Posted on July 6th, 2017 by wombwithaviewblog.com
I’ve received questions lately regarding where to find fetal sex or gender 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 this 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

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

OB 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 3rd 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 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
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 is needed and leave out what is not!
Best wishes for happy and healthy!
wwavblogger, RDMS
wwavblogger, RDMS
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Posted on April 27th, 2017 by wombwithaviewblog.com
3D, 9 Weeks, ultrasound facts

3D 9 Week Embryo

Ultrasound Facts About General Stuff

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

 

Ultrasound Credentials for Sonographers

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

 

Ultrasound Facts About Performing Your Exam

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

 

Ultrasound Facts About Fetal Sex

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

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

Ultrasound Facts About Your Ultrasound Results

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

***

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

Thanks for reading!

wwavblogger, RDMS
wwavblogger, RDMS

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Posted on February 4th, 2015 by wombwithaviewblog.com

I love it when patients call in to the office to schedule their anatomy screening and try to tell us their doctor wants the scan a week or two earlier than we KNOW they want it! I know most of you are a little smarter than that..alas, there are always a few who are not.

Each doctor has a designated time in your pregnancy when he/she feels gestational age is optimal for this test. Since we are discussing the practice of medicine, mind you, it’s important to note that all doctors practice a little differently but should do so within the same standard of care.  So as that applies to this examination, most docs will request you to have this exam performed between 18 and 20wks or thereabouts. As I’ve mentioned before, Baby is just big enough to see most organs well at this point with most patients.

For example, we know in our office that Drs. A, B, C and D will request this exam at 18wks or so. Dr. E will always request it at 20wks and asking for it at 19 will be like twisting her arm. Honestly, scanning a little later most always gives us a better look at fetal anatomy but Drs. A and C don’t feel like arguing this point with patients who are trying to plan the gender reveal party so they will allow their patients to come in at 18wks. Drs. B and D are easy going so they’ll schedule it whenever.

Recently, a patient calls in and says Dr. E told her she could have the scan at 18. Hmmm, really now. However it happened, she was scheduled for the exam. As I’m looking through this patient’s chart, I notice she had a dating scan earlier in her pregnancy that changed her due date..she was only 15wks! Needless to say, after conferring with Dr. E’s nurse, the exam was cancelled and the patient was furious…even though she knew she was too early for the examination. She simply elected to not divulge her true gestational age when making her appointment..like I or her doctor  wouldn’t notice??

My job not only entails scanning Baby for abnormalities at an appropriate time that they can be diagnosed but to also confirm the order by the physician and to ensure the exam is performed within the specified time frame in which the physician orders it.

“I don’t care. I just want to know the gender.” Well, your insurance company cares and they are not going to pay for it twice.

And for the 8,462nd time in my career, we will never confirm gender at 15wks. I’ll probably say it another 8,462 times before I retire!

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Posted on January 21st, 2015 by wombwithaviewblog.com

I’m baa-aaaack! Yay! I’ve missed writing and I’m super happy to be back to post your questions and answers! I am truly sorry it took me so long to go live again but it is a process! ..and one I’ve discovered is not my strong-suit to attempt without technical help.

I have posted some “kids say the funniest things” in the past. Honestly, most of the time when parents bring their kids with them, especially for a lengthy ultrasound exam like the anatomy screen, it truly can be very distracting and disconcerting. Did I also mention irritating? I know I’ve explained myself here before but when I am trying to focus on my patient’s exam, the task is made twice as hard no matter whether a child is screaming, dad is constantly disciplining or grandma is reading a story. We one-track mind sonographers desperately need our quiet concentration!

Every once in a while, however, we have a child in the room who is simply entertaining…like the one who thought his baby sister looked “weally weihrd” from one of my most recent posts and he was NOT making the mistake of coming to visit me again. A totally precious little girl was in today with her Latino family. She must have asked me a million questions. The exam I had to do was pretty short and sweet so it didn’t require too much brain power, fortunately, and I could indulge her a little. Every time Grandma thought she was talking too much, she would tell her in Spanish to stop and pay attention. That would work for about 30 solid seconds before the onslaught of more questioning. She was so cute and smart and SO well-spoken for only four!

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

Any kid who can make me laugh out loud can visit me any day of the week;)

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Posted on December 23rd, 2014 by wombwithaviewblog.com

I’m a little Italian. Well, half. The other half is a Heinz 57 mix of German and Scotch with a little splash of Cherokee Indian. How about that concoction, huh? Most of us Americans are a jumbled gumbo of ancestry. So if you don’t understand the title of this post, you really do! Or you may comprehend “no comprende”. They both mean the same thing. “I don’t understand”. I know this of some of my patients without their saying these words..or a word.

