Posted on April 29th, 2017 by wombwithaviewblog.com
9 Weeks

9 Weeks

What Does Diagnostic Mean?

Anything “diagnostic” describes a test performed to try to find a problem. So, diagnostic utrasound 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. However, first and foremost, it 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 I Really Do When I Scan?

In a nutshell, my job requires me to see what’s in there 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, in other words, 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 any 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 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 that is beyond human hearing.  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.  Things 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.

Many other diagnostic ultrasound examinations are performed on many 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 is precisely why fetal sex is still incorrectly guessed! If the observer, or person holding the probe, is not very experienced at looking at fetal sex..oops!..wrong sex. And we’ve ALL heard those stories, haven’t we?!

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~ Coming Soon! ~

It’s all about first-trimester ultrasound and answers lots of questions for all you new moms out there!

Stay Tuned!

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Posted on April 17th, 2016 by wombwithaviewblog.com

Every once in a long while, or blue moon, I receive an email posing a phenomenal question regarding diagnostic ultrasound! And it’s not one about fetal sex, much to my sheer happiness. Keep reading to see what was on her mind..

concerned mama:  Hi there! I would love to get your opinion on something, if you don’t mind. I was born with bilateral congenital hip dysplasia, and therefore have a 1/12 chance of having a baby with the same issue. I was just wondering, is there any way to spot this on U/S? We have already had our 12 w NT ultrasound, but I was wondering if I should ask at our next one (19w). I know it’s not a major life threatening issue, but I just wondered if it would be worthwhile to ask about when we next see a sonographer. In case early U/S can help you spot red flags for dysplasia, here is a shot of my little one, I believe in spread eagle position, showing both hips (?). I’m no expert 🙂

Thanks for any info you may have! 🙂

wwavb:  Excellent question! In short, no. (Her image was omitted here since it is not relative to her case or this post.) Hip dysplasia is questioned by the pediatrician during neonatal examination and can be confirmed by ultrasound of the newborn by scanning the hip joint in a particular plane while applying pressure at a specific point to see if it’s pushed out of place. I did a few of them many, many years ago and cannot recall all the details of the exam, per se.

Thanks for the great question and I hope you will continue to read! Many blessings for a happy, healthy pregnancy!

wwavblogger
***

It has probably been something close to 20 years since I’ve performed just such an exam. Wow, time flies when you’re having more fun than one can stand in the hospital setting.

If I remember correctly, hip dysplasia is a repercussion of certain long-term fetal positions and I seem to recall a correction involving the newborn in leg braces for a relatively short period of time. Please, PLEASE ask your OB or pediatrician if you have questions about the most current and up-to-date information on the subject and treatment of this condition.

And KUDOS to this reader for asking me a question I’ve never gotten in my entire career!

Many blessing to all you expectant lil’ mamas out there and don’t hesitate to email me with your question by clicking on the ASK ME page above. Thanks for reading!

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Posted on March 12th, 2016 by wombwithaviewblog.com

Everyone wants a healthy baby. It’s something we, as humans, take for granted unless we know of someone who experienced the misfortune of having a child with problems.

I think anyone who has ever come up against the discovery of a fetal abnormality on ultrasound can relate to the devastating feeling of receiving the news. No matter how insignificant the issue, even if your physician wasn’t worried, you sure were..not understanding fully what was seen and/or not being given a definitive diagnosis. Waiting on more appointments and tests and more results only adds to the anxiety. Sometimes the testing leads to a distressing diagnosis of a baby with life-long complications..a syndrome or some structural malformation requiring surgery after birth.

Sometimes, things we see may be cause for concern enough to warrant a referral to Maternal-Fetal Medicine (MFM) so that a Perinatologist can determine the nature or severity of a problem. They may know exactly what is seen, what to call it and how to follow it. For those who are very lucky, following a concern for period of time results in resolution of the problem. Hallelujah! Your constant companions, Worry and Anxiety, get kicked to the curb and you feel you can finally exhale, breathe again and no longer have to contemplate the what-ifs of your pregnancy, your newborn or how it might impact the lives of your whole family. You can finally get some well-deserved sleep and actually enjoy things like your baby shower, decorating the nursery or filling the closet with precious miniature clothing.

So, all this brings me to a patient who made me entirely livid yesterday. She had the audacity to complain about how she was followed with one of her previous pregnancies for a suspected problem pertaining to Baby’s pelvis and a mass seen on ultrasound. The area had been followed for months when it spontaneously resolved. They couldn’t explain it nor was there any further reason for them to see her again. She was released back to the care of her regular OB physician.

What’s that? Prayers answered, you say? Amazingly great fortune? Blessings galore bestowed?

Nope. Not according to this peach.

Her only comment was what a total waste of time it was..”months of anxiety and follow-ups for nothing”. So…would she rather it hung around? Would she have been happier had it enlarged to the point it required surgical intervention at birth? Believe me, she expressed not one iota of appreciation, relief or gratitude..just anger that we found something, she was inconvenienced and made to worry for “no reason”. Are providers supposed to have a crystal ball and magically know whether everything we see will or won’t be a problem? We’re not God.

I will make no apologies for the scope of my job..to look for and find abnormalities, big and small. We’re good at what we do so I won’t express regret that we found something others may have missed. I’m sure she was happy her baby was healthy. It simply would have been nice to hear as much.

Moreover, said peach also complained about a number of other issues. I wouldn’t let her bring in ten people during the exam, I was too mean to let anyone talk on the phone or video the exam and I didn’t give her enough images. Did I paint a pleasant picture here of Miss Mary, Quite Contrary? I think she needs to talk to a patient who didn’t get the good news she did…like the patient whose baby had three barely identifiable heart chambers instead of four and who has needed three surgeries so far in her short little life…one at birth and two more before she turned three.

Diagnostic ultrasound is meant to aid a physician in finding a problem and preparing the patient through education for what is to come. Life is all about perspective, isn’t it? We can either take up residence in the victim mentality or wear those proverbial rose-colored glasses. There’s something to be said for the glass-half-full frame of mind. At the end of the day, I will always prefer to catch an abnormality than to miss one!

Wishing you all happy and healthy pregnancies! ‘Til next time and thanks for reading;)

wwavblogger

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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 December 21st, 2014 by wombwithaviewblog.com

I’ve discussed in earlier posts the true scope and nature of what I do. I’m not a glorified photographer (“go out and get a real job”??). I have always had a problem with that line in Juno. I guess it’s because the words are condescending and diminish the work I really do.  I will add here, however, that the description would not be out of line regarding those who work only in the “elective ultrasound” business, the 3D peek, mommy and me, I’ll-take-your-money-and-guess-at-gender-too-early establishments. I have to wonder if they cannot get a “real” job in ultrasound. Shut it DOWN (in the words of Jess to all you New Girl followers – such a great show!) Okay, enough with movie and TV references, I promise. But whomever wrote the Juno line is either totally ignorant about my “real” job or, conversely, maybe he/she was trying to convey the ignorance of the character of Juno’s mother. Regardless and much to my dismay on a very regular basis, this is the general perception of my work to most lay people.

In a nutshell, my job is to rule out abnormalities. Structural abnormalities and pathology relative to the patient like the uterus, cervix and adnexal regions (out to the sides of the uterus) and of the fetus like the placenta, amniotic fluid, umbilical cord and the fetus itself. I am attempting to exclude some 200 disease processes and/or pathological conditions with the Anatomy Screen or the fetal ultrasound examination otherwise known as “the one where I find out the sex”.  Unfortunately, this IS the most important tidbit of information and we hear it on a weekly basis. Patients call in to find out the results of a chromosomal test asking only for gender results; comical yet sad.

So my job surely is not always fun as I do occasionally find problems but when it is fun, it is great fun. My motto is “Business in the front, party in the back!”. In other words, let’s take all the measurements and make sure baby looks great then have some fun..like the image below.

This little sugarplum is all snug in his bed.  Hope yours is, too!

image

Merry Christmas and Happy Holidays until next post!

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Posted on August 8th, 2014 by wombwithaviewblog.com

When a patient told me today she worried about her follow-up ultrasound scan for an entire month I knew I needed to address this issue.

This scan was ordered by her doctor 4 wks after her anatomy screening ultrasound and the patient thought something was wrong with her baby.  When she revealed this, I tried to ease her anxiety by explaining the protocol of these examinations.  On the anatomy screen we have a whole checklist of maternal and fetal anatomy to measure and document.  When parts on our list are limited, and oftentimes they are, most doctors will typically bring the patient back a month or so later for a second attempt to complete the checklist.  Adequate visualization of all these structures relies on so many variables, especially fetal position.  Most of you already know that if Baby is facing your back, we just can’t obtain that portrait for which you’ve been so desperately waiting.  It also means we can’t document all the facial structures we’d  like to see.  Another example is when Baby is lying on her back; in this position, we cannot evaluate the spine adequately.

Limited visualization is very different from questioning an abnormality.  When this happens, your doctor discusses the problem in question at your very next visit, answers any questions you have and refers you to a Perinatologist, a high-risk OB doc, for an evaluation of the suspected problem and recommendation for treatment.  Every doctor manages their patients a little differently, but this is how our docs handle this issue in our practice. There are many things we see on a regular basis that are quite minor that we follow-up and manage ourselves but your doctor knows when you need a high-risk assessment.

So, if you’ve gone in for your anatomy screen recently and you didn’t get to see this:

SONY DSC

Don’t panic!

Maybe Sweet Pea will let you see his great profile next time:)

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Posted on July 25th, 2014 by wombwithaviewblog.com

Okay now, readers, this is a perfect example of how sometimes I can determine gender < 17wks!   Not much less but at 16w4d, it’s pretty easy to tell on these twins they are one of each. ..Baby boy AND girl gender images in a side-by-side comparison. These were very easy potty shots..hardly an effort to obtain and you can see the side by side difference.  I’ve even labeled parts for you!

Check them out below!

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boy and girl gender determination

 

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female gender on the LT, male gender on the RT

 

Happy comparing and have a great day!

wwavblogger 🙂

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Posted on July 19th, 2014 by wombwithaviewblog.com

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

A Fine Example of Negligence

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

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

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

Turn the Table…

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

Just in Case Your Instructors Didn’t Tell You…

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

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

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

What About a Private OB Practice?

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

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

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

Be Your Own Advocate!

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

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

Comments: 2 Comments »

Posted on July 15th, 2014 by wombwithaviewblog.com

If you think kids say the darndest things, some of their mothers aren’t much better.  I feel my job here in this blog is to inform you but to also make you laugh.  Anyone who works with the general public knows that some people are just not taught the etiquette of speaking or behaving in public.  Therefore, we end up with stories like this.  I hope you get as much a kick out of this story as I did!

My co-worker completes an exam, steps out of the room to allow her patient to get dressed and awaits her exit.  As the young mother, her FOB (father of baby) and toddler walk out she says “I’m really sorry..my boyfriend farted in there and he stunk up your whole room.”

For as funny as this was (my co-worker didn’t laugh as much as I did, by the way), couldn’t she have just blamed it on the baby?!

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Posted on July 12th, 2014 by wombwithaviewblog.com

Technology has its pros and cons.  We THINK we want to know the second we conceive..but do we really?  Some patients find out that often times ignorance is bliss.

