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

9 Week Embryo

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 ultrasound every week, dispels the myths, provides accurate information, answers lots
of questions for all you new moms out there as well as provides info that even the most
popular pregnancy books today just don’t!

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Thanks for reading! Feel free to email at wombviewerblog@gmail.com.

wwavblogger, RDMS
wwavblogger, RDMS

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Posted on April 24th, 2017 by wombwithaviewblog.com

Who needs an amniocentesis? When should an expectant mother consider an amniocentesis? What factors help a patient decide if an amniocentesis is right for her? Only your doctor can help you make this decision, but you can find out a little more about first-trimester genetic testing…some very basic information…here.

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

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

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

Things to Consider Prior to Amniocentesis

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

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

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

What’s Included in Genetic Testing?

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

NT may or may not be performed prior to amniocentesis

NT test

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

What Do the Results Mean?

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

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

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

How Is an Amniocentesis Performed?

Basically, a sonographer will scan you to look for an adequate pocket of fluid. The doctor performing the amnio will determine what is a good pocket and what isn’t. Typically, they like to stay away from Baby’s head and your placenta, depending on where it is located. A nice pocket of fluid might look like the image below.

Pocket of Amniotic Fluid-amniocentesis

Pocket of Amniotic Fluid

The sonographer will measure your baby’s heart rate and anything else the physician requires. The physician will then clean off the area of your skin with betadine just above the desired pocket of fluid (as long as you’re not allergic to it!). Sometimes she may use a numbing agent for the skin, sometimes not. If not, it’s because she can only numb the skin and not down deep. The numbing agent feels very similar to the needle used to withdraw the fluid, like a stick and a burn and a lot like a bee sting. Since this is the case, some docs would rather stick you only once and elect to not numb the skin.

If you have an aversion to needles, you may want to look away. The needle is long because it has to reach the fluid. Usually, the needle is inserted with ultrasound guidance. They’ll ensure it is entering into the pocket as expected. Once there, the doc will attach a syringe to withdraw the fluid. Once she has enough fluid, she’ll remove the needle and push the fluid into a vial. The vial will be sent off to the lab for testing. If all goes according to plan, the whole procedure of performing the amnio will take about ten minutes or so. Pretty quick!

You’ll then be cleaned off a bit with a band-aid over the site. Many times it’s even hard to see on your skin where the needle was inserted! Your sonographer will usually measure Baby’s heart rate one more time, and your doc will give you instructions on receiving results.

What If I Really Don’t Want an Amniocentesis?

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

What to Ask Your Doctor about an Amniocentesis

It’s hard for us to ask questions about something if we don’t fully understand it. That’s understandable! Some questions you can ask your doctor are:

  1. What abnormalities does the testing detect?
  2. What kind of genetic testing do you offer?
  3. Will my insurance cover this testing?
  4. Who will perform these tests?
  5. Where is testing performed?
  6. When will I get results?
  7. Why is the testing recommended?
  8. What are my options after receiving results?

 

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

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

Here’s to your happy and healthy pregnancy:)

 

 

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Posted on January 16th, 2017 by wombwithaviewblog.com
10 Week Fetus

10 Week Fetus

In my efforts to put together first-trimester information, I realized I left off the 10th week of development! So, without further ado, let me introduce the 10 Week fetus. We both need this for my blog and book!

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

Just a note of caution here..you will likely still have the dreaded vaginal ultrasound at this point! The image obtained with this method still yields the best quality for Baby’s peanut size and this is part of our job, utilizing whatever method is going to produce the best image.

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

Only two more weeks until you reach the second trimester! Exciting stuff:)

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Posted on August 17th, 2015 by wombwithaviewblog.com

You know, I just don’t have all the answers. I know you may not be terribly shocked by this revelation. That being said, I get emails all the time with partial tidbits of relative info from which I am supposed to glean an opinion or diagnosis. Sometimes, it’s just not enough to read between the lines, especially with regard to early pregnancy questions. See the emails below to understand my conundrum..

vague mama:  Hi My name is _______.
Here’s my ultrasound.
Thank you in advance.~

The subject of this email read 12w6d ultrasound. Attached were a few crazy bright, quasi fetal bottom view images. Great ultrasound imaging can only be taught. Truly. I can only assume this person was curious about gender but how am I supposed to really know this is the question if it’s not asked?

twin mama:  Wow! So glad I found you. Can you please help with my twin ultrasound? We are confident that baby B is a BOY! However baby A is leaving us confused, we were told possibly boy as well, all guesses on other sites say girl. Just so confused. Thank you in advance for your help. Sincerely..~

So, clearly, this one questions gender, however, no gestational age is included so I have to guess based on how big the baby looks in the image. If you guys know me by now, I DO NOT guess gender before 17-18wks and if you’ve followed me for a while, you’ve read a hundred posts on why that is!

