Posted on June 3rd, 2017 by wombwithaviewblog.com

Frequently, parents do bring their other kids in for the ultrasound experience. And, sometimes, this is a good decision. As a general rule, kids about four and over find it pretty interesting and ask a lot of questions. They seem to understand that it’s their soon-to-be new baby brother or sister in there…even if they don’t quite understand how he or she got there in the first place. Out of the mouths of these babes is where some truly funny ultrasound stories and comments come from. It’s a cool experience and a neat bonding moment all rolled up into one little prenatal package.

Let me first divert a second to say that bringing a toddler can be a total nightmare. If you are considering taking your two-year-old (or less) as a spectator for your diagnostic anatomy screen, please, PLEASE, reconsider! Little Timmy has no clue what’s on that “TV” and could totally care less…no matter how much you point to the monitor in an effort to catch his attention. He just wants his toys and overdue nap and his snacks…or to just run around the exam room. Often times, he cannot understand why this strange lady is touching his mom…and he is not okay with that. Then the crying starts. At this point, none of us are able to fully concentrate on the task at hand or the baby that should be the center of attention.

However, what is so entirely cute is when kids do become engaged in what is taking place. The questions and statements that follow are some of the funniest and cutest! I’ll share some with you.

My all-time favorite is this. Mom comes in with her five-year-old son. He’s kneeling next to her on a chair, his hand on her shoulder watching intently. He’s quietly supporting her…so sweet. I’m pointing out baby parts as the fetus lies very still, napping. Mom is explaining all the body parts and organs as we go along. Suddenly, Baby starts to wiggle around like a little jumping bean, and Big Brother’s eyes fly open. He asks, “What’s he doing in there?!” I replied, “He’s swimming!” He stares hard at the monitor. All is quiet. One second, two seconds go by and mom and I are eyeing his expression. He’s searching and searching. A look of confusion comes over his face, and his eyebrows knit together. Then he asks a very concerning and valid question. “But where are his floaties???”

More Funny Kid Comments

From the youngster who wasn’t so happy about the strange little human in his house… When someone asked, “What’s your new baby brother’s name?” His reply? “Stupidhead.”

A seven-year-old big brother was very excited about his little sister and the state of her health. As I pointed out her spine on the moniter, he exclaimed “It’s a good thing she has one!”

Kids were always fascinated with the appearance of the fetal spine. Frequent comments were that it looked like alligator or dinosaur teeth.

A comment from a big sister: “Does he have clothes on in there?”

Two adolescent boys, about 12 and 10 years old, crossed fingers and squeezed their eyes closed in anticipation of sex determination of their new baby on the way. I froze the iconic image of little brother parts and broke the news. They squealed and cried, “NO! NO! NO! It can’t be! IT HAS TO BE A SISTER!” Poor little guys. They cried inconsolably for the entire remainder of the exam.

When a mom explained to her young son that he was going to have a little sister, he examined the ultrasound image with a very perplexed look and asked, “So, where is her pee pee?”

And last, but not least… Mom planted her feet in stirrups. As I began to insert the vaginal probe for her first-trimester scan, her very inquisitive four-year-old refused to sit in the chair next to her mother as commanded. Curiosity forced her to continually peek under the drape with confusion, and we couldn’t help but giggle with all her questions. “What’s she putting in your tootie, Mommy?” “Mommy, what’s she doing?” “What’s that thing in your tootie, Mommy?” …You get the picture. Now, that is funny.

Share Your Funny Stories!

We all could use a good laugh, couldn’t we? I know you moms have some hilarious moments to share, so please email me by clicking the ASK ME tab above. I’d love to share them with other moms around the world, too!

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Posted on October 11th, 2016 by wombwithaviewblog.com

Ever wonder what your sonographer might be thinking as she calls you back for your exam? While I cannot speak for all, let me give you some insight into some of the heavyweights at the forefront of my thoughts with each new patient.

What’s in a Job?

Firstly, we have a job to do. While the patient may be wondering why she wasn’t called back at her exact appointment time, your sonographer is already very busy with the business of having you as a patient. We are busy with a checklist of items that must be completed before we ever call your name! We are examining your chart and looking for your doctor’s order (we cannot begin without this!). We have to determine why you are coming to see us in the first place, so we have to know what type of exam needs to be performed. Oh, yeah! Your prior pertinent medical history and testing are pretty important, too. In other words, we have to be able to answer the 5 W’s…Who, What, When, Where and Why:

    • Who are we scanning? Who (what provider..doc, nurse practitioner) ordered this exam?
    • What type of ultrasound exam are we performing?
    • When was she scanned last and what was found? Do we have that report(s)?
    • Where are we targeting the examination?
    • Why are we scanning this patient?

Patients or Patience?

After spending so many years in the healthcare field and encountering a challenging personality type or two along the way, we sonographers wonder whether our next patient might be naughty or nice? The Rolodex of mental questions might look something like this:

  • Will my brain get picked for some interesting ultrasound facts or will I get the silent treatment? It is a bit awkward when a patient has nothing to say…I mean zero words.
  • Will she need to beat her dueling children because they won’t let her focus on Baby #3 (who may turn into Baby #1 if they don’t quit fighting)?
  • Siblings are sometimes the most comical addition to an exam, but will I have to listen to “Let It Go” on a tablet for thirty minutes – again?
  • Will her family sound like my Italian kin at Thanksgiving in that tiny. enclosed. room?
  • Will it be standing room only with Grandpa breathing down my neck for the whole exam? Gramps is really nice, but he’s gotta mosey on over to the other side of that table.
  • Will I have to ask Dad to take their screaming toddler back to the waiting room? We hate to kick anyone out. But our eardrums can’t take it, and admin typically frowns upon keeping rum in our exam rooms.
  • Will I get the evil eye if I say that I cannot determine what sex she’s having? And will she then rant on Facebook that I have no idea what I’m doing? I hate when this happens.
  • But seriously, and most importantly, will this baby look normal?

The Questions We Get Almost Every Time

Does everything look okay? Do you see anything wrong? Is my baby growing well?

These are all valid questions, to be sure! But as most patients know, they are ones that only your doc can answer. Legally, only your doctor can review the exam and determine its results. Only she/he can discuss these results with you even if they’re negative. Why is this? So that they can also provide you with the comfort and answers in the face of concerning findings.

My answer was always relatively the same. “So far so good, but your doctor has to review the images and give you the results.” Every blue moon, a patient express that I must know what I’m seeing. I would always agree but reiterate the rules.

There are times and extenuating circumstances where you may know what your doctor is following. In these cases, we have to be careful with our words. Every practice is a little different with respect to how much your sonographer can say. It’s a fine balance! Too little, and we cause you to worry. Too much, and we could be fired!

Of course, every sonographer on the planet is happy when they enjoy the time they have with their patients and families and kids. Some of my favorites have also been the loudest, most fun, and the funniest! One thing is for sure…I can definitely sing the “Frozen” theme song with your kid the next time you visit:)

Many blessings and happy, healthy babies to you all! Feel free to email me at wombviewerblog@gmail.com with any questions or comments!

wwavblogger, RDMS

wwavblogger, RDMS

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Posted on December 15th, 2015 by wombwithaviewblog.com

We’re now into single digits! Tonight’s post will be short and sweet. Day 9 of Baby’s First Christmas gets us one day closer to Santa’s arrival (and Baby’s) with yet another idea for storage under the tree in fancy paper and bows.