Very early in the pregnancy we can’t see a thing.  To simplify, we start to see a gestational sac at around 4wks.  It’s only about 2mm big and literally a tiny black blip within the endometrium.  All we can report at this time is..we think it’s an early sac.  Monumental changes are happening every week!  At 5wks, we see a much bigger sac but it’s only enough information to say..yes, it has grown appropriately and that is good.  Within a few days, the yolk sac develops.  It looks like a little circle inside of the sac, but it’s still too early to see Baby.  Below is about a 5 1/2wk pregnancy of twins (obviously!).

Yolk Sacs

By the next week at 6wks gestation, cardiac activity should be seen along with a the yolk sac and bigger gestational sac.  It’s still very tiny and can be difficult to visualize well if the embryo is lying against the wall of the sac.  At 7wks we can see a little better, but 8wks usually gives us a great image of baby who is now technically a fetus!  Yay, milestone!  And Baby is much easier to measure at this point.

6wk embryo

 

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Isn’t the growth in two weeks incredible?!!!

It’s all a process, it can’t be rushed and only time will tell if your pregnancy is growing appropriately!  If you think you are farther along by your LMP (last menstrual period) dates, and your doctor has an ultrasound done and they don’t see what they expect, it can be a long, long wait for you.  You could just be early or it could not be a good pregnancy BUT ONLY TIME WILL TELL.

It’s so hard to wait.  It’s the longest week or two of your life before your doctor brings you back in again for another scan!  So, you talk to friends and family and you Google ’til your fingers fall off but at the end of the day, only that next scan will give you real answers.

As all of motherhood (especially as our children become legal adults!) sometimes, ladies, ignorance is most definitely bliss!

I’m sending best wishes and loads of patience for the next 21 years to all you early pregnant mamas out there!

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Posted on July 1st, 2014 by wombwithaviewblog.com

As an extension of yesterday’s post, I’d like to share an email sent by a very worried mom-to-be and my response.  I’m hoping my advice will help other moms who are concerned about results.

anxious mama:  I’m writing to you because I find your blog really interesting especially now when I’m pregnant. This whole world of pregnancy-connected things is quite overwhelming to me. I am now 25 weeks pregnant and, although I’m quite a rational person, sometimes I freak out.

Actually, I have some doubts as to my ultrasound scanning. During my 22nd week I was on prenatal ultrasound scan. The doctor checked everything and everything seemed perfect except my son’s feet. He described them to be “strange” and suggested that those are sandal gaps. I was even more scared when he advised me to do amniocentesis which I didn’t do. Now, I know that such feet can suggest DS but my husband says that probably our son has such strange little toes because my toes are not “normal” either.
Anyway, do you think you could take a look at some pictures of my child’s feet? I keep thinking that maybe the moment for scan wasn’t right, or he was moving his toes, or anything…
If you agree to look at these photos, I will send them immediately 🙂
wwavb:  Thank you for reading my blog and I hope it’s answered some questions for you.  And, yes, while pregnancy is very much an exciting time in a family’s life, it can also come with a variety of worries and concerns.

Firstly, I have to tell you that I am not a physician and I cannot in any way confirm whether your baby has sandal gap toes.  Even if I saw your images, I did not scan you live or real-time and did not observe your scan so I could never diagnose something by a single frozen image.
My best advice is this..if this is a concern you now have and it is one that causes you to lose sleep and if it is also an answer you feel you must now have, talk to your doctor.  He is truly the only person who can provide you with an answer.  Sometimes, if there are no other abnormal findings, this can just be a normal variant meaning your baby is otherwise normal.  However, your doctor offered you an amnio because only an amnio can tell you for sure.  This is your doctor’s purpose..to manage your pregnancy and to help you navigate through such concerns.
I’ve assisted on hundreds of amnios in the past and it is usually a pretty quick test with a little stick of a needle and a mild cramp.  Talk to your doc about all the pros and cons and let him know if you are reconsidering.
I hope I’ve helped to some degree and I hope you’ll subscribe to receive future posts!  I wish you all the best for a beautiful and healthy baby:)
wwavblogger
***
My reader never sent me her images, but as I stated in the email, it’s something only her doctor can confirm for her.  I do know pregnancy can be a scary time.  It’s always fun when everything is normal and everyone wants a healthy baby.  But in those times when health is questioned and especially when it is a reality, rely on your doctor to help you through it.
Our babies come to us for all sorts of reasons that we can’t know about now or understand.  Sometimes it’s all in the big plan of life that we are chosen to care for those very special children who need very special parents.  It’s not the end of your world, it’s the beginning of theirs and your life together!
Many blessings to all mamas and babies out there!

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Posted on June 29th, 2014 by wombwithaviewblog.com

Not so much.  Not when it comes to pregnancy and we see it every week…a patient is given ultrasound results by her doctor, she goes home to Google the information and then calls back to the office in a complete panic over what she’s read.  This is a big mistake!!  The internet is filled with more information than we need and than what applies to you in your pregnancy.  You are causing yourself more heartache and worry than is necessary.

What you get when consulting Dr. Google is the whole spectrum of findings and worse-case scenarios.  You also get forums of patients with no medical background discussing their results with quasi-knowledge and missing links.  At the end of the day, your doctor is your advocate for managing your pregnancy.  Only your doctor can advise you on what the next step can be or order further testing.  It always comes down to whether you HAVE to have a definite answer now vs when baby is born. Whatever the decision, discuss it with your obstetrician.

Remember this…  Dr. Google cannot advise you, console you or discuss test results.  This is why you have an obstetrician.

Moreover, Dr. Google will certainly not be the one to catch your precious bundle of joy on the day of delivery.  Direct all your concerns to one who will be…that’s why she is in the baby business:)

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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;)

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Posted on June 18th, 2014 by wombwithaviewblog.com

So because I totally lost my marbles and didn’t post some great story about fathers on Father’s Day, I guess I’ll do it today instead!  So I would love to share this really funny experience with one very overprotective Dad.

A couple of years ago I had a patient who was coming in every week for BPPs or Biophysical Profiles as they are called.  I’ve explained this one before but it is simply a way to determine the well-being of a fetus by scoring the baby on his/her movements.  We also measure Baby’s fluid and monitor Baby’s weight, as well.  During these scans, babies sometimes are napping or lazy.  Sometimes we have to “force” a little movement by nudging baby which we accomplish by poking at mom’s tummy.  If Baby is REALLY asleep, we sometimes have to poke quite a bit.  I, of course, always ask Mom if I am hurting her and I’m surely not hurting Baby.  But Dad, on this particular day while accompanying Mom for the visit, didn’t think so…and he let it be known.

I start poking around on Baby and Dad pipes up saying “You need to stop that..  You’re pushing too hard.”  I assured him that I wasn’t and asked Mom again if she was hurting.  She actually laughed a bit and stated she was fine and that she wanted me to just do what I needed.  She also tried to calm Dad but he wasn’t having it.  After a little more vigorous poking, Dad said “You’re gonna cause Shaken Baby Syndrome!”  I laughed to myself and did all I could to keep from bursting out with laughter at his reaction.  I reassured Dad that Baby is well protected in there and we certainly wouldn’t do anything that could cause harm to the little one.

He eased up but wasn’t happy about it.  I just couldn’t be upset with him.  He was starting his job early..being protective of his baby girl very early in life.

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Posted on June 15th, 2014 by wombwithaviewblog.com

Firstly, I’d like to extend a huge congratulations to a reader who recently delivered!  This is what she had to say..read below!

***

Hi I hope you had a lovely time on your holidays ,just to say I had a little boy at 38+5 and he was a MASSIVE 8lb 7oz :) not half as bad as I imagined ,many thanks for your help to mel

***

I’m so happy and the whole point of my blog is to answer questions you have about ultrasound accurately rather than your reading and taking to heart some of the garbage found randomly on the internet.  Everyone is an expert, everyone has an opinion..and MOST of them are wrong!  Especially when it comes to medicine, just because your cousin Becky had several ultrasounds during her last pregnancy doesn’t mean she can now read yours.

And this is not only in reference to gender, which is what most people question.  Though I can never provide medical advice to anyone, I can surely explain the why’s and how’s of ultrasound better than your aunt, mother or sister who just had one done.

As for gender, I think I’ve made it no secret that determining gender has become the bain of my existence.  When the only thing a patient is interested in is gender, everything I need to do to complete an exam is hurried, or rushed or simply ignored to get to the pink or blue, which may or may not be detected.  People have come to expect that they will in fact know what they are having at this appointment, make it a social event and become upset, sometimes enraged when it cannot be determined or if family is asked to wait outside for a portion of the examination.

Don’t get me wrong!  I love to tell people whether they are having a son or daughter!  The fact remains and should be respected that this is first a medical examination of mother and child.  The sonographer should be able to take the time she needs in a non-disruptive and quiet atmosphere to obtain all required information to complete this exam for your doctor.  This means excited grandmas who want to talk through the whole exam about the nursery and names need to stay out, as well as the toddler siblings, nieces and nephews who scream and squeal for attention.  Believe me, they have no clue they are looking at a baby on that monitor.  And, honestly, any noise in the room other than the sonographer talking is a distraction.

That all being said, I will say it is still the highlight of my day when I have a very happy couple come in for an exam who are mindful of why they are there, so happy to be expecting and are full of questions.  I love to impart some ultrasound knowledge, provide awesome images of this future addition to their family and am still honored to be this third objective party who gets to orchestrate it all.

Best wishes for a beautiful experience,

wwavblogger

 

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Posted on May 24th, 2014 by wombwithaviewblog.com

Who doesn’t love ribs on Memorial Day weekend??!  Today’s post is all about ribs but not the kind we love to bathe in barbecue sauce.

Bone on ultrasound shows up white because it is very dense.  Water, on the other hand, is the opposite and shows up black.  Ultrasound cannot travel through bone so as your baby’s bones become more dense, they become more of an obstacle to see certain things like the heart.

Next time you have a scan, notice the appearance of  baby’s bones.  Because sound cannot penetrate through bone, what you’ll see instead is a perfect shadow behind the bone.  We cannot see anything in that shadow.  Therefore, anything that lies behind bone cannot be well-visualized.

Take a look at the image of this baby’s ribcage below.  Notice the arrows pointing to the white dots (ribs) and the black shadow that follows each one!

SONY DSC

 

Thank you to all the moms and dads who serve our country in the armed forces!  It’s a hard job and we appreciate you!  Have a great Memorial weekend!!

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Posted on May 22nd, 2014 by wombwithaviewblog.com

Here’s an email I received from a UK reader asking about determining Baby’s size/weight.  Read on for my response!

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

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

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

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

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

Cheerio!

wwavblogger

***

I’ve definitely posted on weight before as it is a very often received question!  Everyone wants to mentally prepare for what they are going to have to push out of there.  Check out one of my prior posts on EFW!

http://www.wombwithaviewblog.com/how-much-will-my-baby-weigh/

Comments: 2 Comments »

Posted on May 21st, 2014 by wombwithaviewblog.com

I must have dyslexia.  I originally wrote one artery and two veins..sheez..definitely two arteries and one vein.  So glad I caught that..it’s late!  Already changed!

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Posted on May 21st, 2014 by wombwithaviewblog.com

Very simply, the cord is made up of two arteries and and one vein.  This is one of the important bits of information we obtain during your anatomy screen or the scan most get at 18 – 20wks.

Sometimes only one artery develops and babies can grow just fine in those cases.  Usually, if your baby has a two-vessel cord or SUA, single umbilical artery, as they are commonly referred to, your doctor may request more ultrasounds to follow Baby’s growth over the course of your pregnancy.