Too early = too much guesswork = an ^ in the % of complete wrongness.

This is my professional and VERY scientific formula on how to incorrectly determine fetal gender. Turns out these babies were 14w4d. In other words, you may as well flip a coin. You have the same degree of accuracy and it’s free.  There’s not much worse than paying someone to be wrong, right?!

concerned mama: I just have a couple questions I’m hoping you wouldn’t mind helping me with. I just had my first ultrasound abdominally and also had the internal, as well, for dating. I have a very irregular period so I don’t know my LMP. I had gotten lab work done the day before the ultrasound to check my hcg levels. The nurse said they were pretty up there but not yet 14 weeks. During my tests, my sonographer would not give me any info. I understand they formally cannot give an official diagnosis but she wouldn’t even show me the screen. Is it normal that they don’t give you a picture, either? If you could try and answer these questions the best you can, I would greatly appreciate it:) Thank you so much! ~

So, a layperson may not understand the difficulty here but what am I supposed to answer for this reader? With no images, no measurements, no LMP..virtually no concrete information..I cannot tell her anything she doesn’t already know about her case, which is almost nothing. I am not sure she even saw a heartbeat but without that being stated I can assume nothing. The only opinion I can state here is that it is entirely WRONG that her provider provided no information for this patient (not much of a “provider” in my book) and made her wait an entire weekend for some answers. I am a provider, too, but I answer to a physician. The physician, PA or nurse could have informed this patient about what was seen on the scan, even if they couldn’t yet predict if it would be a good pregnancy.

So, there you are, Ladies..an example of some of my emails! Sometimes I can’t help you very much but I always try!

Before I close out, feel free to check out the great ads to your right! I have vowed to only advertise good or services that you mamas-to-be might find useful or that I wished I might have had eons ago when I was birthin’ and raisin’ babies!

‘Til next time, wishing you a happy, healthy sonogram;)

wwavblogger

 

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Posted on July 22nd, 2015 by wombwithaviewblog.com

First of all, I’d like to welcome my first two advertisers!  Us moms can never have enough access to products and services that make our lives easier.  So, check them out just to the right of this post.  You’re welcome!

Moms, friends of moms and family of moms-to-be..The Corner Stork has some of THE most precious baby shower ideas and gifts EVER!  Where was all this cute stuff when I was pushing out my little pumpkins?  They seriously make me want to run out and throw someone a party.

And for all you moms with little ones in tow already, Zoobooks is educational fun if your kids are fascinated with animals!  What kids aren’t?  These make great gifts, too, so if you’re in need of something for the fifth birthday celebration your child has received this month, check it out!  Our next generation of leaders is bound to soak up more useful facts and trivia here than that from a particular sponge I know.

Onward to my post of the day..

I read something a little disturbing whilst surfing this universal web of ours called the internet.  I don’t often search anything ultrasound related unless it is a medical reference for the purpose of supporting the diagnosis of a case.  I have been told, however, that if I want to increase my visibility of this blog, I must submit my two cents on other sites and provide a link.  It’s very disturbing.  Where do I start??!  There’s so much misinformation out there and it’s very distressing to know people are believing everything they read or are misguided in some way themselves.

Someone wrote essentially a one-liner about her miscarriage.  She stated that she will absolutely never have another transvaginal ultrasound in pregnancy because the one time she allowed it, her baby died the next day.  I was so saddened by this statement.  I attempted to reach out to her with a direct email but it wasn’t possible.  I hope someday, in some small, remote and very unlikely way, she may stumble across this post.

ALL OB PATIENTS!!  Please know that scanning with an internal ultrasound probe in no way, shape or form causes miscarriage or fetal demise.  If this were the case, we would not be allowed to perform the examination! Our docs are in the business of helping you carry a healthy pregnancy and, hopefully, to term.  Transvaginal sonography is the best addition to sonography for early obstetric care and gynecologic studies.  It provides so much useful information for your physician that just cannot be seen with transabdominal scanning.

It helps us find your Baby’s heartbeat and determine gestational age early in the first trimester. It helps affirm for your doctor that your pregnancy is progressing normally or whether it is threatened because of bleeding or a shortened cervix.

Most of you know that your OB/GYN doc has your best interest at heart.  It’s unfortunate and sad that the coincidence of this tragic event happened after her examination..but it was not the cause.  I want you all to understand that having this exam done is what can help your doctor SAVE your pregnancy.  The goal is happy, healthy, full-term babies!  Sometimes we can help you achieve this; sometimes we can’t.  Either way, transvaginal ultrasound likely played an instrumental role in  providing your physician with much-needed and highly valuable information.