The majority of this lack of understanding primarily comes from my really young patients..those under 20.  Sometimes it’s a blank stare (believe me, I get those from people over 20, as well) or sometimes it’s in the form of a series of inquiries which may begin with “huh?”. I reply with essentially the same answer phrased a little differently each time with an effort to break it down just a little further with each subsequent, unending series of the same question over and over and over.  See if you can follow the following conversation:

(I will preface this by stating that when I typically take a patient back for an Anatomy Screen, I will make their entourage remain in the waiting room initially so I can have some quiet while performing the examination. I say this to the patient as I walk her back for the test. Some don’t get it.)

***

“I’m going to take you and your spouse or one other person back first for the medical portion of the examination then you can bring in the rest of your family.”

“Medical examination.” (You know the questions that are asked more like a statement than a question?)

“Yes, I need to get the medical portion of the exam done first, then I’ll be happy to let your family back.”

“Medical portion?”

“Yes, I need some time to perform the diagnostic test on the baby first.”

“Test. What test? I’m not supposed to be having a test today.”

“Your ultrasound. It’s a diagnostic evaluation on your baby. I have measurements to take and lots of things to document first.”

“Oh. So they can’t come in now?”

O M G

***

Welcome to my career. Granted it’s not every day I have to attempt to impart wisdom in such a way and I can only jest because I was almost as ignorant at that age. However, it’s a  l i t t l e scary sometimes that certain people will be called “Mom” in a very short amount of time. I suppose it takes time to become a woman of the world!

Just a cute pic before I peace-out for the morning;)

11wks waving

 

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Posted on June 28th, 2014 by wombwithaviewblog.com

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

***

This is our swimming ool.

Notice there’s no p in it.

Let’s keep it that way.

***

I always thought it was so funny and clever!  And her mother meant it, with all her Italian beauty and ferocity, threatening us that we better not do it!  I have to laugh at that memory.  So, let’s talk about a pool that most definitely contains some “p” and lots of it.  I’m, of course, referencing the amnion.

For people who don’t already know this, you may be grossed out but it was a necessary function in order for us all to get here!  The amnion is predominantly made up of fetal urine and it is one of the things we evaluate on ultrasound.  Baby starts to swallow amniotic fluid somewhere around 11 or 12weeks. During the anatomy screen, we look for fluid in the fetal bladder and stomach so that we know baby is swallowing and the kidneys are functioning properly.  We also look at amniotic fluid level to determine this.

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

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

SONY DSC

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Posted on January 21st, 2014 by wombwithaviewblog.com

Or to many patients..the scan where I can tell the gender.  This scan is done typically between 18 and 20wks.  I know I have said this in the past but let me clarify!  This examination has absolutely, positively nothing to do with any need for determining your baby’s sex.  People usually want to tie the two together; “I’m having this scan and now we can find out.”  I have to stress here that you cannot ALWAYS find out gender at this scan and no one will ever guarantee that you can.  Most people understand this.  If any of you read my rant last week, you get it that some people (God help them) don’t.

Let me go back a little bit here.  Ultrasound was initially created as a means of complimenting your physician’s diagnostic puzzle…a little helper, a way for him/her to see a little of what is going on in there so that he can educate you and so that you can be better prepared to make some important decisions in the unfortunate circumstance that something is not developing properly.  Somewhere along the way, ultrasound got better and became the circus that it is today where people show up with herds of family and expect them all to come in for this examination.  At the end of the day, this IS still a medical examination; my job is to find problems and, hopefully, to rule them out.

We have a long list of things to document, meaning we have to find them on your fetus and take an adequate representative image of each organ and measurement.  Some of the things we look for on a routine scan are as follows:

Cervical length – we measure the length of your cervix.

Placenta – we grade it and tell your doctor where it is located.

Amniotic fluid – we do a subjective assessment, general eye-balling of how much is in there.

We measure your baby:

The head from side to side (BPD or biparietal diameter) and around (the HC or head circumference), around the belly (the AC or abdominal circumference) and the femur length (FL).  These measurements estimate a weight which is usually about 8ozs. at about 18wks.

We document internal organs and other structures:

Brain, orbital lenses, face, upper and lower extremities, heart (very basic views), spine, stomach, kidneys, bladder and umbilical cord insertion and vessels.  We check to make sure these things are present, located where they are supposed to be and look the way they are supposed to normally look.  Yes, we have to know the difference!  Some of the changes we are looking for measure literally in the millimeters.  If all parts look normal, we assume they are functioning properly.

After we take all these images, we formulate a report for your doctor in great detail regarding the above parts.  If something is not well seen or limited because your baby was not in a good position, he/she wants to know that, also.  Usually, if your baby doesn’t cooperate to allow us to see everything we’d like, your doctor will typically (at least ours do) send you back in about a month to attempt a recheck.