Maybe you already know whether you are expecting a son or daughter and have already begun to fill the closet with some of your favorite outfits. Perhaps spending a little too much time at your favorite children’s boutique? Nonsense, right?

Maybe instead you have a cherished christening gown passed down as a family heirloom from one generation to the next. Monogrammed bloomers and bibs, smocked floral dresses and baby blue linen overalls are all adorable gifts that tell Dad or grandparents just who will be joining the family in the coming months. Of course, in my mind, nothing beats a first trimester ultrasound image but I am attempting to supply you with a plethora of unique choices!

Only once in my career did I have a couple who came to their ultrasound appointment with their children and two boxed newborn outfits, one for each sex. Instead of enclosing the surprise in an envelope as most do, they asked me to choose the appropriate color and simply tell them which box they needed to wrap. Cute idea. Then everyone is surprised on Christmas morning!

Come back tomorrow where we’ll look to pro sports for more inventive solutions to inspire the Santa in all football-loving moms-to-be!

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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 February 12th, 2015 by wombwithaviewblog.com

One of the strangest enigmas of my job is the development of my warped sense of time.  I rarely remember patient names but I do remember certain exams and images and I most definitely know faces! I might see a vaguely familiar name on my schedule, then see the patient in the waiting room and immediately put the face with the name. What always blows me away is, in fact, the length of time which has passed since they last delivered!

Case in point.. I recognized a name today, entered it into my machine and was stunned as to why the name did not pop up in the search. After all, she JUST delivered (last year, I was thinking). So, I call her back and begin my usual “so good to see you” gab and asked how old Baby is now.  “Baby”, she informed me, is FIVE! And no, not in months.  I seriously needed a few minutes to gather my composure and I’m sure she could tell by the look of sheer dumbfoundedness on my face.  It was quite amusing to her, I must say.  We both laughed and discussed how incredibly fast time flies when we are moms.

No matter whether someone is coming to see me for their second pregnancy or their fifth, it seems that almost no time has passed since their last visit.  It’s sort of like judging age; I’m getting to be terrible at that anymore, too!

Is it the long career in ultrasound serving the general public or is it our kids that make us this crazy?! Hmm..

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Posted on January 24th, 2015 by wombwithaviewblog.com

I’ve written it a hundred times..or seems like it! Someone sends me an image and wants to know if I can confirm gender. Sometimes I can tell, sometimes it’s clear as mud. I usually have to write back and give my spiel about unclear gender on ultrasound and how, because I wasn’t the one who scanned, I can’t see the whole uterus. Some images are just bad!

In ultrasound, we have either images that are beautiful which belong in a textbook and anyone with an eye for the modality can tell you what is pictured. Then there are terrible images where we just shrug our shoulders and wonder what someone was thinking when she snapped the image.

I’ll share this email from a reader and her image and attempt to give you an example here of clear vs not.

unsure mama:  Hello! I’m on my 4th pregnancy and my first 3 were clear as day regarding genders, all done after 20 weeks. But this one, however, my sonographer seemed like she was struggling to get a potty shot. I’m not sure of real fetal age due to bleeding the entire time until 14 weeks. My sonographer said the baby was breech and sunny side up? Baby was also measuring at 17weeks 4days. She hesitated but then said girl. I didn’t ask questions but I didn’t see lines or a turtle. Here’s the pic she gave me. What would you say? Any information will be greatly appreciated. I have one girl who is oldest and two sons.

image

wwavblogger:  Thanks for reading and I hope you’ll subscribe! So, like I typically say, if it’s not a perfect picture, I just can’t sign off on gender. That being said, it could very well be a girl and this just isn’t a great image. It looks like the view is one of baby crawling away from you, if you can put your imagination to work. Right above the arrow is where you would see the 3 dots, however, the dots can blur together if the image is not entirely clear.

I’ll include a link below where I show a baby girl in a similar position, just a little more to the side. Idea is the same. This one is clear and you can clearly see 3 dots here. You can also compare it to the twin brother shot in the same post, too!

http://wombwithaviewblog.com/twin-gender-update/

I don’t see obvious boy stuff hanging down like I would expect to see here!

Good Luck!
wwavblogger

***

So, girl? Maybe! Boy? Sure can’t say it’s not!

My image in the link above that I sent her of girly parts you’ll find below. Which can you see better?

female gender

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Posted on January 21st, 2015 by wombwithaviewblog.com

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

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

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

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

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

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Posted on December 23rd, 2014 by wombwithaviewblog.com

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

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

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

***

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

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

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

“Medical portion?”

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

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

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

“Oh. So they can’t come in now?”

O M G

***

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

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

11wks waving

 

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Posted on 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 August 6th, 2014 by wombwithaviewblog.com

Young kids are always accompanying their parents to the ultrasound to see their new sibling on the monitor.  Honestly, unless they are over the age of four, interest steadily declines and sometimes rather quickly as soon as the lights shut off.  Mom and Dad want them to be more interested than they truly are.  At 2 and 3 they simply are in the age of “me” and actually could care less about whether their new baby sister or brother, the one they’ll torment for years to come, can be seen on the “TV”.   Furthermore, if they do comprehend what a baby really is, the one on the monitor sure doesn’t look like any baby they’ve ever seen!

Parents try to come as prepared as possible with iPads in hand, games and snacks.  Sometimes none of it matters and they scream and carry on until it’s over or grandma hauls him out.  Every once in a while I’ll have a little visitor who is so cute, I just want to keep him with me all day.  Today I had one such little guy.  He was 3, barely understandable and so stinking cute.  The kids who are quiet are usually intimidated by the surroundings and are fearful Mom is going to be hurt.  I usually break the ice by offering them to feel the gel.  I hold out a gloved finger with a big glob on it.  I’ll make a game out of it and even if they are grossed out initially, very soon they are asking for a squirt.

Little man did just the same today.  After a bit he got comfortable with me and asked what his baby sister was doing in there. I replied she was swimming.  I didn’t understand most of anything he said…except that his baby sister was a fish.  He said it over and over and over again.  And the more we laughed, the more he said it.  Of course, he knew he had a baby sister in there before anyone else did.  I swear I just think they have a connection with one another!  We confirmed it was a sister and he kept reiterating “Baby sister a fish.”

I gave him his very own picture of Baby Sister to keep for himself.  Kids just love that and I made a new little friend.  He walked out of my room and looking up at me with a big smile kept repeating all the way down the hall that his baby sister was still indeed a fish.  Too darned cute!

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Posted on August 3rd, 2014 by wombwithaviewblog.com

Well, we’ve seen this sign many times on a number of establishments open to the general public..but a doctor’s office??  After many moons of serving the obstetrical and gynecological needs of women near and far, we didn’t think we needed to..until last week, that is.

