Posted on May 30th, 2017 by wombwithaviewblog.com


I always know that face..the one with the saucer-like eyes and mouth gaping open in utter shock as soon as I speak the words “transvaginal ultrasound” and point to the probe sitting so quietly on my machine. Poor thing..it gets such scathing rejection and so little credit.

I can’t really blame the poor patient. After all, a gynecological scan isn’t exactly something people volunteer for (unlike the OB ones! At least they have something cute to look at). I can’t tell you HOW MANY times patients have said, “Boy, these are more fun when there’s a baby in there.” A dollar for every one of those comments and I’d have a penthouse in Manhattan by now.

Most patients still in the baby-making stages of life are typically pretty familiar with a vaginal ultrasound. It’s how we see Baby early in the first trimester or monitor the cervix. But many young or older women are not familiar with my long, skinny friend and are mortified at the thought of this exam. These patients are always there for a problem which could be a whole myriad of issues from crazy periods to ovarian cysts.

One thing is for sure..give me a woman with pelvic pain and, I can promise you, the last thing she wants to see is any ferociously long object headed for her nether-regions! I first apologize then promise patients it’s quick and painless. At least they didn’t have to drink a gallon of water and hold it, which is precisely what some facilities still require for a transabdominal pelvic ultrasound (where we scan on top the belly). It is usually enough to get a slow and deliberately labored “Okaaaaaay, what do I have to do now?” But it’s still a consent! Goal.

Vaginal ultrasound is probably, to me anyway, THE best ultrasound invention since ultrasound’s inception. I tell patients it really is the difference between night and day. It’s much like looking out of a clear glass window versus one with a sheer curtain drawn. I would say that about 95% of the time, I can see better when using the vaginal approach. A very large uterus or pelvic mass, however, would require an abdominal approach.

Did you just say you want a little Ultrasound Physics 101?? Well, I thought so! I’ll make it short. The transvaginal probe is built to deliver a higher-frequency sound wave which doesn’t penetrate very deep into the body. It offers by far the BEST resolution because the uterus and ovaries lie close to the probe. When we scan over the pelvis with a full bladder, the fluid provides a window for the uterus and ovaries behind it. However, by the time the sound waves get all the way down to those organs and back, we have a somewhat compromised image. The vaginal probe requires an empty bladder which allows us to see the uterus better.

We cover the probe with a condom or glove and insert it into the vaginal canal like a tampon. We place the probe against the cervix only; it does NOT enter into the uterus. The cervix remains closed (unless you’re in labor) so it cannot push past this point. The sonographer gets a magnified image of the uterus and ovaries and the areas immediately around them. We measure the uterus, endometrium (lining of the uterus), ovaries, and any pathology that we see related to those organs. Air and gas are not our friends, so sometimes those factors interfere with a good image.

Usually, the whole scan takes about fifteen minutes. When it’s over, the patient usually says it wasn’t that bad at all! Frequently, patients will share the reason for their trepidation. It’s mostly because a friend had one done by a technologist with a heavy hand, making it quite a painful experience. I’ll usually respond by saying, “Firstly, you should ALWAYS tell someone when your exam is that painful. And, secondly, we don’t need to see your tonsils!”  I’m not a comedienne, but that comment usually gets a much-needed laugh, and the end of the scan is very appreciated:)

***

More coming about transvaginal ultrasound and your early OB scans with the release of my new book about first-trimester ultrasound. Hopefully, very soon! You can receive automatic updates on the book (along with a little something special when it publishes!) and the most current posts by subscribing to my blog. You’ll see where in the right margin! >>

Once again, THANKS FOR READING! And please feel free to email me any questions you have at wombviewerblog@gmail.com.

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Posted on October 26th, 2015 by wombwithaviewblog.com

As an addendum to the this last published post, I am adding annotated images of the the video in the link below:

9 week fetus

amnion at 9 weeks

 

***

(Published 10/25/2015)

Ever see a real-time video clip of a 9 week fetus? Of a fetal heartbeat?  Well, here you are!  Just click on my link below:

9 week fetal heartbeat

This clip demonstrates a quick video of baby with transvaginal imaging. First, we see the head, then we see a long view of baby’s body and the incredible flicker of cardiac activity in the chest. The fetal head lies to the left of your screen and the small circle near baby’s bottom represents the yolk sac.  Also, notice the thin white line around baby. This is the amnion or amniotic membrane. Looking carefully, one can make out the beginning of arm and leg buds.