You may sometimes see your sonographer add “color” to Baby’s cord.  Typically, we apply blue to the vein and red to the arteries.  This color flow just allows us to see them better so as to evaluate the flow within the cord in the 3rd trimester.

We can never see all the cord from placental to fetal insertion later in the pregnancy.  Baby gets to be too big and we see segments of the cord here and there.  One question I always get is if the cord can be seen around the baby’s neck.  Ya know, sometimes we do see a nuchal cord but it just isn’t something your doctors want or even need to know about.  The cord moves all the time and they just will not even give it a second thought unless it’s wrapped twice and you are near your delivery date.  Otherwise, there’s nothing anyone can do about it and cord accidents are actually quite rare.  It’s one of those things in life you simply cannot worry about like getting on a plane for a 10 hour ride.  You’re not going to ruin your trip to Europe by stressing about it, right?!  Of course, you shouldn’t!

Wow, you guys are gonna be a plethora of ultrasound knowledge after reading my blog;)

‘Til next time!

SONY DSC

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Posted on May 8th, 2014 by wombwithaviewblog.com

I LOVE IT!  What a breath of fresh air I received from a reader…someone who actually doesn’t want to know her baby’s gender.  Now, don’t get me wrong!  Though I held off on the potty shot for my first, I was a full-time registered sonographer working several years by the time the second came along and personally couldn’t wait to see for myself, even scanning myself in the process (we all do that, by the way).

But wouldn’t ya know it, someone wants to wait for The Stork but that’s just not good enough for everyone else!

distressed mama:  Hello,  I’ve really enjoyed reading your blog. From everyone’s posts I can see that I am in the minority — my husband and I want to be surprised with the sex of the baby on the day I deliver.
We got the anatomy scan a few weeks ago and the tech was very respectful of our wishes. She didn’t reveal the sex to us, and we left with the attached pictures.
We sent my sister the top picture in a text message. Upon seeing it, she immediately said, “I think I know what it is…,” and blurted out her guess. That really bothers me, because it seems that the rest of my family believes her and is taking her opinion as fact. I still don’t want to find out, but I don’t want anyone else to be so certain that they know, either!
Based upon the first picture in the set of 3 I’m sending, is the sex of the baby obvious to you? I figure that if you can’t tell then my sister who is NOT a trained ultrasound tech can’t tell either!
Thanks for your blog, it’s always fun to hear what you think about these ultrasounds from “the other side” of the wand!
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wwavblogger:  I LOVE IT!!  First things first.. Absolutely, positively NO genitalia in that shot whatsoever!  The black oval in the pelvis is baby’s bladder and I’m guessing she thinks she sees something just above that which is a very small section of umbilical cord at abdominal insertion. Either way, you are totally correct in that if I can’t see parts, neither can anyone else!  Tell your fam they have a 50/50 shot at guessing;)

Thanks so much for reading and I can’t wait to make this a post!! And, yes, the overwhelming desire of patients to know gender as soon as the pee stick shows + is ridiculous anymore. Patients drive all us staff crazy with wanting to know as soon as possible. God forbid if we can’t determine this at the anatomy screen. Most people are becoming obsessed and demanding…it makes me crazy!  I will not miss this aspect of what I do when I retire from clinical!  Some days my job is reduced from pathology finder to glorified photographer.

I’m so glad you are enjoying my blog and thanks for subscribing!!!

Best wishes for a happy and healthy baby!
wwavblogger

***
It really is comical to me how people deem themselves sonographers and declare this sudden newfound knowledge to be able to read images after having a baby themselves, especially when they didn’t even view the scan live!  Oh, well, everyone is an expert, right?!
What’s funny is her family believes the sister but I, an OB/GYN sonographer of 23 years who has scanned tens of thousands of babies, gets questioned “from the other side of the wand” (I had to use that!).  Hilarious!
Distressed Mom, be sure to let us know what The Stork drops at your door 😉

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Posted on April 26th, 2014 by wombwithaviewblog.com

I love my readers!

Thanks for subscribing and emailing, too.  It makes my blog appealing and adds interest to be able to post your questions and images.  I would love to transform my site into a book one day!  I personally love paper or hardbacks and imagine a wall of white shelving loaded with books in my next house.  Yeah, I’m a bit old-school, I guess.  But for all those who love technology, don’t you think it would make a great Kindle read, too?!

Read below for some props (thanks!!) and a gender question from a new reader and subscriber:

reader:  Hi! I’m expecting my third little one in October. I just wanted to say, before I ask my question, I’ve been reading your blog for the past 3 hours while my kids are down for a nap. I love it! I went for a private 3d ultrasound on Monday, and he said it was a girl! We are so excited because we have two little boys already. I’ve heard so many horror stories since I got it done, and I’m terrified he was wrong. I clearly see ‘three lines’, but I’m no ultrasound technician. What do you think? Thanks in advance! I’ve already subscribed, and I’m excited for more!

unnamed

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wwavb:  Hi! First, let me say thanks so much for reading and subscribing. I’m so happy you are enjoying my (sometimes) sense of humor!  I really am very honored that you spent three hours of your own personal quality time reading my stuff!  Very cool.

So, I am going to guess that you are maybe 14wks?? 15? Please write back and let me know. Maybe you have already come across some of my posts and may already be familiar with my opinion of these ultrasound drive-thrus!  Baby looks a bit small in these images like you may be a little early to determine gender.

If you are less than 18-20wks, wait to paint!  That is really the best time (and later) to determine gender and those images are not proof enough to me to paint pink just yet!  Please know I am not telling you he’s wrong, I just cannot concur based on these images.

Warm wishes,
wwavblogger

reader:  You’ve guessed correctly! I was 14 weeks in this ultrasound. I have, in fact, read your posts about the drive-thrus. I must say, if I’d had know your opinion before, I probably would’ve waited. He told me he was 75% sure it was a girl and to come back in two weeks for another look for free. I’m definitely not convinced that it is a girl, nor have I bought anything pink. I do hope that it is, though! Thanks for your input!

wwavb:  I hope so, too!  Pink is so much fun to buy and you could use some estrogen in your family!

Feel free to email me again when you go back and then again when you go for your screen, the diagnostic scan with your doctor’s office at 18-20wks;)

I’d love to tell you pink, too!  Thanks again for reading!

Happy pregnancy,
wwavblogger

***
To anyone who is reading now or in the future, don’t let anyone take your money to guess gender at 14wks!  It truly is a guess and anyone has a 50/50 shot without looking at all, right?!  I say do it if you have the extra cash and if you can keep yourself emotionally neutral.  Check out my recent post to see what I mean by that!
http://www.wombwithaviewblog.com/want-guess/
Otherwise, wait to buy pink or blue, wait to paint and (by all means) wait for an ultrasound professional!  You’re not gonna find those in the 3D turnstiles.

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Posted on April 22nd, 2014 by wombwithaviewblog.com

..or do you want me to be RIGHT??!”

This is the statement I make to all patients who pressure me for gender way too early in pregnancy.  Baby not being in a great position doesn’t help, either.  Ya know, there’s more at stake here than just being “wrong”.  Parents start to identify with being a mom or dad to a new baby girl.  Thoughts jumpstart to dance recitals and her wedding day.  Dads immediately daydream of the fishing partner they always wanted or run out to buy his first tiny baseball glove.  These are strong emotional ties that often get broken when someone casually throws out the gender card on ultrasound.

Read on to see how this case of “mistaken identity” affected this mom:

reader:   This is my second pregnancy and I am 18 weeks. At my 20 week ultrasound of my first pregnancy I was told by the head ultrasound doctor (radiologist?) that it was definitely a girl and picked out a girl’s name. I ended up going into labor early at 30 weeks and at the hospital while an ultrasound was being done, I kept asking if she was ok.  The poor tech said, “Why do you keep saying she? Were you told it was a girl?” We said yes.  She said, “Well, I see  a scrotum. I’m going to get the Dr.” So it turns out we were the first time this head doctor ever got it wrong and now we are legend at his hospital. We were already calling the baby by the girl’s name we picked and I had a really hard time with the news. The only way I can describe it is like I had to grieve this little girl I had in my head that was suddenly gone. I wouldn’t change a thing about the amazing toddler boy I have now, but at the time, I was a wreck. Needless to say, I don’t want to go through that again. I was told today that the baby is a girl (again) and it is hard for me to believe. So, I just want to see what you think!

probable baby girl-18wks

wwavblogger:  OH MY GOSH!  I HAVE to post this email!  Your story is EXACTLY the reason I implore sonographers to give careful and cautious consideration when determining gender! This is also why I won’t cave to the pressures of patients begging when it’s too early.  I quit the % thing a long time ago…the I’m 80% sure it’s a this or that.  No.  I learned many years ago that even if I say I am not sure but give a “possibly”, parents are already thinking ballet slippers and pink tutus or sailboats and whales!  It’s so true.  It’s just an emotional attachment you begin to develop as soon as an inkling of pink or blue is mentioned.

And any radiologist should know better.  Most of them can’t scan worth a stink anyway (yeah, I said it) and if he was not scanning you and simply observing the sonographer, she didn’t obtain a great image for him…but he should have known that. OBs just read OB ultrasound better than radiologists in my book.
Joke of the day..What’s the difference between a radiologist and an obstetrician?  The obstetrician KNOWS his/her sonographer is a better scanner!  I’m sure I’ll piss off any radiologist who reads this but I don’t care.  That’s why I work for obstetricians:)
On my table, gender has to be very obvious or it’s a no-go.  When patients plead, my motto is “Do you want me to guess, or do you want me to be right?!!”  Then they quit begging.
Now, not having scanned you real-time myself, looking at one single image can be tricky.  By this image only, it looks like dance recitals may be in your future!  Looks like the typical three lines we see in a baby girl but just know I can’t guarantee that by any means! PLEASE, send me another image of gender every time you have another scan in this pregnancy!  Especially since she already has the perfect name!
Best wishes for a healthy pregnancy and baby,
wwavblogger

Comments: 5 Comments »

Posted on April 12th, 2014 by wombwithaviewblog.com

But not in my room.  Sorry!  Cameras are not allowed.  Why are people so surprised by this?  This is a medical exam and a doctors’ office. People, however, think it’s a party anymore…a time to celebrate. And bringing a new life into the family most definitely is a thing of greatness to celebrate!  Just not at your doctor’s office.

People want to record every moment like a birth, a wedding or shower or first birthday.  In this age of technology and such great ultrasound resolution, so do we have the high-res imaging and high-def video capabilities on our cell phones.  Such advances have made it easier than ever to record every moment of our lives. Americans have just assumed the same liberty applies to their ultrasound exam. It does not.  And there’s really nothing like being jerked out of total quiet, ambient lighting and deep focus in the middle of a study with the thunderous click and blinding flash of someone’s point-and-shoot.  After I declaw myself from the ceiling and my heart stops pounding, I have to once again say this is not allowed and resist hurling it to the floor. One would think it to be an obvious rule, like in a theatre during a play or musical.  To say it’s a slight distraction is an understatement.

Okay, enough of my rant.  Let’s laugh at a 3D shot where Baby wasn’t quite enjoying the moment, either!

SONY DSC

“Wow, it’s gotten crowded in here!”