If the medical community feels it is safe enough for ourselves and our own families, we certainly want to provide you with the same quality care!

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Posted on July 17th, 2015 by wombwithaviewblog.com

Every once in a while we have a patient who desperately wants to pin down the EXACT day she conceived so she can determine the father of her baby.  Ultrasound can give you a general time-frame within a few days of reliability early in the first trimester (about 8-10wks gestational age) but it cannot be specific to the day.  Moreover, ultrasound measurements become less accurate the farther along in the pregnancy you are.  Someone who shows up for dating at 23wks, for example, will get an estimate or “best educational guess” for a due date.  Determining paternity by ultrasound is not “cut and dried”.

Some would like us to pin it to the hour.  Sorry, ladies, you are SOL if you find yourself in this boat.  Only DNA testing after Baby is born will help you in this case.  Literally, a young girl in college be-bops into the practice one day hoping we could differentiate within one week between three possible candidates.  Really?  She was very cavalier about her dire straights but what threw me more was that her mother, who was with her, thought it was just as funny.  Personally, I have to say I’d be mortified if it were me and even more so if it was my daughter.  I’m not being judgmental here; I just think it’s a serious matter and not a laughing one. Being a little more selective in this department than this girl, both women AND men, would not be a bad thing!

The first thing your doctor will ask is when your LMP or last menstrual period started.  Most people ovulate between days 10 and 14 but some people have very short cycles and others have longer ones so the actual day the egg is released is quite variable.  Some people experience very irregular periods, oftentimes skipping several months at a time, which is totally unreliable for dating, unless you know exactly the dates you had sex.  Moreover, semen can live for a few days within the vagina (don’t quote me and I’m sure this is an exact science in some literature but I am not an expert in the life cycle of sperm) so it would be hard to pinpoint the exact day of conception.

Getting a good dating scan in the first trimester by someone who is experienced in determining the best measurement is the next order of business, providing Baby is easy to see. I personally feel a transvaginal ultrasound at 8-10wks is the best time to obtain a CRL (crown-rump length, measurement from head to butt) because Baby is not too small or big.  A 6wk pregnancy where the embryo measures a whopping 3mm can be very difficult to see well.  At 12wks the fetus is fully formed and very active which can make obtaining a good measurement challenging.

See the images below to see the difference in a CRL at 6wks, 8wks and 11wks!

6wk embryo

6wk embryo

Baby is so small here that it can be hard to see in some patients depending on how it is positioned!

 

8wk fetus

8wk fetus

This is the best dating here! Baby is usually pretty easy to see now at about 1/2 inch.  This measurement is accurate within 1-2 days.

 

11wk fetus

11wk fetus

Dating is still fairly accurate here within about 3-5days.  They move a lot and bend and one can imagine that a bigger measurement will yield a baby a little farther along if he/she is stretched out vs curled in a little ball.

 

I get it; things happen.  People who are in a serious relationship break up.  They see someone else during the pause..rebound, shoulder to cry on, etc., and then reconnect.  This can be a wonderful reunion! But it can still make for a bit of a hairy situation if these encounters happened within 2wks of one another.

On a final note, imagine yourself in this situation.. You’re pregnant with twins.  You’re in the throes of labor.  Out pops your first baby.  Joy! Success! Beautiful!  Baby B is right behind.  Big push!  He’s out!  Oh.  Wait a minute.  One is black; one is white.  Yes, this definitely happened.  Lucy, you have some ‘splaining to do.

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Posted on May 10th, 2015 by wombwithaviewblog.com

HAPPY MOTHER’S DAY!!!!!!!!!

My blog is nothing without paying homage to the celebration of life and the incredible women who help to create it!  Thank you for reading and subscribing and I sincerely hope you all enjoy a wonderful day surrounded by your family.  Hopefully, they brought you breakfast in bed and are obeying every command with the tinkle of your handy-dandy little bell (or foghorn, whichever your prefer).  Contrarily, but no less enjoyable, maybe you’ve opted for the fam to disappear, leaving you to delve into your favorite book or hobby for a day without stinky diapers, PB&Js or laundry…or fighting!

Last week I included a 3D image of a 9 week fetus as shown below.

9wk fetus in 3D

You can see little arm buds and leg buds getting bigger.  What looks like a tiny lump on the top of the belly is just part of the cord.

Below is a 2D image of a 9wk fetus:

9wk fetus in 2D

Baby is upside down here and you can see from the dimension taken that it is measuring just about a whole inch now!