There are many signs we expect to see when visiting our physicians:  Sign In Here, Check Out Here, Payment is Due at the Time Services are Rendered, Please Turn Off Your Cell Phones Because We Can’t Hear Ourselves Think (wishful thinking on that one). We’ve never really had to address the issue of our patients being fully dressed.  Last week I called my patient’s name to take her back for her ultrasound in the usual fashion and she requested I wait until she stepped out the door to our entrance where she proceeded to yell for her friend to “Hurry up!”

I try not to judge too harshly the way someone is dressed.  You don’t need to be a fashion plate who just stepped out of Milan for your doctor’s appointment and scrubs are a far cry from haute couture.  Most people, however, do tend to at least bathe and wear something from the closet instead of the hamper.  Not these people.  I had an idea of what might be in store when the friend stepped inside and I was right.  She had that partied-all-night and slept-in-my-makeup face and the hair..let’s just say a brush had not seen that head in about a week.  She was a literal hot mess. Though this surprised me just a tad, I was totally not prepared for her naked feet.  Yes, just-walked-across-the-parking-lot-outside-with-no-shoes feet.  Grocery store feet, as the adults in my family called them when I was a kid.  It took me a while to figure that one out but it makes all the sense in the world, right?  Can you imagine how black your feet would be if you went bare-footin’ around Wal-Mart?  God forbid you have personal experience with this but, if you do, I apologize now for the insensitivity.  If you can stop in for groceries, you can take a sec to swing by the shoe department and pick up an $8 pair of flip flops.

Just so you know, as a medical facility we perform procedures in our exam rooms and utilize red bags for biohazard trash.  Sometimes we have spills on the floor that we have to clean in a particular way to disinfect but, much like Wal-Mart’s floor, it’s probably still not a surface you’d want to really come in contact with.  Well, most of us feel that way.  Not to mention that hundreds of other people have traversed the area with all kinds of things on the bottom of their shoes.  I never really thought that required explanation.

Needless to say, the rest of the appointment was just as interesting, but not nearly as much as the expressions of everyone else in the waiting room as she passed by.  Note to self: try to keep that poker face in check.

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Posted on August 1st, 2014 by wombwithaviewblog.com

I’ve discovered there is an understandable progression of waning interest in ultrasound as a pregnancy advances.  It’s true!  It’s especially true of those moms who are forced to visit us every single week after 32.  The natural order of excitement goes a bit like this:

  • How soon can I have my first ultrasound? – Asked from pee stick positive and the first doctor’s visit

 

  • How soon can I have my next ultrasound? – Typical inquiry immediately after the first ultrasound

 

  • When can we look again? – Asked as soon as the gel is wiped off after the 18-20wk screening

 

  • Do I get another one? – Mid to late 2nd trimester

 

  • Oh, yay!!  I get to have ultrasounds every week!! – Early 3rd trimester

 

  • This is so great.  I can’t wait to see her every week! – This goes on for a few weeks

 

  • What?  Do I really have to come in twice a week?? – Response to bi-weekly Biophysical Profiles until delivery

 

  • This was fun at first but I’m getting tired and my feet hurt. – One month left

 

  • Okay, poke me with a fork, I’m over it.  – The dreaded final two weeks

 

It’s so funny to me how parents positively can’t wait for ultrasound in the beginning. Some ACTUALLY argue with their physicians to have scans early (you know they have to plan that gender party!).  Initially, it’s so surreal that this is YOUR baby and you can actually see the heart beating.  Incredible.  You think it’s something you could positively NEVER tire of watching.  Tis not true..  After a while, especially if Baby never cooperates with cute face shots, the family quits going with you and all the fun oozes right out the door.  It’s just the same gray clouds over and over again, not to mention the belly is growing ever bigger and your piggie toes are swelling like little sausages.  You’re just done.

It’s okay to feel that way and I promise I won’t take it personally that you are sick of seeing me every week!  “Oh, no, not you again.”  We get it.  The gel has dried up and you can’t see below the equator anymore..  I do believe the Man Upstairs or Mother Nature has a way of making pregnancy miserable for most of us toward the end.  If it didn’t get tough, we would be too happy with baby inside and too afraid to face the unknown of labor.  Peeing on ourselves seems to be the last straw.

Gray and white is cool but color is better!

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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!

SONY DSC

boy and girl gender determination

 

SONY DSC

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 13th, 2014 by wombwithaviewblog.com

I think not. I was mailed a flyer from a 3D ultrasound businesses who offer 3D franchises and ultrasound education in a matter of days for anyone off the street with no prior ultrasound knowledge or training. The goal? To start their own entertainment ultrasound business. Before this, I had no idea such a business was even legal.

Firstly, I don’t want anyone to believe this nonsense. As a certified sonographer of over 23 years, I feel confident enough to say that no one can adequately learn ultrasound well enough in days or weeks to be responsible for the moms and babies they scan. And, furthermore, the people “teaching” haven’t learned it, either.

To Those Who Are Not Qualified to Scan..

Make no mistake about it. Waiver or not, if you scan a pregnant woman for fun and miss gross pathology, you can still be the subject of a law suit. Contrarily, how would you handle seeing something you feel is abnormal or you cannot explain? What do you say to the patient? Would you even know if a problem existed? If you do not have experience in the medical field, you also have no idea how to address a mother-to-be with a fetal abnormality. Most of us only get slightly better at breaking terrible news, but it is never easy. It is always a sad and difficult scenario. This unfortunate experience will inevitably be yours at some point. How do you explain to your this to your customer when you have no idea what you are seeing yourself?

Moreover, I will also add here that it takes a bit of artistry and (again) proper training and experience in order to obtain good 2D images, which are also needed in order to create good 3D images. Providing sub-standard images takes advantage of the customer paying for it, especially when they assume you know what you are doing. Anyone can set up a 60″ monitor and some comfy seating.

Good Luck Guessing Fetal Sex!

Now, let’s address fetal sex. I have what seems like hundreds of posts on this subject! These places market accurate determination of fetal sex guaranteed by refunding your money along with a gift certificate if they are incorrect. This is irresponsible. A guess too early in pregnancy is a toss-up. An expectant mom is better off flipping a coin than to pay these people to casually throw out any guess. For those of you who are entirely out of your realm of expertise, anyone can show you how to press a few buttons. It doesn’t mean that you providing a fair service or doing it well. It’s unethical, and you shouldn’t be doing it at all.

And to patients who utilize these facilities, please be sure to ask if the person scanning you is a certified sonographer with experience and not a former used-car salesman. You are paying someone real money for this service. It’s disgraceful enough that some of these places boast they are “mom and pop” shops. In my opinion, this is only a good thing if you are running a restaurant. They either employ those who are right out of school or with no formal training at all. Please do your research. You would be better off with this elective scan at doctor’s office instead. A sonographer there is far more likely to detect a problem if one exists. At least your doctor or another physician would be in-house to discuss it with you and answer your questions.

Please Do Your Research!

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

Even though this can be a fun experience for the family, the potential for serious issues is real. Please do your homework first, educate yourself, and make an informed decision. Giving these places your hard-earned cash may not be worth your while.