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Posted on April 7th, 2014 by wombwithaviewblog.com

Ok, people, I’ve done virtually nothing with my Twitter account so help me change that!

You can find me @wombwaviewblog

I’ll try to keep up with tweeting about my latest posts and whatever else is going on in the world of ultrasound so please follow me on Twitter @wombwaviewblog!

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Posted on April 6th, 2014 by wombwithaviewblog.com

Studying ultrasound is no easy task.  Actually, it was the most difficult and challenging thing I’ve ever done.  Check the email I received from my ambitious Aussie reader below:

reader:  Hi there, I just wanted to start off by saying I love reading your blog!

I especially wanted to message you because, whether I’m the first person to say so or not, mothers aren’t the only readers you have!
I am not pregnant, (or even anywhere near the ballpark of having children!), rather, I am extremely eager to pursue sonography as a career, specialising in Obstetrics and Gynecology so I can do what you do. Showing parents their children for the very first time is such a special moment that it would make all of the hard work and waiting worthwhile.
You truly inspire me and keep me motivated, as currently I’m only starting my path towards becoming a sonographer. That’s because sonography is a post-graduate course, and I am new to university this year. (Thus, about 3 years before I can even begin studying ultrasound)
I hope that you take pride in knowing that your blog is bringing comfort and joy to parents as well as inspiration and motivation to people like me. I really do see you as a role model for the type of professional that I would like to be in the future. Please keep up the amazing work!
You are blessed to have such a rewarding career, even with the ups and downs of pregnancy. I am not so blind as to think that pregnancy is always complication free, especially as a reader of your blog, but I know that the smiles on the faces of just one happy couple could make any day a great day.
I’ll be silently cheering for you to continue blogging!
***
I wish her and every other aspiring sonographer the best in their ultrasound endeavors.  Best advice?  Don’t be afraid to ask questions for as long as it takes to reach clarity.
I was interviewed a while back and I’ll add a small segment from that..basically, general advice for all sonographers.  Enjoy!
I’d love to add a message for sonographers, especially those who are new to the field. A quality exam is important. Your thoroughness, accuracy and attention to detail can determine whether your patient goes to surgery or goes home, only for a Stage 4 process to be found six months later because you only did a quasi-sweep of the RT adnexa. Ultrasound, being the most operator-dependent modality, requires great experience. I recommend all newly-certified sonographers work in a busy hospital where education and supervision are emphasized. You should NOT try to work in a clinical setting alone right out of training! It will take time for you to recognize pathology on your own. You WILL miss things and it will be a disservice to your patients. I cannot emphasize this enough. Ask questions of your supervisors and physicians. Ask for supervision while scanning. Look up answers. Become informed. Details matter. Talk to your patients and listen. It’s important they feel you care about why they are seeing you. Don’t just be a good sonographer, be a great one. Your patients deserve it. Good luck in your ultrasound career where education and the opportunities to learn are endless.  We never know it all so keep challenging yourself!

Comments: 1 Comment »

Posted on March 31st, 2014 by wombwithaviewblog.com

I commonly get questions about the report as I pull up this page on the monitor when I am revealing Baby’s weight after taking a biometry (that is, the measurements of Baby’s head, belly and femur).  Patients usually want to know why the measurements I took differ from the current gestational age.  The fact is they can..this is not an exact science so even a difference of a week can be totally normal.  Sometimes, a large difference can simply reflect a dating issue, meaning you are either farther or less along than you thought.  Your doctor knows how to differentiate between the two.

Check out part of the report below.  This is an old exam on a Baby B who was growing just fine!

SONY DSC

First, notice GA.  This is the Gestational Age of Mom currently.  EDD of 8/15/2007 is the Estimated Due Date determined earlier in the pregnancy which corresponds with the GA.

Below that, you’ll see AUA or Actual Ultrasound Age.    It says 19w3d, a couple of days farther along.  This is merely an average of all four measurements taken and is considered consistent with GA, meaning her due date will stay the same.

The biometry consists of the BPD (width of the fetal head), HC (head circumference), AC (abdominal circumference) and FL (femur length).  The names in parentheses refer to the physicians whose charts for these measurements are programmed into the software.  The values are taken in centimeters and each one represents a GA based on that measurement.  You can see that the BPD measured 8d larger.  This is totally normal.  All the other measurements were pretty close to GA within a couple of days.  Again, these all demonstrate normal growth.

Below the dimensions you’ll see EFW or Estimated Fetal Weight calculated in grams with a small standard deviation and also displayed in ounces.  This is determined by the four above measurements entered into the system by the sonographer.

Below that are ratios of these measurements.  If baby isn’t growing properly, it will reflect here but we will also see that in the individual measurements.

Below that is an M-Mode or Motion Mode which demonstrates the fetal heart rate (HR) taken.  120 – 160bpm or beats/minute is totally normal.

This is only a small portion of a report on twins but enough to explain Biometry.  This concludes Ultrasound 101.

Have a great day, people!

Comments: 1 Comment »

Posted on March 29th, 2014 by wombwithaviewblog.com

I thought this title was a very appropriate follow-up to yesterday’s post!  Not only is there sometimes a crowd in the uterus but also in the ultrasound examination room.  While this is an exciting time for the couple, it has become very much like a reunion where hoards of family show up for the occasion and actually expect to all pile into the room for the spectacle.  This is not okay.  You see, I LOVE the diagnostic, puzzle-piecing together of each examination.  The finding of pathology..how it presents..how I can learn from that.  The entertainment part of it..not so much..but it comes with the territory.

Over the years, as ultrasound has become more commonplace as an important diagnostic tool for the obstetrician, so people in general come to have expectations about these visits.  It has always been and will always be, first, a medical examination.  I am looking for abnormalities in or around your baby.  Occasionally, I find them.  This is the goal of my job and the scope of the practice of ultrasound.  When this is your first baby or if you’ve never experienced a fetal abnormality in the past, patients seem to be oblivious to the possibility of such findings.

If you bring your parents, grandparents, in-laws, siblings, cousins, aunts and uncles and all your nieces and nephews of all ages with carriers and strollers, expect to leave them outside.  Examination rooms are usually quite small and we need some quiet and concentration here.  We cannot focus on your baby and the task at hand with random loud chatter, jokes and laughter from the peanut gallery; people breathing down our necks and talking in our ears; a multitude of fingers pointing at the monitor; twenty questions of “what is that dark space up there” (one of a hundred dark spaces and I’m expected to point to the monitor until I find the area in question); the ringing and text alerts of ten cell phones and family carrying on their own conversations about everything from what they saw on TV last night to neighborhood gossip to what everyone wants for dinner.  This is exactly what happens when so many are present…distracting, to say the least.  But we know they are simply there for the fun and excitement of having a new baby in the family.  We understand this which is why we do business first and party later.

So, typically, I will take the patient and one person back first.  Do the important medical stuff.  I love to point out parts of Baby as we go along (without the help of random family fingers on my monitor) and patients usually desire and appreciate this narration.  When diagnostics are complete, I’ll allow family in and then do a once-over on Baby, pointing out all the cutesy parts I can find like little piggies, a cute profile and gender.  This is usually all they want, anyway!

So, when it’s your turn for an ultrasound, bring your spouse and mom if you want but lie to everyone else.  Tell them it isn’t allowed.  They can see pictures later.  It’s sometimes a pretty funny sight, though.  Once the exam is over, after being packed in there like sardines, I’ll open the door and all the family comes spilling out into the hallway like mimes or clowns pouring out of a VW bug.

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Posted on March 28th, 2014 by wombwithaviewblog.com

Is three company or is it a crowd?  I think when we are talking a uterus, crowded..definitely crowded.  Granted, they may start out with lots of wiggle room but space is a hot commodity by the end.

I scanned first trimester triplets the other day and couldn’t help feeling this woman has no idea what she is in for.  I know twins can be a quite difficult pregnancy so imagining three in the third trimester and as newborns is completely unfathomable.  They were IVF babies; two were implanted.  Go figure one of them would morph into two!  They were thrilled..and scared.

We really only scan anything beyond twins in the first trimester and then refer them out to the perinatologist for management of the rest of the pregnancy.  An ultrasound exam is quite easy early on.  My job is to determine how many babies are seen, how many main sacs (chorions) exist and how many amnions.  If two babies share a space, then it is important to try to discern a separating membrane between them.  We also measure each one for size and document normal heart rates and yolk sacs.

You can google images of triplets by ultrasound. I don’t personally have any to share!

I’m sure this couple I met is wondering how in the world they are going to get through the next several months, much less provide for three babies at the same time.  It’s like I always say, our babies come to us when they are ready..not necessarily when we are.  Sometimes they need a little company coming into this great big world.  Many families have done this before them; all of you with three buns in the oven will find a way, too.  There always seems to be enough love to go around.

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Posted on March 20th, 2014 by wombwithaviewblog.com

..is not something I always hear.  Don’t get me wrong!  Plenty of my patients are thoughtful enough to spout these words of gratitude (which I SO appreciate!) and it’s not like I HAVE to hear it from every patient!  ..but some people need manners…and a bath.

There are some patients about whose upbringing I have to wonder.  I think anyone who deals with the general public on a daily basis feels the same.  When someone helps you, you thank them.  When you go out in public, especially to your doctor’s office, you put on decent clothing.  Most people don’t wear attire in which they are more out than in.  You typically bathe daily, make an effort to brush your hair and, especially, your teeth.  Some people missed out on these very pertinent lessons somewhere along the way. For example, I am in the middle of scanning a young patient today.  I get a knock at the door.  Honey Boo Boo’s family walks in.  Joy.  Well, it was only two people but I am assuming it was the sister and the BF/FOB.  He says nothing…the entire time.  The sister yammers on (barely recognizable as English) about some family garbage.  They barely acknowledge the ultrasound and moving fetus at all.

I just wanted to ask if their mother never taught them any manners..or personal hygiene.

People can have kids left and right but raising them properly takes time, effort, lots of love and discipline.  If our children are going to grow up to be responsible and respectful young adults, teaching them manners should also be at the top of that list.  My kids knew how to say “thank you” before 2 and, thankfully, grew out of the stinky “I don’t want to use soap” phase a couple of years later.

Rude and smelly people are not my cup of tea.  Thank heavens for Febreze Air Effects (linen & sky – it’s my fave).

 

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Posted on March 15th, 2014 by wombwithaviewblog.com

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

I am asked several times per week, “Now how accurate is this weight?”  Are we always right on with birthweight?  No.  Are we always close?  Another no.  But MOST of the time, we are.  It is an educated guess and based only on the measurements WE take and there are many variables that play into obtaining those properly.  As baby gets closer to the EDD (Estimated Date of Confinement – don’t ya love that acronym??!  So appropriate!), Baby gets bigger, the head becomes more engaged and the fluid can start to diminish a bit.  There is only one right way to measure Baby and all of these things make her harder to see and these measurements more difficult to obtain, especially depending on Baby’s position.

Also, Baby is packing it on in the last month!  Average growth is about 1/2lb per week!  If you’re baby is trending heavier, Baby will usually gain more than the 1/2lb and if trending smaller, then less than 1/2lb per wk.  This is why when a patient comes in at 32wks and asks how much I think her baby will weigh at birth, I always say “If I could predict that, I could have retired a long time ago!”  Sadly enough, we don’t use a crystal ball.  Sometimes babies grow in spurts, too.  We might see a huge head at 30wks and a few weeks later see that everything else caught up.  So…..NO WAY to predict!