I don’t think it’s too much to ask to spend one day a year sans the multiple hats that come with motherhood..chef, chauffeur, maid, teacher, referee (for those of you blessed with more than one little angel). It’s the most difficult, most enjoyable and most important title any woman will ever hold.  Shaping and molding our future generation of leaders is no small task!

To carry them, raise them, care for them, discipline them and love them defines us as Mothers.  Any woman who puts her all into this job deserves to spend this day any way she pleases!  Enjoy it!

And for those first time moms-to-be..relish the peace and quiet now while you still can;)

HAPPY MOTHER’S DAY TO YOU ALL!

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Posted on March 26th, 2015 by wombwithaviewblog.com

In the last post, two babies were finally seen, both measuring about the same at 6wks with great cardiac activity!  So let’s check out a few changes. The image below is of embryos at 7wks.

7 week embryos

You don’t really need a measurement here to see how much bigger they look compared to just one week prior!  You’ll notice that the gestational sacs are bigger, too, and yolk sacs keep the same general size and appearance although they are not pictured here.

 

Since I didn’t have much to post about Week 7, let’s skip ahead a little and look at 8 weeks, too!

a8wks

Can you believe the difference in just 13 days? Baby A is a whole 12mm bigger!  The more round area to the right is Baby’s head. We can even make out little arm buds and the little white lines you see on each side of Baby represents part of the developing amnion or sac of fluid around Baby.

 

Now check out Baby B below!

8 week fetus

Baby B is now a whopping 13mm bigger!  What an animal!

 

8 week twins

Not only is the 8 week fetus a site to behold but all the changes seen in every week of the first trimester are really quite unbelievable and it truly is one of the most favorite aspects of my job.  I love it!  It makes me realize what a privilege and honor it is to be able to catch a glimpse into this amazing world on a regular basis.

One day they’re 3mm; you blink, and they’re 16mm!  Wow, our kids just grow up so fast! (sniff, sniff)

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Posted on March 15th, 2015 by wombwithaviewblog.com

In the last post I wrote that we were able to FINALLY see a first trimester embryo in each sac in this twin pregnancy!

Lo and behold, they both measured 6wks!  We could not explain why the gestational sac of Baby A was smaller or why that of Baby B was larger.  We were still a bit concerned about that finding but the fact that we saw two strong heartbeats and two babies that measured essentially the same were both very reassuring!  See the images below for measurements of the embryos.

 

Embryo measurement at 6wks

Baby A Embryo

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

Embryo measurement at 6wks

Baby B Embryo

Baby B measured about the same at 3.4mm.

Now check out the heart rates as determined by pulsed doppler so Mom could hear them.  Typically and with modern equipment, if we can see it, we can also hear it.

Embryonic heart rate at 6wks

Baby A Heart Rate

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

Embryonic heart rate at 6wks

Baby B Heart Rate

Baby B’s heart rate was just a tad faster and a little easier to hear as you can see by the strength of the cardiac cycles on the baseline.

Stick around and keep coming back to read more about these twins!  In the next post they’ll be 7wks and you will be impressed at how much bigger they look in only one week’s time!

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Posted on February 1st, 2015 by wombwithaviewblog.com

Most OB patients today get an endovaginal ultrasound for 1st Trimester dating when they establish care for a new pregnancy. Most offices maintain requirements for when this first visit should be scheduled. There is good reason for this! Most patients want to see their docs AS SOON as the pee stick demonstrates that little plus sign. However, the problem here is that very little can be determined by your doctor too early in the first trimester. Except, of course, that you’re pregnant!

Some home pregnancy tests like to brag that you can know you’re pregnant as early as your first missed day. But this isn’t always a good thing, especially for those overly-anxious mamas. Naturally, the next question they all have is “Is everything okay?” If you are less than 6 Weeks (from your LMP or last menstrual period), your healthcare provide just cannot confirm this. If you ovulated even one week later, it means we still aren’t going to see much on your endovaginal examination. The earliest we can measure an embryo and detect cardiac activity is about 6 Weeks gestational age.

Even then, it can be quite difficult to see well or measure depending on position of the embryo and uterus. If you are even a few days earlier than this, we would only see a gestational sac and possibly a yolk sac. It’s not feasible to scan you every day and your insurance company will not allow it, anyway!  All the above reasons are why some docs specify a confirmation visit no earlier than 8wks for a 1st trimester dating scan, when we should be able to confirm a fetal pole and a heartbeat.  Coming in too early if your dates are off means your doctor will then have to order a follow-up visit for you in a week or two to confirm a normal early pregnancy.  Trust me!  This will feel like the LONGEST one or two weeks of your life!