Comments: 3 Comments »

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 11th, 2014 by wombwithaviewblog.com

We all know that our family and friends can be quite nosy, opinionated and sometimes even rude when it comes to all things pregnancy related.  After all, they’ve been there and done that and they know better than you because this is your first and you know absolutely “nothin’ ’bout raisin’ them babies!”  Hopefully, they don’t really speak like that.  I’m sorry if they do.  That is, sorry if I offend and sorry you have to listen to it.  (lol)

In the course of conversation during a scan, especially with my weekly patients, we glide from the political correctness and appropriate medical office pleasantries to cutting up about life happenings.  My patients take this opportunity sometimes to vent about just such personal offenses.  One of my readers recently did the same!  Read on about her dilemma..

irritated mama:  Hello!  Firstly I would like to say what a great blog you have and I’ve really enjoyed reading it.  Secondly I’m wondering if you can take a look at my scan pic from my 20 week scan. I’m now 25 weeks. We didn’t find out the gender as my husband didn’t want to but his family are convinced its a boy from the scan pic and are even calling it a he which is quite annoying.  I’m just wondering is there anything on this scan pic that confirms the gender? Obviously we didn’t get a potty shot.  I hope you can help.  Thanks

unnamed

wwavb:  This email cracks me up as you are not the first to be annoyed by in-laws who think they are ultrasound aficionados!  Everyone is suddenly an expert.  You’ll be happy to know gender is nowhere to be found on this image!  It’s a great side shot of Baby but when you get down to baby’s bottom, part of the hip is in the pic so it’s not a side shot between the legs.  So, now you can tell your in-laws to mind their own biz! Ha ha.

Best Wishes!
wwavblogger

irritated mama:  Brilliant thank you – that settles it I will tell them haha!

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So just know, all you pregnant moms out there with in-laws who are driving you to drink..firstly, wait until Baby is born and secondly, you have to stick up for yourself!  There are nice ways to say anything so next time your mother-in-law (who doesn’t know what a femur is) attempts to read into your ultrasound image, kindly thank her for her oh-so-professional opinion and say something like “Wow, you are so good at this. Maybe they should let you do my next scan.”

Yes, I am a smartass at times but I blame it on my brother, the ultimate King of Smartassness, one-liners and wisecracks.  It’s a crown he wears proudly.

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Posted on July 2nd, 2014 by wombwithaviewblog.com

Sometimes my patients crack me up with their stories and venting.  Whether it’s family, work, kids, friends or strangers ruffling their feathers, it brings a bit of humor to my otherwise medically-infused day.

I was scanning a late 3rd trimester mama who was about 37wks.  She was nearly due and ready Freddy for last call on this party.  She was huffing and puffing about how tired she was, how more ready she couldn’t be and how frustrated she was with her spouse and the lack of help.  She says “And, ya know, husbands just SUCK now.  The first time around it was all ‘Let me rub your toes’ and now I look over and he’s snoring.”  I had to gut laugh with her…husbands just suck.  She was so disgusted AND so funny.

All I can say is don’t mess with a mama laden with full-term hormones!  You’re simply on the losing end of that battle.  Make her happy, give her what she wants, pamper her in any way you can, Spouses!

We all know that when mama is happy, everybody is happy 😉  And don’t you forget it!

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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!

Comments: 2 Comments »

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.

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This is our swimming ool.

Notice there’s no p in it.

Let’s keep it that way.

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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 28th, 2014 by wombwithaviewblog.com

Has anyone ever heard this term before??!  I have never heard it in my life until this week and twice at that from two different patients.  The first was from a new patient and the second from one of my favorite couples ever.  Soup coolers refers to..wait for it..Baby’s lips!  Sometimes, with a really great profile, we can get pics of some really big, beautiful lips.  I call those luscious!  Daddy called them soup coolers.  Hilarious!

Most of you know that ultrasound images can be quite magnified and so sometimes parts look bigger than they really are.  I think there’s no doubt that this baby has some of the most precious soup coolers around!  And Mom was happy to share them:)

This precious little pumpkin below is about 33wks.  The first two are 2D images and the other three are 3D.  Love ’em!

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Posted on June 26th, 2014 by wombwithaviewblog.com

I don’t get it.  Most every American girl has her ears pierced but this age of head to toe studs and bar thingy piercings has me begging the question “Why in the world there??!”  And for as attached as women are to their dangling belly stars and rhinestones, they absolutely HAVE to be removed prior to your ultrasound exam!  Sorry, ladies, they can damage the footprint of the probe which is made from rubber.  We request people take them out before they come in for their scans, but alas, some don’t and end up fighting to get them out for 10 minutes..10 minutes of precious scanning time, I might add.

I have all kinds of people and all walks of life lie on my table for a scan.  I’ve seen the eyebrow, lip and dimple piercings.  I’ve seen gages and bars and multiple hoops and rings in the ears and nose and, oh but yes, I’ve seen clitoral piercings.  Holy cow, and I’m holding my breath typing this just thinking about it, but why in the mother of pearl..???  Ooh.  or Ew.  That’s all I can say about it.  I’m sorry if I offend anyone with such metal in her nether regions and I’ve heard stories about WHY they are obtained.  Just know that I shudder only because it’s something I could never and would never do in a million and five years.  No way.  No how.  To each his own and you are more woman than I.  That being said, today was a first…

So, as I am draping my patient and tucking the green paper into her undies, two barbell piercings with a ball on each end are revealed on her pelvis just inside her pelvic bones.  Huh?  Just looped through the skin.  Why in the world would anyone put them there?  (or anywhere, I’m thinking) But on your pelvis?  What’s next, the elbow?  I’ve seen some crazy tattoos down there (enough for another post all by itself, believe me) but never a pierced pelvis.

You know, it’s funny to think about but it will precisely be those people who so adamantly require their metal in odd places that will give birth to a child who will grow up repulsed by them!

Remember, all you pierced mamas out there..belly rings OUT prior to your ultrasound!  It’s just more time you’ll have to look at your little pumpkin 🙂

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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!

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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

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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 29th, 2014 by wombwithaviewblog.com

I have to laugh, quietly to myself that is, when patients have gel-phobia. Not only do they have to wipe off all traces with numerous drapes, but they also need tissue..then feel their bellies..then more tissue..then feel again. Finally, they say it’s time to redress then..oh, wait a minute..”I missed a spot in my belly button.”  More tissue. Then they’ll go to the sink and wet some paper towels and wipe some more. After that, these ladies will move to the mirror and  make a few last swipes.

Five minutes and a half box of Kleenex later, they are finally done.  Sometimes I feel if knew these patients would take so long, I would probably have spent less time trying to get cute pics for them. It’s not mean!  But it is fact that I have 30 minutes for each patient. Anything else is cutting into someone else’s time, right?

I also see the other type of patient who could care less about gel. She’s the one who does the quasi drape sweep leaving half of it behind and then hops off the table with an “Oh, well, my doc’s just gonna put more on.”

It’s funny how different people are..always entertaining.

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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 17th, 2014 by wombwithaviewblog.com

I love receiving uplifting emails from readers!  It inspires me to continue blogging and to look for more ways to inform you about your fetus and you.  It also gives me great content to share with other readers!  I encourage all my readers, subscribers or not, to share with me your ultrasound stories, comments, images and photos of your baby!  I hope you’ll read, enjoy and subscribe to my blog to find answers for all your ultrasound questions!