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

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

Here’s to a fat and happy fetus!

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

Thanks for reading,

wwavblogger 🙂

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Posted on March 14th, 2014 by wombwithaviewblog.com

Or maybe not..especially if your physician’s office has a “no video recording” policy in his/her practice.  Let me just say I catch lots of flack for this!  It’s me who has to enforce it and me who has to hear it when I do.  In this day and age of technological advances where you can pretty much do all things in life, necessary and not, with a smartphone, patients and family automatically whip out that phone and start setting those video options about the time they step foot into my room.

Then I have to be the bad guy.  “I’m sorry, you can’t record.”  Holy cow.  The world stops spinning.  Mouths drop.  Chests puff up.  Attitudes ensue.  I immediately get hit with the following:

“Why not?”

“It’s MY baby!”

“Whose rule is this?”

“Well, the doctor is not in here right now.”

” I want to talk to your manager.”

“They just want you to pay for pictures.”

“This sucks!”

Suck, though it may, if it’s office policy, you don’t really have  a choice but to oblige or step out.  My co-worker has a problem enforcing this law of the land.  She hates confrontation and is always afraid a patient is going to come flying over the table and hold a knife to her throat.  I, on the other hand, don’t really care.  It’s not my rule!  That usually is my first reply.

Then I go into my spiel.  “First and foremost, this is a medical diagnostic exam.  They legally own it.  Yes, it’s YOUR baby but it’s THEIR practice, their machine, I am their employee and this is a service THEY are providing for you.  You can ask your doctor in the room if you can record the heartbeat but I can’t let you in here.”

If someone refuses to put the phone away, I can stop scanning and ask him to leave the room.  I can call for back-up if he refuses…the office manager (you don’t want me to do this).  Finally, I can Tarzan-call the Video Mafia who will drop out of the ceiling and capture the trouble-maker with a fish net.  I haven’t had to resort to such theatrics yet.  It’s simply a matter of time 🙂

 

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Posted on March 7th, 2014 by wombwithaviewblog.com

So, what do you do when a patient freaks out?  I don’t get it, really.  Who in their right minds yell, scream, stomp feet and curse their OB staff?  Really?  These are the people who are taking care of you in your pregnancy.  These people work with your doc to bring a healthy baby into this world for you.  Moreover, these are the people you have to put your feet in stirrups for..they stick you with needles and shove all kinds of instruments into your nether regions and you are going to tick them off?  Our staff is the utmost in professional to everyone, bitch or not, but  you win more bees with honey.  I’m just sayin’.

Practices, like many other offices, rely on computers to manage all their scheduling.  But humans operate computers.  So you are bound to encounter computer-generated human error somewhere at some point in your lifetime.  Does this mean you should go off the deep end?  When this happens, we truly bend over backwards to try to accommodate a patient’s needs.  Truly.  That means we’ll do whatever we have to do to make it right..stay late, work during lunch or squeeze her between two other appointments.  Alas, we work on a schedule (even though we all know how that schedule can go awry in a doctor’s office) and most of us have a life outside of the office that demands our presence, especially when we have kids and families and pets of our own.  So, sometimes we’re limited…our schedules are booked, her doc isn’t here, the sonographer can’t stay.  It’s life.

There is a saying in management among doctors’ office administration..patients are the lifeblood of the practice.  So, of course, without patients, there is no practice.  However, anyone who works with the general public KNOWS that you just can’t please all people.  That is to say, some people are not EVER pleased, ALL of which who also have absolutely no personal accountability.  These are the ones that I’d like to boot right out the front door..pregnant or not.  Good thing it isn’t my practice, I guess!

So what happens when patients are late?  And I don’t mean two minutes late; I’m talking the more than 15 minutes, or 25 or 40 or 1 1/2hrs late.  Their appointments get cancelled or rescheduled to a different time or day.  This is the only option.  Is it fair to boot the person on the table or the one who showed up on time?  Not gonna happen.  Late, late, late with no phone call, explanation or apology just late..and horrendously bitchy.  Often times, these patients present with a mouth white with foam and a spinning head that spews forth obscenities like pea soup from Linda Blair.  It’s not a pretty site.

All I can say to any patient with a mouth like Nicki Minaj and a how-dare-you attitude is don’t expect any favors..I won’t have any openings, no cutting into my lunch and I sure won’t be staying late.   You won’t be making any friends here.  If you’re not careful, you may get dismissed from the practice so they never have to deal with you again.  It’s happened.

Remember, it’s good to have friends in GYN places…bees, honey…it may be cliche’ but there’s a reason that saying has been around longer than ultrasound.

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Posted on March 4th, 2014 by wombwithaviewblog.com

Don’t you remember the first time you ever saw your child’s heartbeat by ultrasound?  It was so surreal and pretty amazing, wasn’t it?!  It’s one of the first things a parent asks to see.

Home pregnancy tests these days are so advanced and boast being able to tell you your pregnant from your first missed day.  This may be a great advance in pee tests but all it does is make the mom-to-be want to rush out to her doctor’s office for confirmation.  The problem is most OB docs won’t try to confirm a pregnancy until 6 or sometimes even 8wks.  So, mom has to wait..and wait..and wait.

We’ve talked about heartbeat so many times in previous posts.  I will reiterate here that  too early in the pregnancy, we just can’t see it.  The earliest we can see a heartbeat is about 5w6d from LMP or Last Menstrual Period and then only with the most current and modern technology like the mac daddy I use at work.  The only machine better would be used at MFM, Maternal Fetal Medicine, the high-risk OB office.  If your dates vary even by a day earlier, we will likely not see the flicker of cardiac activity.  Even then, it is discernable but sometimes very difficult to measure for a rate.  Waiting a week makes a world of difference in how well we can see, even better after two.  It’s also much easier to measure the embryo for dating the pregnancy.  For these reasons, you must wait to see your doctor and have your first ultrasound.

A fetal heart rate ranges between 120 – 160 beats per minute or BPM.  As an embryo, it starts out slower, really increases over the next couple of weeks and then levels out to the 120-160 range.  I won’t discuss how slow is too slow or how fast is too fast because it depends on GA (gestational age) and how other things look early on as to whether your doctor is concerned about the rate.  Like I have stated numerous times before, some things sometimes have to be deferred to your physician’s interpretation!

Regardless of when it happens in the pregnancy, seeing Baby’s heartbeat for the first time is still an amazing thing to share with parents, especially when it’s a wanted pregnancy and the waterworks ensue.  It’s hard for ME to choke them back, specifically on occasion when you know it’s IVF or this patient has long struggled with infertility.  It’s a really special event to witness..sniff, sniff.  (Note to other sonographers..keep a box of tissues handy!)

 

 

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Posted on March 1st, 2014 by wombwithaviewblog.com

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

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

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

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

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

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

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

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

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

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

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

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

 

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Posted on February 27th, 2014 by wombwithaviewblog.com

So, I wrote this post about two years ago as one of my firsts.  It’s worth addressing again.  Now that I have a few regular readers and since most of you are pregnant, it’s definitely worth repeating!

Basically, you have questions..some we (sonographers) can answer and some we just can’t!

***

Probably, the most frequent question I get asked is if everything looks okay, healthy, normal, etc.  Wow, if I had a dollar for every time I’ve heard this I could retire by now!!  Usually to the patient’s dismay, this is something NO SONOGRAPHER can ever tell you.  Firstly, not everything that is abnormal can be seen by ultrasound (some chromosomal abnormalities, for example).  No sonographer can ever say that a fetus has Down Syndrome simply by an ultrasound examination alone.  Yes, we look for red flags; occasionally, we see them; sometimes we don’t.  However, other tests have to be done to confirm such.  If you’ve ever been pregnant, you know there are a multitude of tests that your doctor will request at certain times in your pregnancy depending on what the two of you have discussed.

Secondly, only your physician, his/her nurse or doc on call in his/her absence has the legal right to give you these results.  Yes, it is my job to know what I am seeing and to know if something does not appear structurally normal.  That is the scope of my job..to find abnormalities and report them to your doctor.  I have to be able to answer his/her questions about what I am seeing, questioning or diagnosing and how other parts of your baby are functioning in light of the finding.  It’s a big piece of your pregnancy puzzle that helps your doctor determine how your pregnancy needs to be managed.

Regardless of whether it is something relatively insignificant that we see or seriously abnormal, it is NEVER our place to inform you of these findings.  Our job is to share this information or any suspicions with your doctor, your doctor examines the information and concludes whether he or she agrees with our findings and your doctor then shares his/her interpretation of the information with you along with what options he/she recommends next.

The reason it is done this way is because

a) sonographers are not physicians; your doctor went to school for many years to learn how to manage your pregnancy and care and

b) your doctor is the only person who is truly qualified to answer the plethora of ensuing questions when a problem IS suspected.

Finally, you have to remember that it is your physician with whom you have the personal relationship.  Your doctor cares for you and your unborn child and your doctor wants to be the person to break any news to you, console you and inform you.  Occasionally, I will have a persistent patient or spouse who will say, “Yeah, but you KNOW whether you see something really wrong or not.”  I’ll admit that I do but I always defer to the physician’s interpretation.  I know it is simply parent anxiety and a lack of understanding of proper medical protocol that drives the questions.  For the nervous patient, it does sometimes feel like an eternity waiting for results.  My usual response when a patient has asked this question is “Your doctor has to look at all of these images and he/she will discuss your ultrasound when you see him/her next.”

Only your doctor can advise you, calm your fears and reassure you about your pregnancy in a way that no one else can!

***

As always, feel free to ask me your questions!  If it pertains to the scope of my job, I’ll be happy to answer.  If it’s a question your doc needs to answer, you can be sure I’ll defer to your physician!

Happy pregnancies to you all 🙂

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Posted on February 20th, 2014 by wombwithaviewblog.com

This is a first trimester screening test for chromosomal abnormalities which I have performed for a couple of years now.  We have to have special certification in order to perform this examination.  I will not get into any serious depth regarding the subject because I am not a doctor, I am not YOUR doctor, this testing is quite complicated and only your doctor can give you the most pertinent, accurate and up-to-date information, as well as, answer all your questions on the subject!  I CANNOT STRESS THIS LAST STATEMENT ENOUGH!!!  I literally am only scratching the surface here from an ultrasound standpoint.

Read on for this question from a reader regarding NT scans:

reader:  I just read about NT scans and how they can be a way to detect Down syndrome. My doctor never mentioned anything about this to me. Do you think it was done during my 12 week dating ultrasound? Or is this something that you need to specifically request? I’m 29 and have no family history so I’m not sure if that’s why it wasn’t offered. After my 12 week ultrasound she did offer other tests but she said I wasn’t high risk and we opted not to do them.  Thank you for your time!

wwavb:  I can chime in on this because I do the NT scan so I know a bit about them.  You answered your own question.  The tests that your doctor talked to you about may have included the NT scan but you opted not to do them, so that’s why you didn’t have it.

