answer a few questions for her! This mama emailed me again a couple of weeks later with an update..

mamax2: I just had to message you back to let you know … YOU’RE CORRECT! We have fraternal boy/girl twins! Thanks again for easing my mind and fears! We are now 16 Weeks! Thank YOU!

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I was so happy to hear both babies were still growing well at 23 Weeks! Now THAT is a Christmas blessing. 😉

Got any questions or stories about your twin pregnancy?

If so, please share; you may help another expectant mom in the process!

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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