Read this great email from a fellow healthcare worker:

nurse and mom-to-be:  Hello!! I must say I love your blog & wit!! Patients are so lucky to have such a skilled sonographer like you. I must say I’ve experienced both. My last one we met  (18 week ultrasound) with was great, 20+ years experience & worked with higher acuity patients, too. She respected our wishes and wrote down the sex with a picture for us to open later. She asked us to leave the room so she could analyze the image. We also asked her track record and she says she does not reveal if not sure. She labeled every body part for us and thoroughly educated us, as I’m sure you do too!!  I’ve been a nurse for 10 years so I can only imagine the questions you get!  Love the idea of your site – you really utilize your talent and help us crazy pregnant ladies!!

 Best wishes & I’m now a subscriber (&huge fan), yay!
wwavb:  Hi and thank you so much for reading and your kind words!  AWESOME!!  I’ve worked two years on content and I would love to make my site into a book one day!!  I think it would be an entertaining read for anyone and a great shower gift for new moms:)

Your great feedback was a great Mother’s Day gift, by the way!

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Posted on May 11th, 2014 by wombwithaviewblog.com

Even though the work of a Mom is the most difficult, most important and most challenging job you’ll ever have, it is also the most rewarding. The time and effort you put into your children will reflect when you see them become productive, loving and passionate adults.

Whether you are fortunate enough to be a stay-at-home Mom, one who has chosen to work hard to educate herself and built a career or one who has to work to support her family, know that what you do for your children is important on an every-single-day basis even though it is only really validated once a year.

I can say as a working Mom my children’s entire lives, as much as I would have loved to stay at home with them while they were small or even work part-time as they grew up, it just wasn’t an option for me.  I had to support myself and my children.  No one else was going to do it.  Balancing it all and maintaining my sanity was a daily chore.  Thank God for the help and support of some great care-givers along the way.  Not only could I leave my babies knowing they were being taken care of, but my children learned that someone else could care for them, too, in my absence.  We loved her and she loved us.  Even though I couldn’t be with my children the way I wanted, out of it grew a love none of us would have otherwise experienced.  Your children will have many teachers in life; you are the first.  Teach them what love looks like so they know the difference between the good teachers and the bad ones.  

I’ve enjoyed a long career and I’ve learned so much that has helped me become a better care-giver to my patients over the years because I’m also a mother.  We wear many hats and sometimes you don’t realize how all those hats help you help others.

My kids think I’m superwoman.  They put me on a pedestal and it feels amazing.  So all of you moms out there working to bring home the bacon while raising your children, it pays off.  No matter how crazy you feel, if you always make quality time for your children, love and encourage them, it just pays off tenfold in the love they give back to you.  You also realize that what you’ve taught them can be defined as the importance of education, responsibility, resilience and accountability. To watch your children flourish as talented impassioned adults is the greatest Mother’s Day present of all 🙂

And it all starts here:

Baby A 8wks

Thanks for reading my blog and being a part of my life.

HAPPY MOTHER’S DAY!!!!

wwavblogger

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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!
unnamed
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 May 7th, 2014 by wombwithaviewblog.com

You just cannot compare your pregnant belly to anyone else’s!  Though some so-called friends and family may try and though you may receive tons of unsolicited opinions, pregnant bellies are as different as people are different.

If you are fortunate enough to be tall and lanky with a long torso, your uterus will have more room to grow up instead of out.  This sounds like a blessing and it is physically.  But it usually results in women who don’t show very much and end up getting hit with a barrage of questions like “Are you sure you are eating enough?” or “Is your baby too small?” to comments like “You need to feed your child.”  Patients come in for their ultrasounds worried about the growth of their baby because of comments from idiots like these.

Conversely, if you are one who is height-challenged or in possession of a short torso, your poor little uterus has no choice but to grow out.  It only has so much “up” room.  These patients are usually miserable by the end of their pregancy because they tend to have bigger bellies and can appear farther along.  Sometimes, having too much amniotic fluid in the third trimester (quite common) can make your belly look bigger, too.  And, yes, of course, they get hounded with such questions all the time, not to mention the old “Are you sure there are not two in there?”.

So, if you fit either one of the above categories, you should first discuss any concerns you have with your doctor.  If your doctor says you and your baby are just fine, you have the right to blacken the eye of the next person who dares to say such to your face.  Tell security hormones made you do it (I can’t condone violence but the thought is nice, right?).  If you’re not into smackdowns then think of some clever comeback to make them think twice about what a stupid comment it was they just made.  (Hmm..how about something like “Hey, how about that..my baby is almost as big as your beer gut.”)  Hopefully, they feel terrible enough that the mere presence of another beautifully expectant mom makes them turn and run for cover 😉

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Posted on May 4th, 2014 by wombwithaviewblog.com

A reader asked me recently about a “nub” pointing up or out as a means to determine gender early on in pregnancy around 12 Weeks. You might know it as the Nub Theory.

Yes, there is some school of thought regarding the “angle of the dangle” as she put it!  I’ve said before that both boys and girls each have tissue that protrudes at this gestational age.  First, imagine a fetus lying on his or her back.  Now if this little bit of tissue is sticking straight up, the thought is boy.  If the tissue is sticking straight out, as in parallel with baby’s spine, the thought is girl.

Baby Girl at 12wks, but be careful! The Nub Theory is only about 73% accurate!

12 Week Baby Girl, Nub Theory

I can tell you from personal experience that this little experiment does NOT always..let me repeat..does NOT always turn out to be correct. Sometimes the tissue is equivocal in direction, meaning it doesn’t appear up or out but half-way.

As part of early genetic testing, my co-workers and I obtained certification for Nuchal Translucency testing. During our training, the sonographer providing the training stated that sex determination is about 73% accurate when Baby’s position is perfect. Hmm, is that really enough of a percentage to rely on to paint a nursery? Not for me.

There was one patient for whom I had scanned all five of her pregnancies. She wanted me to guess at 12 Weeks, and we talked about how it was early and the Up or Out Theory. Baby’s “stuff” stuck straight out like a little girl, no question; no equivocal findings, no halfway nub. Just like in the above image! Textbook finding for a baby girl as defined by the above method.

 

Boy, oh boy! Were we surprised at her anatomy screen! And I mean boy! His parts were very easily seen. No doubt. After this, I never guessed at 12 Weeks again!

My patient didn’t really care which sex she had. They had boys and a little girl so they were thrilled either way.  But I will caution the patient who is strongly desiring one sex over the other. You do start to become emotionally attached to this “supposed” baby boy or girl and if it’s determined later that the info is incorrect, patients tend to be sad for the sex they “lost”. So, for this very reason, I’ll stick to my guns on gender prediction before 18 Weeks.

And now you know why!

So, I’ll say it yet again..NOTHING, absolutely nothing in life or medicine is ever 100%! 😉

Comments: 2 Comments »

Posted on May 2nd, 2014 by wombwithaviewblog.com

What’s the purpose of the gel?