The NT scan is an attempt at a measurement of the nuchal area along with a finger stick.  The measurement cannot always be obtained.  It is probably one of the most tedious examinations I do and this measurement can only be taken one way.  Period.  There are a number of variables which depend mostly on fetal position that dictate this.  If we can’t get the measurement, the test cannot be performed.  The lab takes the measurement from the scan and some numerical values from your blood and personal history and puts that all into a formula.  The result determines your RISK or CHANCES for having a baby with four different chromosomal abnormalities, of which Down Syndrome is one.  This result does NOT tell you whether your baby has these abnormalities or not, only your risk for having a baby with this problem.  If it comes back elevated, you have to decide whether you want to proceed with other tests like amniocentesis which WILL determine if your baby has a particular one of these abnormalities.
For your greatest clarity, you should ask your doctor at your next visit if the NT is something she would have offered.  If you have a concern and would like to look into genetic testing, certainly discuss with your doctor what options she would recommend for you.  She is your best educator!!  
Hope that helped!
Here’s to your happy and healthy pregnancies!

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Posted on February 7th, 2014 by wombwithaviewblog.com

No kidding..  A patient requested her anatomy screen examination be cancelled because she went to a facility where students practiced on her and they already did the scan so she didn’t need to have it done a second time.  Huh?

Um, no.  When you have an ultrasound done, it’s because the examination was ordered by your physician and whomever is doing your exam must have in possession a written order or, if in the same facility, see the order in writing in the patient’s chart.  No order, no exam.  Yes, students practice and that’s ok.  Actually, they shouldn’t practice unless they have written permission by your physician but that isn’t carved in stone..just my opinion.  If I was running an ultrasound education program, it’s something I would require.  If I was a pregnant patient and students were going to practice on me and my baby for an hour or two, I’d want to make sure my doctor was ok with that.  I’ve never heard of them NOT being ok with that, but as your care provider, your doctor probably would like to know about it.

A student or many students practicing on your belly does not a formal and official scan make..by any stretch of the imagination.  And why in the world would someone think such?  I have no clue.  I decided to quit trying to figure out what patients are thinking a long time ago.  Students are still struggling to make heads or tails of your fetus, don’t know the function of half of the buttons on the machine and have no idea how to measure something..anything on their own.  One would think that would be obvious to the person being scanned..maybe not.

Anyhow, I’m sure most of my readers will know that your doctor will want a report of your ultrasound from the qualified and experienced facility from where or person from whom he/she ordered it to be performed.  I’m just guessing, but he /she PROBABLY wouldn’t want it signed by so-and-so, sonographer-to-be in several short months if my grades are good.  Just saying.

P.S.  Sarcasm has been a family trait passed down from many generations so, though I try to stifle it, it still manages to come seeping through even my written word;)

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Posted on February 1st, 2014 by wombwithaviewblog.com

I simply HAVE to give a shout out to my VERY FIRST subscriber overseas!!  You know who you are:)  I’m so happy to know my message of quality sonography is as far-reaching as the UK, a beautiful land with some of the most amazing vistas for the photographer in me (I don’t just enjoy getting a great shot of Baby) and totally on my bucket list!

I will continue to do my best to post informative as well as fun and humorous facts and pics from the world of OB/GYN sonography as I know it.

A fun little fact from overseas:  I once received a report from a patient who transferred her OB care from London.  Did any of you know they call amniotic fluid “liquor”?  Interesting!

“The more that you read, the more things you will know. The more that you learn, the more places you’ll go.”
― Dr. SeussI Can Read With My Eyes Shut!

Until next time..

wwavblogger

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Posted on January 25th, 2014 by wombwithaviewblog.com

A lot of people get confused by this and I have to admit, early on in ultrasound training so was I.  LMP or last menstrual period is used to determine how far along you might be.  So the first day of your cycle that you started your period is Day 1 and most people get pregnant about mid-cycle, around Day 14.

However, when calculating gestational age, all calculations are measured by LMP.  We know you didn’t really get pregnant until about 2wks later and you may wonder why those two weeks are counted before you were ever pregnant.  It’s just because that’s how it’s always been done.  Way back in OB provider history, no one knew when they actually became pregnant.  All they could go by was the first day of your cycle, so then all types of charts and equipment were made and calibrated for such.  Over the years, it was just never changed to adapt to time of conception and people tend to conceive at different times anyway.  There are not many out there who know the exact day of conception (unless they had some help with IVF, etc.).

So, if the first day of your last period was December 1, you would be considered about 7w3d by gestational age today.  And if your dates are consistent with what we see by ultrasound at that time, we would see an embryo that measured about 7w3d +/- a few days.

That’s my ultrasound lesson for the day:)

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Posted on January 23rd, 2014 by wombwithaviewblog.com

So let’s go way back to right before you found out you were pregnant.  A couple of weeks before your baby started developing, you ovulated.  Most people have a huge misconception about ovulation, ovarian cysts and how your ovaries really function.  Every month your ovary makes a cyst that ruptures and releases the egg..yep, that’s ovulation.

Your LMP (Last Menstrual Period) refers to the first day of your last period.  This is Day 1 of your menstrual cycle.

We also know that most women ovulate between Days 10 and 14.  Some people have over-achievers for ovaries and ovulate sooner; some have late-bloomers and ovulate later.

Everyone starts out with a bunch of follicles (little fluid-filled sacs) on the ovaries.  Each follicle contains an egg.

At some point early in your cycle, one of the follicles starts to get bigger and bigger and ruptures sometime mid-cycle.

Sometimes we feel mid-cycle pain (sometimes resulting in an ER visit) when the cyst ruptures, most times not.

Most of you who stayed awake during 7th grade Health education class have known the rest of the story for quite some time.  The egg travels through the tube and into the uterus.  If sperm is there to fertilize it, great!  I’m in business.  If not, Tampax is and two weeks later you have your period.

I just thought a little clarification was in order because every week people seem surprised to have a cyst on the ovary.  They equate it to something bad.  Although the ovary can make bad things like any other organ in the body, creating a functional cyst is simply a monthly event for most people.  And if your extra special, your ovaries might even make TWO per month.  If you’re one of these special people, you’re also one that probably needed TWO of everything at your baby shower;)

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Posted on January 22nd, 2014 by wombwithaviewblog.com

I get these questions several times a week:

“Can you see the cord?” or “Is the cord around the baby’s neck?”

A nuchal cord is when the cord is looped around baby’s neck one or more times.  It’s a scary thing for most patients because, unfortunately, all we hear are the bad outcomes of nuchal cords and rarely the ones where it was looped but baby was fine.  The honest truth is that we cannot see the entire length of cord later in the pregnancy.  We see segments or loops of it at a time.  Sometimes we can see it around the neck but sometimes we can’t even see baby’s neck well to say whether it is looped or not.  The other truth is that even if it is looped, especially early in the pregnancy, it doesn’t mean a thing.  Babies get looped and unlooped all the time.  Usually if it is going to be a problem, it is something they can determine when you are in labor, when they are monitoring baby’s heart rate.  For example, my older daughter had a nuchal cord x 3 when she was born but was never in distress.  We had no clue!  She was just determined to come into this world.

If the cord is looped twice, if it is tight, if you are near a safe delivery time and if we feel baby is compromised or restricted by what we are seeing, your doctor would want to know.  This is exceedingly rare and I can tell you that I’ve seen it be a problem MAYBE three times in my whole career.

In other words, it’s one of those things you can’t worry about!!!  It’s just like getting on an airplane or walking across a busy street..of course, a risk is there but how remote is it?  You wouldn’t want to give up that trip to Europe, would you??!  Eyes on the prize, ladies, eyes on the prize..  That sweet bouncing baby will be here before you know it and ignorance, to a certain extent, is most definitely BLISS!

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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 January 12th, 2014 by wombwithaviewblog.com

As promised, a more light-hearted (and even comical, if I do say so myself) post!  I’m going to give you a little test.  What do you see below??

 

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Did you say a smiley face??  If so, you are entirely wrong!  BUT you are among hundreds who have guessed the same.  I cannot tell you how many people have asked, young and old alike, if we were looking at baby’s face or if baby was smiling.  Do our faces really look like this??  I always ask this of myself, to myself when anyone asks this question but then I remember that they can’t read ultrasound and to the lay person it really is like looking at clouds.  You can make all sorts of crazy things out of the images passing by on the monitor.  That’s why you have me, the narrator, to point out what you are REALLY seeing.

This is a cross-section of the fetal abdomen.  Imagine chopping down a tree and looking down at the trunk..it’s a circle, right?  Same thing here.  On the left is baby’s spine, on the right is the front of baby’s belly.  See my image below for an annotation of all these structures!

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ivc = inferior vena cava or main vein in the torso

ao = aorta or main artery in the torso

gb = gallbladder

uv = umbilical vein – we are only seeing a tiny segment of that vessel in the image.

stomach – self-explanatory!  When baby swallows amniotic fluid, the stomach becomes more distended and shows as black like the amniotic fluid is black.  Sometimes, patients will ask, “What is that hole?”  It’s funny how we associate black spots as holes and they are always surprised when I say that it’s not a hole and it’s actually a stomach that is full!

Anything fluid on ultrasound is black, so the blood vessels appear black, as well.  In the gallbladder, you have bile (a fluid) so it presents as black, too.  The other organ that is present in the image is the liver.  It is difficult to outline the liver but it is the gray stuff above and below the gallbladder and above the stomach.

 

Unbelievable question of the century??  “What is an abdomen?”  No, I’m sure in the heck not kidding.  I’ve gotten this question only a few times but each time it came from some teen or young adult (who should have known better) and each time I’m totally flabbergasted.  Slept through biology, maybe?  There’s your good laugh for the day.

So, next time you go for a diagnostic ultrasound, providing you are in your second trimester and beyond, look for the “smiley face” when your sonographer measures your baby’s abdominal circumference (AC)!

Hope you enjoyed Ultrasound 101 today!

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Posted on January 11th, 2014 by wombwithaviewblog.com

So, a question I get asked frequently is “You have such a fun job, don’t you?”  They’re always surprised when I say, “No, not always”..until I explain why.

A really very unfortunate circumstance of pregnancy is the sometimes displaced or ectopic one.  This just means that the pregnancy is located somewhere other than where it is supposed to be which is within the uterine lining near the top of the uterus.  If a patient has pain early on in a pregnancy, and we can’t see evidence of a pregnancy (at least a gestational sac) inside the uterus and we think we should by calculating LMP (last menstrual period) along with blood values, we start to look for an ectopic.  This is a gray zone because too early, we just can’t see it.  These patients are watched very carefully with blood work and extra ultrasounds until we’ve proven one is there.  Physicians want these patients treated as soon as possible because they can pose a health risk for mom.

Most of the time these pregnancies present as a mass somewhere outside of uterus, usually in the tube between the uterus and ovary.  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 are challenging scans that definitely put one’s ultrasound ability and expertise to the test and helps to know that your sonographer is a seasoned veteran!  It’s okay for a newly certified sonographer to scan you, this is how one learns pathology and how to scan well.  We all started somewhere.  BUT she NEEDS direct supervision while doing so..by another seasoned vet!!!!  (This comment is made in the hopes that any new sonographer will read this and heed the information!!)

So, some of the time, great fun. Other times, very much not.  About once a week or so, sad.  Every day, educational in some way, shape or form.

Today, you get an informative post, though a bummer it is.  Tomorrow, something fun.  I promise!

 

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Posted on January 10th, 2014 by wombwithaviewblog.com

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

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

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Posted on January 4th, 2014 by wombwithaviewblog.com

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

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

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

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

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Posted on January 1st, 2014 by wombwithaviewblog.com

Happy 2014 to all my readers and moms-to-be everywhere in this new year!

May your pregnancies be joyful and healthy and lives full with bouncing babies.