It’s so cute already!

Can anyone guess what the black represents? Yep! Amniotic fluid. You guys are so smart.

Come back tomorrow and I’ll annotate all the parts for you. Have a great day!

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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 June 23rd, 2015 by wombwithaviewblog.com

Transvaginal ultrasound was developed somewhere in the 1980s and, in my opinion, is THE best contribution to ultrasound, bar none.  It gives us a high resolution image because the probe lies closer to the organs and utilizes a higher frequency than with abdominal probes.  But, women, do you really need company to have this done?

Case in point.  A young patient comes into the office with an entourage.  I seriously had to check my memory twice, reminding myself that she wasn’t there for an OB appointment.  With her was Mom, Child and Boyfriend and Mom insisted on coming in for the exam along with the child.  Of course, I could care less as long as the patient wants them in there.  I have to ask all the same questions regardless of who else is in the room.  If you don’t want someone hearing all your personal GYN business, you better have them wait outside.  This wasn’t the case here on this day but, nonetheless, no truer statement has ever been spoken…well, typed, that is.

About 80% of the time, I get the same reaction.  I say the word “transvaginal” and I see people’s eyes get as big as dinner plates.  I realize the hesitation on several points.  If you’ve never heard of it, if you’ve never had one done or if you’ve never been to the GYN doc, I condone “the look”.  However, if not, I sometimes want to just tell women to get over it.  Come on now.  You’re sexually active, you’re in your 20’s or older and you may have even already had a child.  It’s not your first rodeo in stirrups but the transvaginal ultrasound just put you into a tailspin.  It’s an altogether different scenario if someone has had no sexual experience (and I don’t mean virginal by today’s standards) or if a patient has had a bad personal experience in the past which has left them emotionally scarred.  Usually, I know about these well in advance and we plan around them by having the patient fill her bladder or by simply explaining the exams and allowing her the choice if she is old enough to make one, of course.

It’s almost always awkward for the patient (though never for me) and having someone with her is most certainly recommended if she is at all anxious about the exam or results.  The most strange of these situations, however, is when she wants the husband or BF to come in for the exam when he has NO desire whatsoever to be there!  What the heck, Lady?  Do you drag him in for your Pap, too?

In my opinion, guys should be left at home unless you’re there for new-addition-to-the-fam care.  Otherwise, if none of the exceptions above apply, put on your big girl panties and treat yourself to some Haagen Dazs afterward.  Isn’t that the sole purpose for ice cream anyway?  I think it would make for an interesting new ad campaign.  Ice cream..the perfect post-stirrup consolation prize!  ..I’ll have to send that one in..

Stay tuned for the next post where I’ll expound on the details of having this exam done with some fancy shmancy pics, as well.  Thanks for reading and have a great day!

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Posted on May 23rd, 2015 by wombwithaviewblog.com

You’re almost out of the woods! ..of the first trimester, that is.  Your baby is now just shy of two whole inches in length from head to bottom.  The 11 week fetus is looking more and more like a baby instead of a blob and, in real-time imaging, watching baby flop around like a little fish out of water always creates a chuckle for us spectators.

Transvaginal ultrasound is still usually the preferred method of scanning as it gives us the best resolution but we can adequately measure what we need with the abdominal approach in a thin patient.  Arms and legs are almost fully developed.  Baby’s head still looks bigger than its body but there is a lot of brain still growing in there!

In the image below, you’ll see the crown-rump length (CRL) measuring Baby from head to butt, a tiny little foot which is about 1/2 inch long and tiny pair of legs and feet.  So cute!

 

11 week fetus

 

Hit me up if you have any questions about the 11 week fetus or anything ultrasound-related at my email address, wombviewerblog@gmail.com, or by clicking the Ask Me page above.  You can also find me on Twitter, @wombwaviewblog.  Follow me!

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Posted on November 24th, 2014 by wombwithaviewblog.com

The past week at work has been incredibly busy..chalk it up to a holiday week!  More than the fact that a holiday is approaching is that I have just seen a lot of pathology lately.  More pathology means more time dedicated to each patient’s examination and reporting.