Ah..that amazing blue stuff..sometimes shockingly cold, oftentimes warm like a comfy blanket but always messy and usually hated by Mom.  Ultrasound gel gets everywhere, it takes a few drapes to get off, it feels tacky until it dries but no one will have an ultrasound without it!

The role of gel is two-fold:  one, obvious to most, is that it allows the probe to move smoothly over Mom’s belly; second, it actually, and most importantly, helps to conduct the sound waves.  No gel, no see!  Ultrasound cannot travel through air or gas.  Without the gel, there lies a bit of air between the probe and skin which produces no image on the monitor!

I did this little experiment one time for a patient who asked and she was pretty amazed.  It’s really cool, actually..touch the probe to the skin with no gel and all you see is black.  Add a little gel and voila’!  Baby.

So, there you go.  Another lesson in Ultrasound 101.

Have a great day and a healthy pregnancy 🙂

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Posted on April 30th, 2014 by wombwithaviewblog.com

Is there a dedicated dress code for your doctor’s office?  Probably not but there should be in my opinion.

It’s like one of those things you should have been taught as a kid..eat all your vegetables, dress warmly when it’s chilly out and stay out of the mud with your new shoes.  Someone should have also taught you to dress decently when you go anywhere.  It’s bad enough that the “People of Wal-Mart” (have any of you seen this site??? – in a word..unbelievable) appear in public in such a way but I’ve always felt a little higher standard is required for places of professional business.  Am I wrong here?

Please leave the pink fuzzy slippers at your bedside.  PJs are meant to be worn to bed only and if all you have in your wardrobe is a dirty t-shirt with holes then, by all means, just make sure it covers your body so that flesh is not hanging about for all to enjoy.  Sometimes, it’s simply a matter of pulling up your pants all the way.  And, no, I’m not talking about guys here..pregnant adult women who should know better.  You should have been taught this fundamental at age 2.  I guess it comes down to the social complexity that some people just don’t care how they look.

It’s a shame..mostly because they are bringing someone else into the world to whom they will need to teach to care about pride of self and personal appearance.  I guess my overall message here is to just bathe, find something clean to wear and cover your body with it appropriately.  If you care about how you look, you just might feel better, too.

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Posted on April 29th, 2014 by wombwithaviewblog.com

Sometimes it’s just effortless, well with the exception of trying to get this baby girl to just turn over!  We asked, she listened.  What a good little baby!  The result was just great imaging.  She was 27w3d here which is an optimal time for a 3D scan.  Babies have begun to develop some fat in their skin so cheeks look a little more plump now.

What you’ll see here is a great 2D facial profile, which is ideal for great 3D images and then two really sweet 3D images.  Mom was happy to share:)  She’s a keeper!

2D facial profile

 

SONY DSC

 

SONY DSC

 

 

Comments: 2 Comments »

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

unnamed_2

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 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.

Comments: 2 Comments »

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 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 8th, 2014 by wombwithaviewblog.com

Every healthcare provider knows that nothing in medicine is 100%…but somebody forgot to tell this joker.

I still can’t believe some of the emails I actually get from expectant moms who’ve essentially been promised the gender-equivalent of the moon and stars based on crappy images…and I don’t mean a little crappy. Who taught these people to scan?  One of the things all students should learn in ultrasound training is that any image one takes, another (reading professional) should be able to look at it and know what it is that he or she is seeing.  The perfectionist that I am scans (sometimes too long), striving for the perfect shot with just the right magnification, contrast and clarity with a “no question” angle.  Often times, it just ain’t gonna happen, but this is my goal!  It kills me when I see terrible images like these…and I don’t mean simply for gender.  There are a hundred other fetal parts that deserve the same attention to detail.

Moreover, most are WAY too early in their pregnancies to make such big commitments regarding Baby’s sex!  We’re talking 15-16wks here. No, it’s not an impossible task and I’ve done it myself before but the best of all imaging circumstances must be in order to make such a bold determination.

Read below an email from a reader who has experienced this very situation:

reader:  Hi! I just found your site and I love it! I was hoping that you could just reassure me that what we are having is a little girl? My ultrasound tech said that he was 100% sure it’s a girl because there were definitely no boy parts. But I just wanted a second opinion! Thank you so much!

unnamed unnamed_2

 

I took one look at these images and thought, ‘What the..?’  Really.  Are you serious.  No sonographer with any level of adequate experience, especially those who specialize in OB, would ever dare to label this a girl OR a boy MUCH LESS to seal it with a “100%”.  Maybe this is why the image isn’t annotated!

I could tell the fetus looked a little small..aka early gestational age ie, too early to determine gender..of course it was!

wwavb:  Holy cow!  All I can say is DO NOT paint a nursery based on these images!!!  And I would be leery of any sonographer who calls anything 100%!  First cardinal rule of ultrasound..nothing in medicine is EVER 100%..  It makes me crazy when patients are given images like this and told it’s a definite!  This is precisely how mistakes with gender determination are made.

 First, I have to know how far along you are.  Based on the images, I’m guessing pretty early??  Now, I don’t want to burst your bubble and this is not to say that you are not having a girl..let’s be clear.  I’m simply saying that determining girl by those images alone is impossible. I did not see your scan live.  However, these are not textbook images for girly parts.  Check out my link below to see a much better image of girl stuff!  It was sent in to me by a reader..
http://www.wombwithaviewblog.com/jenas-sweat-pea-update/  (it’s the second image you see that says “GIRL” on it)
Send me an image later on in your pregnancy and, hopefully, it’s better than the ones you now have.
Thank you so much for reading my blog, writing me and I hope you’ll subscribe for future posts.  Also, follow me on Twitter!  So glad you are enjoying!
Many blessings for a healthy baby,
wwavblogger
***
Ya know, I can’t teach the world to scan.  But maybe I can nip some mistakes in the bud..one crappy disheartening image at a time.

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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!

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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!

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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 23rd, 2014 by wombwithaviewblog.com

Patients typically find out about this the hard way.  They seek medical attention and end up with a terrible reaction to latex that they didn’t even know they had.  Whether the unwanted outcome is hives, swelling or itching..none of it is fun!

Of course, we exercise universal precautions when performing ultrasound examinations..we wear gloves with every patient and wash hands when removed.  We have signs throughout the office, as most places do, reminding patients to let us know when latex is a problem.  As one less thing I have to remember, I simply use vinyl gloves instead.  They do not have as much “give” as latex gloves but get the job done, nonetheless.

Most of you ladies are familiar with transvaginal ultrasound exams.  Pregnant or not, if you’ve ever needed a pelvic evaluation with ultrasound, it’s probably been performed with this approach.  One of my very first posts was about ladies who have had this done for the first time and their subsequent reaction.  I usually get the big saucer-like eyes and hilarious commentary!   Here is a link to that one along with a picture of the “said” probe…(you may need to drag this link to your browser)

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

So, even for these exams I use a glove instead of a condom.  Again, it gets the job done but it looks pretty funny.  I usually insert the middle finger of the glove over the probe, leaving vinyl fingers flapping around.  Patients typically do make comments about this or laugh.  Hey, we have to make comedy in medicine wherever we can find it, right?