Thank you for reading, subscribing and contributing to my blog.

Here’s hoping for a fruitful year ahead with resolutions to all your ultrasound queries!

SONY DSC

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Posted on December 31st, 2013 by wombwithaviewblog.com

As promised..I’ll explain Biophysical Profiles today (as known about the OB office, BPPs for short).  So, pretty frequently we’ll get hit up by one of the nurses with “Can you squeeze in a BPP?”  Our answer is always “Of course, we can..” ..because BPPs are the kind of exam that our docs need that day.  If we can’t do it, the patient has to go to the hospital to have it done.  And why in the world would anybody want to go to the hospital when they can have it done more conveniently (and better, if I do say so myself) in our office.

If a patient comes in complaining of decreased fetal movement in the third trimester, you’re almost guaranteed to have one of these ordered.  We also schedule them weekly after about 32wks for patients who have gestational diabetes, hypertension or a myriad of other maternal or fetal conditions that need to be monitored.  It’s basically an assessment of fetal well-being.  So, if baby is moving and growing and fluid is good, all is well with the uterine world for another week.

So, let’s get technical.  We give baby a score on his/her movements and amniotic fluid.  The maximum score I can give is an 8/8, a 2 for each of the 4 things we look for.  Baby has to demonstrate the following:

  • 3 movements of the torso
  • 1 episode of flexion/extension of the hands or limbs
  • diaphragm movements (or what we call fetal breathing movements) lasting 30 seconds.  The breathing movements only mimic real breathing and it’s something they do every once in a while…it’s only practice!  Ask your sonographer to show you..it’s really cool to watch:)
  • AFI, which I talked about yesterday.  If baby has enough fluid, we give a 2 for that.

 

It’s not uncommon for baby to not perform the breathing movements.  We see it all the time and it doesn’t mean baby isn’t doing well.  If all else is good, it just means we have to give baby a 6/8 instead and sometimes your doctor will do an NST or Non-Stress Test in addition to the BPP.  The NST means you have to sit with a monitor around your belly and press a button every time baby moves.  A strip will print out a tracing of baby’s heart rate and your doctor will evaluate it.  If good, baby gets an 8/10.  If the tracing is not to your doctor’s liking, it usually means a trip to L&D for extra monitoring.

That’s BPPs in a nutshell.  Now if you need one, you kinda know what’s going on!

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Posted on December 19th, 2013 by wombwithaviewblog.com

Yes, it should be a thing..a short briefing by your physician, maybe.  For some, an entire class devoted to the subject would be necessary.  And signs don’t do the trick.  I feel it’s coming to the point in my job where I have to run through the whole list of things that need to take place before I start an exam, like a flight attendant.  “Turn it off.  No, really, turn it off.  Really.”  Between the plethora of cell phone text beeps, email pings, call ringtones and tablet games, does anyone feel my pain when I say I need to focus?  Don’t even get me started on all the family members and friends who carry on their own conversations through the ENTIRE exam, especially when they talk over me.  Dads or Grandmas correcting children or reading stories or playing googoo-gaga with them t h r o u g h o u t  t h e  e n t i r e  e x a m.  For as long as I’ve done this, I still have come up with no real good way of telling visitors to shut their traps.  For the life of me, I don’t get why some people think the ultrasound is merely showtime.  What we do requires a great deal of concentration.  It also takes us longer to complete your exam when we are distracted.  Distracted, in my job, is not a good thing.  I understand the excitement and some of that is great as we say our hellos and get settled in the room but I feel when probe touches belly, silence should be automatic. Momma and baby come first, right?

So, please, readers..do your sonographer a favor and next time you have an ultrasound exam and you have a bunch of yammering friends with you, can you please be the one to pipe up and ask them to button up?  Pass it along!  If every patient I have would do that for me, it would be the greatest Christmas present ever.  Or maybe I just need a handy roll of duct tape.

‘Til next time!

 

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Posted on December 15th, 2013 by wombwithaviewblog.com

Patients are confused by the need (or not) of a full bladder for ultrasound.  As a general rule, having a little fluid in the bladder for your mid-pregnancy scan aids a little in evaluation of the cervix; a length of the cervix is what we measure. However, later in the pregnancy, especially after we have determined that your placenta is in a good place, having a full bladder is not necessary and only makes you miserable.  Early in pregnancy or if the patient is not pregnant, an empty bladder is necessary for the transvaginal ultrasound.

For a non-pregnant and non-sexually active patient, a full-bladder prep is required in order to see the organs.  The uterus lies behind the bladder and since sound waves penetrate easily through water, having the full bladder sort of acts as a window to the uterus and ovaries.  It’s still somewhat limited because abdominally the organs are much farther from the probe.  We usually get a much better resolution with TV (transvaginal imaging) because the probe is much closer to the organs with an internal scan, providing a more magnified view.  Having a full bladder with this approach only gets in the way.

Every office or hospital has a different protocol.  Some will have you fill your bladder, scan that way first, then empty for a TV scan, also.  Usually, pregnant or not, your doctor may want a urine sample if you are seeing him/her that day.

Best advice?  Ask about a bladder prep when you are making your ultrasound appointment and ask when you arrive if a sample is needed or if you can empty.  Every once in a while someone gets it wrong and then you’ve peed when you needed to hold it or you drank 400 ounces of water and you didn’t have to or you didn’t get a prep at all and now you have to be rescheduled.  It’s a bummer.  We’re all human and we hate when it happens!

When in doubt, ask if you are free to pee!

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Posted on December 9th, 2013 by wombwithaviewblog.com

So below is an email from someone who paid for an elective scan at some ultrasound drive-through (these should be prohibited by state and federal law, in my personal and professional opinion).  She was only 16weeks!  Even though it is not impossible on every 16 weeker, it is difficult on most that age so my best advice for patients is to just wait for the sake of accuracy.  Read why below!

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

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wwavb:  Thanks for reading my blog and your question!  First of all, and this is just my professional opinion, no one should be offering gender determination scans at 16wks. She’s absolutely right..it is early so it would have been better to explain that first and then recommend you wait a couple of weeks more for the best chance of determination.  No one can guarantee gender 100% at any gestational age (NOTHING in medicine is 100%) and especially not at 16wks. It’s not that you can’t ever make a determination at 16wks, but it’s definitely harder then than at 20 or 22wks. I never give percentages.  Either I can tell or I can’t.  No guessing!  When a patient asks me to guess I always say, “Do you want me to guess or do you want me to be right???”

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

SOOOOO…buy pink if you want and keep the receipts and hold off on painting a nursery!!  Feel free to email me an image of your next scan if you wish!  Hope this helped!

 

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Posted on December 3rd, 2013 by wombwithaviewblog.com

Don’t you hate it, pregnant readers (I don’t really know what other readers I’ve got), when random people of family or friends ask you if you are feeling baby yet?  ..and you say ‘No, not really’ ..and they scare the living daylights out of you with a reaction of total terror and a panic-stricken look on their faces? ..oh, and I forgot to mention, you’re only like 16wks.  Now, I can’t condone violence or anything but you can politely remind them to mind their own business with whatever expletive you’d like to add.  It’s your right as a pregnant person (in my opinion)!

I’m frequently asked that question, “When should I start to feel baby move?”  There is no definite start time as we are all shaped differently so that time varies as much as people do.  It’s a question better posed for your doctor because he/she can give you more specifics on fetal activity and kick counts later on in gestation.  As far as ultrasound is concerned, we see baby jerk and kick and wave around arms and legs but not every second of the scan.  They’ll become very active for a couple of minutes and then become very still and take a little siesta.  The very beginning of fetal movement I can usually see at about 8wks when they look like a little gummy bear and they just start to do the tiniest little wiggle.  It’s the cutest thing!  They get more and more active from there and even just a few weeks later one can see baby doing feats of all kinds of athleticism!

So, you 18 – 20 weekers, if you’re still not sure you are feeling baby, it may be totally normal for you.  As always, if you have any questions WHATSOEVER, always always always (can I stress it enough?) always call your doctor!

And, please refrain from smacking Aunt Jude right between the eyes.

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Posted on November 23rd, 2013 by wombwithaviewblog.com

This one is for sonographers.  I thought initially the patient could read it, also, to understand what it is she should expect from her sonographer.  However, I quickly realized this isn’t something the patient needs to read to understand..it’s something she already expects.  Every patient that walks into your room, regardless of how she reacts to you, EXPECTS to be greeted kindly and with a smile; EXPECTS to be explained in a fully understandable way what kind of examination she can expect to have performed and how it will be performed and whether it will be painful.  She expects conversation..and she deserves it.

Sonographers, you have GOT to get out of the mindset that your only job is to look at that monitor and say nothing else to your patient.  She is human, she has feelings.  Sometimes, she is even scared and anxious about the examination she is going to undergo.  Sometimes, she’s not afraid of the examination but fearful of results.  Sometimes, she’ll even tell you so.  YOU are a provider.  YOU are the master and conductor of the environment in your room at that moment.  You have to remember that the exam you are performing requires “invading” the personal space of another individual and actual contact with that person.  It IS a very personal experience for that patient and, often, a very uncomfortable one.  Your patients are trusting that you will do a good job for them because you are there representing, an extension of, her physician.

You can ask her how she’s feeling today.  If she says ‘Terrible’, you can lend apologies and say you hope her day will be better as soon as this test is over!  Patients often laugh as I’m gelling up the middle finger of a vinyl glove as I slide it down over the vaginal probe.  I always say ‘Gotta have a little comedy in medicine somewhere, right??!’  They’ll ask about your family, pictures, your kids, your experience in your career.  Talking to them during the exam helps most people to just get through it a little more easily.

Don’t be afraid to open a conversation for fear of being asked the question we all cannot answer regarding results.  The best way to respond to this is to simply state ‘Well, my job is to take these measurements and images.  Your doctor will want to examine them along with your other clinical information and then decide how your ultrasound fits into that picture.  Only your doctor has all the pieces of that puzzle!”

For OBs, you just about can’t get through an exam without mom or dad asking ‘Does everything look ok?’  I’ll usually say ‘So far, so good but, you know, your doctor will go over this entire exam with you and you can ask her any questions you have.’  Point out their baby’s parts as you take your images.  Thank the heavens for postprocessing!  You can always go back and focus on things that need special attention after your patient leaves.

On occasion, they’ll say ‘Yeah, but you know what you’re looking at.’  I’ll say ‘Yes, I have to know what I’m seeing to know which measurements to take but it’s your doctor who has to decide what it all means for you.’  Or otherwise explain that her doctor will get a report from the radiologist.  And be knowledgeable regarding how long they’ll have to wait to receive results.  You can bet the farm you’ll get THIS question.

One thing I’ve realized over the years, and anyone who works with the general public would agree, that you can’t make everyone happy all the time.  It’s just impossible.  Some people can’t be made happy.  But when you go out of your way to make conversation with your patient, make her feel comfortable, answer her questions and show her how cute and fat her baby’s cheeks are, it (most of the time) makes for a happier patient.

It feels good to get a warm ‘Thank you’ as you walk your patient out.  If you can send her out with a good chuckle, even better:)

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Posted on November 19th, 2013 by wombwithaviewblog.com

All patients ~  your ultrasound, sonogram (same thing) should not be painful!  Regardless of whether you are having a transvaginal scan or an abdominal one, it should never really hurt.  Now sometimes a patient may come in with some pelvic pain already.  That may even be the reason for the ultrasound to begin with (mostly in non-pregnant patients).  In this case, it may be uncomfortable but should never be painful.  I always tell my patients to be sure and let me know if something is.  Patients tend to NOT want to say anything.  They want to tough it out.  They fear they will not get an adequate exam if they say something.  Your sonographer wants to know and NEEDS to know if something is hurting you too much.