I cannot remember a time when I’ve seen two cases of cancer in one week…one ovarian and the other was a suspected fallopian tube cancer which is very rare.  Either way, it is always a bit dis-heartening to see a mass in the pelvis with concerning size or features.  Sometimes we take one look and just know it is something bad for this patient.  It’s hard for me knowing I have to put a smile on my face and show this patient out the door. I think about how her life will be changed and what she will have to face in the upcoming months. I think about her family and how they must feel upon hearing the news and then facing the repercussions with her.

The only thing that makes me feel a little better is knowing it was caught but feeling a little sad the patient didn’t come in sooner.  We all do it.  We put off symptoms thinking they’ll go away or it’s nothing.  We can’t ignore the things our bodies are trying to tell us.  The best we can do is to address it sooner than later and hope it turns out to be nothing. If nothing is really something, maybe something can be done to treat you now vs having few choices later.

I have thought of those two ladies many times.  I keep checking their charts and with their doctors to follow-up for news.  I have kept them in my prayers.  It makes me a little sad to think of how their holiday might be changed for the worse.  Alternatively, it’s also quite surprising how such news can also be a Pandora’s box of unexpected blessings and thankfulness.  I wish them much of both.

 

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Posted on November 14th, 2014 by wombwithaviewblog.com

Gosh, don’t you just hate it when your words gets jumbled in a professional setting and what comes out is anything but? ..professional, that is.

It happened to me this week!  I can laugh about it now and I do have to applaud myself that I kept my composure because it was damned funny at the time.

So, routinely during a pelvic ultrasound, when I cannot find an ovary or see it well with transvaginal imaging I will scan the patient abdominally, as well, and explain this to the patient.  Often times they are surprised or concerned and inquire as to why it is that I cannot see it.  What I usually say is that there is gas and air in the intestines which gets in the way and ultrasound cannot see through that, obscuring the ovary from view.

However, this time instead of gas and air I said, “You know, in the intestines, we have ass and – gas and air..” I didn’t skip a beat and just continued with my spiel. Thankfully, she didn’t even blink!

Yeah, most people haven’t heard of ass and gair..

 

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Posted on August 9th, 2014 by wombwithaviewblog.com

Are we ever too old for ultrasound?  Do we ever get to an age where we won’t ever have a need for a pelvic ultrasound exam?  ..Never.

Working for obstetricians means they also manage their patients before and after they have babies which means that not only do I scan many babies but I also perform diagnostic ultrasound on a number of baby-free uteri and accompanying ovaries.  Moreover, my 70-80 year old patients have never even fathomed vaginal imaging.  Unfortunately, we ladies have female issues long before and long after our babies come along..everything from pelvic pain to ovarian cysts to abnormal periods to postmenopausal bleeding. I have heard more than once that they “NEVER thought they’d be doing THIS again”.  I wish I had a dollar for every time I’ve heard this in my career.  I’d probably be in Costa Rica somewhere sipping on a little umbrella drink with my toes in the sand.

My response to them is always the same..as long as you are a woman and your heart is beating, you will ALWAYS have to put your feet in stirrups. We will never ever be too old for ultrasound, a pelvic exam or those awkward metal foot holders. Believe me, it’s not my favorite way to spend 30 minutes, either.  Feet here and slide on down to the end, Ladies!

I’m coming back in my next life as a man.

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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 July 7th, 2014 by wombwithaviewblog.com

Insomnia is not a beautiful thing.  But I suppose if it helps me write a post..

Why I have the cervix on my mind at this hour is beyond me but it brings to mind the question I get from patients in the third trimester almost weekly  which is “Can you tell if I am dilated”.  The answer is no. Though ultrasound is a good method of determining cervical incompetence or shortening of the cervix early in the pregnancy, it’s still something your doctor has to check for manually later on.

Now there have been some schools of thought with regard to scanning vaginally and obtaining a 3D view of the cervix to measure dilation seen at the external os (your doctor’s view with a speculum) but these are only studies with published articles on the subject, to my knowledge. The good ol’ finger assessment is still the most routine method used for determining degree of dilation of the cervix.

It’s just another one of those uncomfortable things we have to tolerate with our feet in stirrups, Ladies!  Here’s to OBs with small hands!!

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Posted on April 17th, 2014 by wombwithaviewblog.com

Oh, what our poor patients experience at the hands of our inexperience and in the name of education.