Next time you find yourself about to come in close personal contact with a transvaginal probe, ask your sonographer about the cover if you have a latex allergy.  Down South is not a place you want to discover you have one!!

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Posted on March 21st, 2014 by wombwithaviewblog.com

It always cracks me up when grandmothers-to-be come in for a sonogram visit.  They tell you how excited they are, that this is the first time they are seeing their grandbaby and they just can’t wait.  I start my examination and the funniest part of this whole experience begins..they talk to their grandchild as if he or she is already here.  And it’s hilarious.

It’s the “coochey coo” in the baby voice and “Nana’s here!”

Also, it’s “Come on, turn for Grandma.  Let’s see your precious little face..come on, come on!”, as she pokes on mom’s belly.

I think at some point she forgets that there are only adults in the room and she continues her entire conversation for the duration of the scan with the baby voice.  “Nana came just to see you today.  She had such a long flight and mommy has that room all ready and we all just can’t wait for this baby to get here.  It’s so cute, yes it is, yes it is.  Let Granny see that baby.  Oh, look at that little ear.  Oh, those toes are just so precious.  Can we tell what baby weighs, today?  It’s Granny’s precious baby…” and on and on.

Keep in mind I’m still trying to do my job and undeniably distracted but you gotta love Grams.  She’ll teach your child all kinds of great things, spoil her a little and provide unsolicited advice for child-rearing for the rest of her life but she’ll be there in a pinch.  I hope I can be that kind of pain in the ass one day when I’m a Nonna, too.

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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 16th, 2014 by wombwithaviewblog.com

So, any of you ladies out there who are old enough to have visited the Gynecologist at some point in your lives are familiar with the fanciful attire we have you wear.  “Okay now, undress from the waist down and cover up with this!”, as we point to the green paper drape on the table.  We’re women, too..we get it.  This is not a visit to the spa and no woman enjoys scooting to the edge and setting her feet in stirrups.  Alas, it has to be done if we are to properly take care of our person.  And we do understand that people who are pregnant look WAY more forward to doing this than those of us who are not.

Funny story about those paper drapes:

So a little old Asian woman is on my schedule for an ultrasound.  She barely understands English and speaks it very brokenly.  She nods as if she understands the instructions for getting undressed so, very unsure of this, I step out and give her a minute.  When I re-enter..relief!  Ah, yes, she understood and did just as I asked.  She must comprehend way more than she can speak.  I proceed with her examination and when all was done, I give her instructions again on how to clean up, get dressed and come outside into the hallway so I can show her where to wait and be checked in for her doctor.  She nods (many times) in understanding.

Let me pause here to explain that as I am waiting for the patient to dress, I am just outside my door furiously making notes on my images to ensure a complete and accurate report and circling diagnosis and procedure codes for my billing slip.  The patient opens my door to leave, I look her in the eyes and smile to say “thank you” and she says it back. I direct her to the waiting room and hurriedly look back at my notes.  I proceed to my room for clean-up and to begin writing my report of the exam.

A few minutes later, one of the MAs (Medical Assistants) comes to my room and asks why my patient is sitting in the waiting room covered with her drape!!!  H O L Y  C O W!!  Yes, she did.  She exited my room without getting dressed, with the drape still around her waist and I didn’t even notice!  Poor thing obviously did not quite comprehend ALL her exit instructions.  You know, Mandarin translator I am not but you never really EXPECT for a patient to walk out of an exam room with no pants.

Half naked for your test is one thing.  Half naked in the waiting room?  Probably not a good trend to start…

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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 13th, 2014 by wombwithaviewblog.com

Some patients do not have a filter.  Seriously.  Sometimes the information they divulge is hilarious.  Sometimes it’s unbelievable.  Most often, it’s just too much information.  Regardless, we have to master the poker face  (pa pa pa pa poker face.  I’m sorry, I couldn’t resist.  Love her, hate her, meat dress or not, you have to admit she is an amazing talent).  Ok, so enough pop culture and back to TMI..

No, we can’t determine to the day when it was exactly that you conceived, much less pm vs am.  Your sonographer doesn’t need to know you slept with two guys in the same day so you’re just going to wait and see what color the baby is when you deliver to determine paternity…good job.  (Yes, this happened.)  She also doesn’t need to know you had to call the cops on your crazy mother or that your FOB (father of baby) used to date your sister.  TMI.

We don’t need to know what things you put in your vagina, unless of course, they get stuck up there and that is the reason for your visit.  Even still, this information may be necessary for your doc but it’s not something you have to share with me.  Really.  TMI.

There are many other things the entire office, including staff and other patients, also don’t need to know..like what’s going on in your custody battle, that you’re two months late with your car payment or what’s on the grocery list for your post-PAP Smear errands.  And nobody cares who posted what on Facebook.  Some things can just wait until you leave your doctor’s office and nobody wants to hear it.  This is simply one of those places in which cell phones should be banned.

There is such a thing as Doctor Office etiquette; let’s keep it on a need-to-know basis, people.

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Posted on March 12th, 2014 by wombwithaviewblog.com

Several times a week after I squirt gel on a belly, I usually get a surprised “Wow, that was warm!” or “I thought that was going to be freezing!”  Most doc’s don’t have gel warmers in their exam rooms so most people are pretty surprised when I point to the electric warmer plugged into the wall.

I’m pretty amazed when people say they’ve never heard of such a thing or that it’s such a great idea.  Yes, it is, as a matter of fact!  But the truth is they have been around for longer than I’ve been a sonographer, so new they are not.

Gel, at room temperature, does feel like ice.  Aquasonic 100 is the brand that practically monopolizes the gel industry.  It possesses just the right degree of viscosity that it pretty well stays where you squirt it without running down the sides of mom’s belly, the way mineral oil used to do before gel’s inception.

We go through a gallon or so per week!

Funny gel story:  We sonographers typically hold the bottle upside down and shake, like attempting to coax out that last ounce of ketchup for your fries.  I once did this with a bottle directly over mom’s belly..and the cap wasn’t screwed on entirely!  Yep, you guessed it.  The cap catapulted onto mom’s belly along with a half bottle of gel.  Oops!  :/ Fortunately, she wasn’t hurt and we ended up laughing about it!

 

 

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Posted on March 9th, 2014 by wombwithaviewblog.com

It’s positively amazing to me the power of the fetus.  Our children can melt our hearts in a way no one else can.

So, as a follow-up to my last post, the very same couple who left our office like fire-breathing dragons melted like a hot knife in butter the very second they saw their baby on that monitor.  Total transformation.  It was ooh’s and ah’s and oh-my-gosh-did-you-see-that’s.  It’s hard to stay mad when you watch your unborn child bouncing around in there like she is on a trampoline.  It’s pretty cute.  And incredible.  And surreal, especially if it’s your first.  The awe you feel is an understatement.  Considering what happened the day before (I, fortunately, was not there or witness to the wrath), I decided to play up the moment and took a little extra time to point out flailing arms, hands waving hi and 10mm feet.  Seeing a little nose and lips pretty much sealed the deal.  They were totally in love and forgot all about the circumstances surrounding getting their appointment made in the first place.