I will say that we tend to get quite focused on the task at hand which is to find that oftentimes ever-elusive ovary or to obtain that perfect measurement.  I’m very technical so I often strive for perfection personally..yes, that’s good but it sometimes causes me to take a bit more time than I really should, fighting to obtain that just-right view, when really in the whole scheme of things it doesn’t really contribute significantly pertinent information.  It’s true to some degree that the harder we push, the better image we obtain..for some things.  The novice tends to forget there’s a human under that probe!  She is so concentrated on the monitor and overwhelmed by all the lighted buttons and sticking to exam protocol that she forgets to ease up on the pressure.  Most of us have experienced this at one time or another.  There is a loooonnng learning curve to peforming ultrasound properly.  It takes time, a lot of experience and a lot of supervision.  A sonographer cannot learn to scan well if he/she is not TAUGHT to scan well.

So, next time you have a vaginal scan performed and you feel like your sonographer has perforated your uterus, SAY SOMETHING!  Tell her she’s pushing too hard and to please ease off.  Ultrasound people, if you can’t obtain your images without killing your patient in the process, you’re not doing your job properly.  Like I always say, we don’t have to scan your tonsils!

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Posted on June 21st, 2013 by wombwithaviewblog.com

Who knows???  We don’t have a crystal ball, right?

Even so, that is a question I get most every week.  If I could determine THAT with any accuracy, I’m sure I could have retired a long time ago!  The only thing ultrasound can really do is a biometry to estimate an approximate weight at present, called an EFW or Estimated Fetal Weight.  We do this by measuring your baby’s head in two dimensions, a circumference of the abdomen and a femur length.  These measurements are converted by the software into grams/pounds and the result has a standard deviation of about +/- 1+lbs in the 3rd trimester..or +/- 1/2 lb if you’re really good;)  All measurements, as all of ultrasound imaging, are extremely technically dependent and can vary quite a bit.  As sonographers, we are trained to know which views provide the most accurate measurements which are universally standard; however, sometimes baby’s position makes it difficult to obtain them adequately.  The EFW really provides just an educated guess since we can’t actually put baby on a scale.

These individual measurements tell your doctor whether baby is growing adequately, not enough or too much.  Either far side of average and you may find yourself getting scheduled for more ultrasounds to follow baby’s growth.  After all, nobody wants to push out a 12-pounder!!

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Posted on March 4th, 2013 by wombwithaviewblog.com

They made it!  Beginning the second trimester is a big deal and it started yesterday.  Everyone has just worked so hard to get to this point..so much growing and developing!  Babies are 12w1d now, fully formed and just have to keep growing from this point.  They really look like babies now and not so much the alien they used to resemble.  Tiny hands and feet are distinctly recognizable now as you can see in the photos below.  Awww!

Some organs can be seen at this point like the stomach as it fills due to baby’s swallowing of the amniotic fluid and the urinary bladder as it becomes more distended due to functioning kidneys.  The stomach and bladder appear as black because fluid shows up black on ultrasound.  The brain can be seen but is still developing at this point and the heart is a beating machine but still too small to see much detail.  All of these things and more will be evaluated around the 18-20wk timeframe or as your doctor orders.

Notice, in the image of the itsy-bitsy bottom of the foot, the scale in centimeters on the right-hand side. The foot measures about 1cm or less than 1/2 an inch right now!

Baby A is showing off today and waving to Mom.  Bye-bye ’til next visit!

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Posted on March 3rd, 2013 by wombwithaviewblog.com

We all know this is the age of technology.  And, no, I’m not talking about ultrasound software, though this technology is ever-amazing and always improving almost as fast as your iPhone.  What in the world, pray tell, can I be referring to but the dreaded cell phone??  I realize almost every person above the age of 6 has a smartphone but do you really have to be on it during an ultrasound exam??  Do you really have to iron out a billing issue with your internet provider right now?  I know people use it to pacify the kids but I’ll be quite frank..THEY don’t need to be in there, either!  If they are at an age or of the mindframe that they need to be kept busy with something else during the exam, they should not have come with you in the first place.  The music and games are loud and provide a terrible distraction for those of us who are trying to work!  We have a job to do..to make sure your baby is normal and this requires concentration.  Little Einsteins squawking in the background makes that a little more difficult to do.  I hate to ask people to mute games or leave with screaming kids but sometimes I just have to do it.

For the love of Pete, please do your sonographer and doc a favor and turn off all electronics during your exam and let grandma take the kids to the waiting room.  Better yet, let grandma babysit them at home.  I love when patients show up with no help, no carrier and baby in arms or with a toddler and no stroller or additional person to take out the screaming toddler because he is pissed to be strapped in and can’t see Mom.  It’s really great when someone shows up with two or more kids and no help.  Really?  Ladies, you’re moms..you juggle and manage a lot of things so please use your common sense when it comes to your medical exams.  We can’t examine your next kid very well while you are trying to discipline your others.

We will not be upset if you reschedule for a time that you have a sitter.  I promise!  We’re moms, too.  My kids didn’t grow up around family, either, so I know what it’s like to need a reliable sitter.  However, at the end of the day, it’s a medical exam and very young children need to stay home.  Please, please, please..just reschedule.

 

 

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Posted on February 17th, 2013 by wombwithaviewblog.com

It’s now Week 9 and the babies have grown a whole centimeter!  That’s a little less than 1/2″ for all  you Americans out there reading this.  Just a little bigger and still in that very gummy bear-looking stage.  You can compare the dimensions between the 1st image and the last post.  Also, note in the second image, that baby is beginning to demonstrate arm and leg buds!  This is very exciting:)  Roll over the images for a brief explanation of them!

9wk fetal ultrasound

 

9wk fetal ultrasound

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Posted on January 29th, 2013 by wombwithaviewblog.com

A day later and these babies are about 6w6d!  Before we ever see an embryo, we see a gestational sac and a yolk sac.  The yolk sac, very basically, provides nutrients for the embryo until the placenta is fully developed.  It looks like a little round circle next to the embryo/fetus.  In the first picture, you see the twins, each in their own sac.  In the next image, you see their yolk sacs, one in each gestational sac.  Things are looking great!

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Posted on January 27th, 2013 by wombwithaviewblog.com

Wow!  So the holidays came and went in a total blur and I’m finally posting again.  On with this pregnancy!  So now we are up to 6weeks and 5days gestation.  You can see that each embryo = 8mm each.  Crazy, huh?  Measure that out on a ruler.  So tiny yet can be seen so easily with the magnification and high frequency of a transvaginal probe.  The heartbeats can very easily be seen at this point.

I had to edit the image a little so as not to confuse the reader but you can see that each fetus, labeled “A” and “B”, are each in their own sacs.  This is called dichorionic meaning that they each came from a separate egg and can be different genders.  In other words, they are fraternal twins.

Aren’t they so cute?  Until next visit..

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Posted on December 16th, 2012 by wombwithaviewblog.com

Since December is celebrated in part by the birth of Christ, let’s focus on another new beginning…the very beginnings of a pregnancy and what we see as sonographers.  It’s quite an amazing transformation from week to week!  We will start at about 5weeks, 5days (5w5d)ere.  We can only estimate because we cannot yet see an embryo.  However, we can see a gestational sac (GS), where the baby grows, and a yolk sac (YS), which provides nutrients for the embryo/fetus until the placenta develops.  The black inside the GS represents fluid.  Until an embryo can be seen and measured, measuring the gestational sac is the only way to estimate gestational age by sonography.

Keep visiting this site for an update on this baby’s growth and development through the first trimester!

Merry Christmas!

 

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Posted on August 17th, 2012 by wombwithaviewblog.com

Sometimes, the answer to that question is a big fat no.  It’s actually a little condescending to us sonographers who always try to give a patient great ultrasound pictures and will usually give MANY images if baby is cooperating so it implies that we are not TRYING to give you great pics.  I know that some sonographers are just downright unfriendly and unhappy in their hospital jobs (prey tell, why?) so I cannot say this is not sometimes the case, unfortunately.  In ultrasound, fetal cooperation IS the name of the game.  If baby doesn’t cooperate, cute pictures simply are not gonna happen.  Especially when baby is facing mom’s back, it then becomes very difficult for me to see the specific organs and structures that I need to document much less to be able to get cute pics of the face.  Because of the way ultrasound works, baby needs to be facing upward toward mom’s belly in order to see the face well.  Usually, if baby is in this position without limbs or the cord in the way, we can typically get some really great shots of the fetal facial profile.  The feet and hands are cute but it is seeing that face that identifies us with another person.  Without this shot, the patient usually leaves feeling a little empty-handed.  Poo.  I hate when this happens.  I usually apologize profusely and just say that their baby simply did not want to cooperate that day.

Also, the one major thing that can hamper images..weight.  I will never say this to a patient when she asks the above question but it is truth.  The more tissue the sound waves have to penetrate, the worse the image will be on the monitor…Ultrasound Physics 101.  So, unfortunately, the more a patient weighs, the less likely it will be that I can get good pictures no matter what position baby is in.  Same for 3D.  We cannot tell a patient who weighs 300lbs that she cannot have a 3D scan, but we know it will simply not be a good one and we just try to get her the best images we can.

So, at the end of the day, we can jiggle all we want, we can poke at the belly and we can stand mom on her head but sometimes those babies just won’t budge.  “Can’t you get me better pictures?”  For the 20th time this week, I’ll just smile , apologize and hand her an image of a penis and a foot.

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Posted on May 19th, 2012 by wombwithaviewblog.com

Most people cannot wait for the day of their sonogram.  They lose sleep in anxious excitement to see their baby, hear its heartbeat, see the face of their unborn child and, the piece de resistance..learn their baby’s gender.  However, there are the examinations that cause parents to lose sleep for more frightening reasons.  These people have had a miscarriage or pregnancy loss, lost a child due to some complication which may have been first documented with ultrasound or know of someone who had this experience.  These patients do not enter my room with smiles or happy chatter.  They are scared…scared and in need of some reassurance.  Even though I cannot discuss details of the examination with them as this has to come from her doctor, if all looks structurally normal with the ultrasound, I will say as much.  I do my best to point out structures and organs to them and will discuss with them findings on their prior ultrasound.  If patients have a need to talk about this, they will initiate the conversation.  I will gladly explain all I know about the subject and do whatever I can to make them feel they have a competent sonographer and are receiving a thorough ultrasound examination.  Maybe something was missed on an old scan, maybe it wasn’t missed but didn’t develop until later in the pregnancy.  Whatever the case, these patients need a caring and experienced sonographer.

To all patients whom this article refers, you are not alone.   I know this is one of the most stressful times in your pregnancy and the only thing that will make you relax is to hear from your doctor that whatever was seen before is not seen in this baby you are now carrying.  Just know that those pregnancies, those experiences are some that stay with us for a lifetime and are life-changing.  You may not understand now why this has happened, but surely this experience will make you more sensitive and perhaps a support for someone else who experiences a similar tragedy after you.  To be a blessing for someone else is one of the most amazing gifts we can share with one another as humans.

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