Let me capitalize the following statement.  ONLY YOUR DOCTOR CAN DISCUSS THE RESULTS OF THIS SCAN WITH YOU!!!!!  NOT me.  Never, never, never the sonographer.  For those of you who have had the terrible experience when we suspect something is wrong, you have a hundred questions and your doctor is the only one who can answer them for you properly.  Your doctor is the one with whom you have the important relationship.  He/she wants to be the one to give you unfortunate news about your baby.  These patients will usually be referred on to MFM or Maternal Fetal Medicine which are doctors who specialize in high-risk OB.  They will scan you again and give your doctor their opinion on what they believe is going on and how your pregnancy should be managed in light of the problem.

So!  Nowhere in the report is there a space to include gender.  That’s because it is not important to the health of your fetus and your doctor doesn’t really need this information.  We know, however, that it is important to those of you who want to know.  And there is nothing wrong with wanting to know!!!  Believe me, I couldn’t wait to find out myself!  I did have to scan myself for 3wks, though, before my own kid would cooperate!  True story.

We love a fun family and love being able to give this news when we can.  What we don’t like are the people who don’t care about anything else, are demanding of us to give them gender information and then ask us 400 times if we are sure of what we see.  As you can see, we have a big job to do which requires time and focus.

It’s okay to find out your baby’s sex.  It’s okay if you don’t!  It’s okay to even have a preference.  It’s just not okay when that’s all that matters.

Questions??  Great!  Email me and I’ll answer what I can!

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Posted on March 12th, 2012 by wombwithaviewblog.com

Consulting Dr. Google…

Don’t do it, Moms-to-be! As much as you may be tempted, I have to caution you to not web-surf fetal abnormalities on ultrasound.

In this day and age of anything we want to know at our fingertips, it is nearly impossible to NOT research something that piques our curiosity. So, naturally, when you get your ultrasound results from your doctor, and he mentions you have a lot of amniotic fluid (polyhydramnios) or your baby has cysts on its brain (choroid plexus cysts), you freak out a little (or a lot). It’s completely understandable!

The truth is, however, that when you surf the net for these details you end up finding an entire spectrum of possibilities ranging from normal to severely abnormal fetal findings. And most of them may not apply to your circumstances at all. The result is usually the same. Your imagination runs away with you, and you start to worry that everything you’re reading applies to you and your baby. I always know a mom has been consulting Dr. Google when I get questions like “Is my baby’s bladder inside its body??” My response is usually the same…I reassure her with an “It sure is!” Then with a little smile, I advise “Quit looking up stuff on the internet!!!” Moms’ responses are usually the same, too. “I know, I know…I just can’t help myself!”

If Your Doc Wants to Refer You…

Sometimes, we sonographers (even the experienced ones) detect things we just can’t explain. This doesn’t mean something detrimental to your baby; it just means we can’t fully explain it. We know this is disconcerting to an expectant parent(s). Usually, if something requires the attention of a high-risk specialist (aka a perinatologist or MFM or Maternal Fetal Medicine), your doctor will tell you when he discusses your ultrasound results. In such a particular case, he/she will usually express that something noted on the examination stands out as abnormal (or possibly a normal variant – something that’s a little different but considered normal), and he would like a second opinion.

In my experience, if your provider feels it is not grossly worrisome, he/she will say so. Your doctor will then refer you to MFM so they can do a more extensive Level 2 ultrasound. The perinatologist should discuss this ultrasound with you, provide an opinion on the issue, and the severity of the problem. MFM will also let you know if they feel there really is no problem.

If Your Report is Normal

If you are not referred to a perinatologist, then it’s very likely that nothing worrisome enough was seen on your ultrasound. Your doctor will also let you know that your ultrasound was negative or unremarkable. At times, we can’t see something well because of Baby’s position or other factors. Usually, it’s something like Baby’s heart or spine. In these cases, your doc may want to look again to ensure a normal appearance. There are many minor findings that we may note on a regular sonogram which may not be alarming to your doctor. Mostly, they just require a follow-up later to see if the issue is resolved. They mostly turn out to be insignificant, especially if no other abnormalities are seen with your baby. In other words…they are likely not a big deal!!!

So don’t make yourself worry! Don’t ask Dr. Google, ask your doctor instead. Make a list of all your questions, and he/she will let you know if other tests are needed. I know it’s tempting, but this is only the beginning of all the things that drive us crazy as moms! Save your sanity for when your kid is a driving teenager!

Best wishes for a happy and healthy pregnancy!

wwavblogger, RDMS

wwavblogger, RDMS

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