Ya know, one of the things students learn is not only how to use the buttons on the machine, not only how many images to take and what kind, not only how to detect pathology but also how to (or how not to) insert a transvaginal probe.  It can be a little tricky!  We are not gynecologists, sitting there with our head between our patient’s legs, however, there is a right way and a very wrong way to place this probe.  The vagina can be an elusive little boogar depending on a patient’s body shape and, especially if you are at all very new to vaginal probe placement.  One suggestion to a new sonographer is not to try this with your eyes closed.  The gel on the end of that thing can make it feel like a slip-n-slide down there if you’re not careful!  Just like you have to look at the road to know you are in the correct lane, you also have to look at your patient, briefly, to ensure the probe doesn’t migrate..well, south.

Read part of an email from a pregnant patient:

reader:  I had a (pretty harrowing) ultrasound at 7 weeks due to pain and spotting, in which the student tech tried to insert the probe into my anus, twice (really). She didn’t so much as wipe it before shoving it very hard into the correct orifice :-/  Actually there was another lady in the room, but she was tapping away on a computer. When I yelped due to the wandering wand, she looked up and asked if the student needed help, but she said no and continued. I suspected she was a student because of this episode, and sure enough my little report confirmed it.

wwavblogger:  Let me just say that your email and the case of mistaken orifice identity is unfortunate but you totally made me laugh (really).  One of the things a new sonographer has to learn about using a probe is how to insert it.  So sorry this was your experience.  I’m interested in knowing, though, if there was an experienced sonographer supervising her?  Did she say she was a student?  Just curious..  Students and new sonographers should always be supervised.  It’s a peeve of mine when this doesn’t happen!

***

Patients, speak up if this happens to you!  If you have questions about the competence of your sonographer, you have every right to discuss the concern with your doctor.  Sonographers, pay attention to what you are doing.  If you are unsure, you have to learn to ask the patient if the probe feels like it is in the vaginal canal.  Believe me, she’ll let you know if you are flying south.

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Posted on April 13th, 2014 by wombwithaviewblog.com

There exist a whole plethora of reasons to do an ultrasound on the female pelvis before and after a little bun is baking in the oven.  I know, I know, it’s not as much fun to talk about those “other” things but they are just as important as Baby.  So today’s post is dedicated to the under-appreciated empty uterus.

Our bodies are amazing pieces of fleshy technology!  We are a well-oiled machine, my friend, and the same holds true for GYN parts.  The uterus bleeds like crazy in attempt to remove things that shouldn’t be there or will make us sick and the ovaries produce a cyst and ovulate (release the egg) every single month (for most women).  The lining of our uterus gets thick every month JUST IN CASE a baby might want to implant there and if not, sheds with a period.  Again, this is if your parts are functioning like clock-work.  When they aren’t, my docs come to the rescue.  See, they are not just baby catchers!

Many symptoms warrant your gynecologist to order a pelvic ultrasound.  Abnormal bleeding of any kind at any age is a good place to start..too much bleeding, not enough bleeding, no bleeding, bleeding between periods, painful periods (are any of them pleasant?) and bleeding after menopause are a few of the most common reasons.  Periods are no fun and having one for a month is certainly no celebration!  Pelvic pain or discomfort, bloating or something felt by your doctor during a pelvic exam are other very routine causes for ordering this exam.  Maybe something was diagnosed by a previous ultrasound or CT (CAT scan) and a follow-up was ordered to see if it is resolved.  If you have a family history of some GYN disease, this is yet another indication for ultrasound.  There are certainly many more which is why there are volumes dedicated to the subject in med school.

If one is ordered for you, check with your doctor regarding prep.  Sometimes you have to drink a ton of water for an abdominal scan, most often you don’t in which case this would be a transvaginal ultrasound.  It may sound terrible but it’s not, especially if you are sexually active.  If this is the case (let me think of a politically correct way to say this), the probe is much skinnier than, hopefully, anything that has been introduced to you before.  There.  How was that??  I didn’t say exactly what I wanted here but you get the point.   In other words, if you can manage one, the other will not be a problem!

Here is a link to one of my favorite early posts on the subject of transvaginal exams (you may have to copy and paste the link).  Enjoy!

http://www.wombwithaviewblog.com/youre-gonna-put-what-where/

And since not many people really want to see an image of a uterus or ovary, I’ll attach one of a very cute baby instead!

IMG_1439

And what a precious little angel this one is!

 

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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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