Sometimes the dates conflict. Your LMP may say you are 10wks but we see a fetal pole that measures 6wks. This just means you really became pregnant a month later. When these numbers are discrepant by more than just a few days, your doctor will typically use the gestational age we obtain by ultrasound.  See the fetal pole and report images below.

10w2d Fetus

SONY DSC

Note that on the report, the patient should have been 11w3d by her LMP of November 10 but Baby measured 10w2d instead.  With dates = 8d off at this point, her doctor will likely go with the due date of 8/25/2015 instead of 8/17.

So, take my word for it.  The only thing worse than waiting to see your doctor for your first OB visit is going to see her and then leaving without answers.  Trust your doctor’s office when you call to make this appointment and they say it’s too early!  They know what’s better for you than you do;)

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Posted on October 20th, 2014 by wombwithaviewblog.com

We all know kids say some of the funniest things! And when Mom is 11 Weeks pregnant, Big Brother enters my ultrasound examination room with SO many questions!

We realize, as adults, just what a different perspective of life they have when, on hilarious occasion, they express to us these tiny pearls of realism in a way we never considered. They see the world in such simple terms; it’s unfortunate how we grow out of that over time. Oftentimes, we can actually see those mental wheels spinning, trying to make sense of the ultrasound monitor with their limited knowledge.

A Kid’s Precious Perspective

So, last week as I am scanning Mom, Big Brother of about 6 or 7 is watching intently. He was very excited to see “his” baby and had lots of questions about everything I was pointing out to him. I typically start with the head, try to demonstrate a great profile of the face and, of course, I make a point to include hands and feet. It takes a minute for older children to really appreciate that it’s a baby on the monitor. After all, that black and white and gray blob on the screen doesn’t look like any baby they’ve ever seen!

If I can obtain a decent shot of the arm and hand, I’ll annotate on the monitor “hi!!” and tell the excited on-lookers that Baby is waving to them. It’s just one of those fun aspects of my job and the reactions are always cute.

11 Weeks Pregnant, 11 Week Fetus

11 Week Fetus

As I did just that, Mom laughed. But Big Brother was quiet, and we could tell he was deep in thought. After a few seconds he finally spoke up and asked, “Mom, the baby can already spell?!!”

Mom and I had a great laugh over that, and Big Brother was happy to learn that his baby wasn’t smarter than him just yet!

**I would love to read YOUR funny stories.  Email me at wombviewerblog@gmail.com and tell me all about it!  Yours just may be my next post!

Thanks for reading!

wwavblogger, RDMS

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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

 

SONY DSC

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 January 29th, 2014 by wombwithaviewblog.com

An interesting and sad outcome of an early pregnancy is the blighted ovum. Basically, it just means that a gestational sac developed but a yolk sac or embryo never did. You’re still pregnant. But all the components of pregnancy did not develop properly enough for an embryo to start growing.

Of course, we perform a transvaginal ultrasound to see best early in the 1st Tri. What we typically see is a gestational sac with nothing inside of it. We measure the sac, which is the only estimation of gestational age without an embryo, but we know that at about 5 1/2 Weeks we should see a yolk sac inside of the gestational sac, like the image below.

gestational sac, yolk sac

5w5d Gestational Sac with a Yolk Sac Within

 

Or an example of an early twin pregnancy could look like this:

Yolk Sacs, dichorionic twin pregnancy

Twin Gestational and Yolk Sacs

 

But a blighted ovum would look something like this:

gestational sac, blighted ovum

Gestational Sac/Blighted Ovum

You would see the gestational sac with only the black of fluid inside. If the sac is measuring 6 Weeks or greater, we might suspect a blighted ovum.

Usually, your doctor will ask you to come back in another week or so to confirm whether an embryo is developing. There are typically huge changes in the first few weeks as I’ve shown you in prior posts. Most of the time, the gestational sac will be bigger on your next scan, even if a blighted ovum. This is expected because the hormones of pregnancy still exist which will cause the sac to continue to grow even if there is no baby inside.

Some patients feel a little better knowing a baby never developed. For others, it is still quite painful to find that what you thought was growing doesn’t exist, especially in a desired pregnancy. For all, it is still a loss which makes trying again that much harder.

I’ll tell you as I have all my patients who have suffered a blighted ovum or other pregnancy loss – our babies come to us when THEY are ready…not necessarily when we are;)

Best wishes for a healthy pregnancy to all!

As always, thanks for reading! And please email me at wombviewerblog@gmail.com with any questions or comments!

wwavblogger, RDMS
wwavblogger, RDMS

 

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