In this business, you have to learn how to diffuse a situation with calm words, a smile and professionalism.  When that doesn’t work, Baby will take care of the rest 🙂

Jena's Sweet Pea

 

SONY DSC

 

SONY DSC

 

SONY DSC

 

These are pics that not just a mom can love!

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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 18th, 2014 by wombwithaviewblog.com

When your feet are in stirrups.  Is there anything really so very important to text about when your feet are in stirrups and a probe is in your vagina?  I think not.  And are people really so tied to their technological communication with other people that this is absolutely necessary during a medical examination?

It’s also rude for other people to be texting during your examination.  It’s distracting and the phone should be off.  This is a time to focus on your exam or for your friend to hold your hand.  If he/she wants to text, they can go back out to the waiting room.

Pregnant or not, there is a time to put away the phone…while you’re behind the wheel, while having your teeth cleaned and any time you’re half naked with feet in the air.  Just sayin’.

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Posted on February 16th, 2014 by wombwithaviewblog.com

Why do some people have great ultrasound images and some look like fuzz?

Most people know that ultrasound uses sound waves, basically sonar (like a fish finder!) to obtain images.  The sound waves leave the probe, travel through the gel, through skin, fat, muscle, through the uterus and fluid, through Baby and then back up again.  Voila’.  An image is seen on the monitor made up of all the things the waves hit along the way.

The sound waves travel great through water, in this case, amniotic fluid but they slow down as they travel through tissue and don’t travel at all through bone, air and gas.  This is why ultrasound has some limitations and can’t see everything. This is also why we use gel. It acts as water to help conduct the sound waves. Without it, a thin layer of air exists between the probe and skin producing no image…or very little.

Sound attenuates as it goes further into the body..that is, it loses power.  So the deeper the sound waves have to go to get to Baby, the less power they have by the time they get back and the poorer the quality of the image on the monitor.  When a thin person is scanned, the sound waves don’t have to travel very far which usually produces a phenomenal image.  When a heavy person is scanned, the sound has farther to travel and it loses much of it’s power on the way down so it then has very little to send back up to the monitor.  It is simply Ultrasound Physics 101, though we can absolutely not undermine the VAST complexity of this subject to call it simple.

Other things interfere, as well.  If Baby is facing your back, we see very little, especially in the way of cute images.  Maternal intestines or bowel loops contain air and gas and we can’t see past that, either.  For some patients, it is an unexplained body type issue.  I have scanned thin people that ended up a terrible scan and heavy people where I thought I’d see nothing but ended up getting great images.  It all just depends on how much and what kind of tissue lies between the probe and Baby.

It hasn’t happened very often in my career, but every once in a while I’ll get a patient who is not thin and snaps at me because I’m not getting great images for her.  She’ll say something like “My friend had an ultrasound done and HER pictures were great. These aren’t very good at all.  Can’t you get better ones?”  …Like it’s my fault and I am intentionally slacking off or just don’t know how to get these great images like her friend got to take home.  I can’t say what I’d like to here.  Some patients will ask “if their fat is getting in the way” and I’ll just explain the above and that it can interfere…I’d never want to hurt a patient’s feelings.

So, there ya go.  A little ultrasound education on a Sunday never hurt anyone 🙂

 

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Posted on February 13th, 2014 by wombwithaviewblog.com

This is an epidemic for most all moms-to-be.  For some reason, the hormones kick in and we can’t remember shit.  No, that wasn’t a professional statement but, nonetheless, very true.  I see it a lot at work when patients are given a cup as they check in.  You know the one.  Pee in it and put it in the little door in the wall.  It is necessary.  Your doc will need some before every visit and sometimes we need an empty bladder for your ultrasound.

I laugh at how many times I’ve called a patient’s name and she gets up with cup in tow.  The same story always follows.  “I can’t believe I did this!  I had the cup in my hand, totally peed all the way and then realized I was still holding the cup!  I swear, I can’t remember anything since I’ve been pregnant!”  Yep, pregnancy brain.

I’d like to say it’s temporary but I really don’t think it is.  You might have a chance of remission after the first pregnancy but forget it after the second comes along.  What happens after that are things like running around the house looking for your car keys with a kid on one hip, grabbing the hand of the other while pulling her lunch box off the counter with your teeth, sweating bullets because you should have left 5 minutes ago and nobody is even buckled in the car yet only to realize they were in hand the whole time.  Oh, yeah.  Wait for it.  It WILL happen.

So, this wasn’t so much ultrasound-related but job-related as pee in a cup is a daily routine.

Until next time!

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Posted on February 11th, 2014 by wombwithaviewblog.com

A phenomenon that always amazes me is when parents say nothing to me during an exam..absolutely nothing.  Call it nerves, anxiety or plain old anti-social-ism at its finest.  A history of miscarriage in an early dating scan is totally understandable and I have discussed this in other posts.  I’m talking about patients who don’t say “Hi” back when I call their names and introduce myself.  They don’t return the smile.  They don’t ask questions.  They don’t make comments.  I get her set up on the table..no conversation.  When I point out different areas of baby’s body, they have nothing to say.  I usually get “wow, that’s so cool” or “that’s amazing” or “I had no idea you could see all that”.  Nothing.  Silence.  I sometimes look over to see if they are simply taking advantage of the ambient lighting to grab a quick power nap or if they’re just unconscious…maybe I missed an opportunity to call Code Blue, too focused on Baby’s great profile.  I shouldn’t jest but COME ON!  How often do you get to see your baby in utero, for Pete’s sake?  Do I have to break out the paddles for a reaction?  Sometimes, I guess so.  Every once in a while I’ll get the patient who will talk to everyone in the room BUT me, like I’m non-existent.

Then, I finish up with the exam.  I give her a drape to wipe off the gel and tell her she’s all done.  Nothing.  I give her cute pics of Baby.  Nothing.  Sometimes I get a “Thanks” barely muttered.  I guess it’s better than nothing..which I also get. At this point, I’ve never been happier to end an exam and show people OUT of my room.  Thankfully, this scenario doesn’t occur on a regular basis.

Just when I think I’m ready for some interaction with my next patient, I see she has her screaming two-year-old, not in a stroller who throws food all over my room and tries to get into the biohazard trash. A day in the life..

See!!  I told you people it’s not all glamorous!

 

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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 6th, 2014 by wombwithaviewblog.com

One of my readers sent me a few images of her baby boys!  Enjoy!  And please share yours, too!

 

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Cute profile!

 

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I love baby feet:)

 

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Thumbs up, dude.

 

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NO paparazzi!

 

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A great profile!  He’s contemplating what he’ll do first today.   Hmm..so many options.

 

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Oh, I think I’ll just nap..

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Posted on February 4th, 2014 by wombwithaviewblog.com

Calling all readers!

Everyone, especially me, can really appreciate a great ultrasound image.  So, send me some!!

If you are in possession of really great ultrasound images, please email them to me and I will share with the world.  If you have a great profile or 3D image of your baby’s face, great 2D images of hands, feet or funny things your baby did during your ultrasound, please share!  By the way, you know they’re great when your sonographer tells you so!

Most people love an opportunity to ham it up and, sometimes, so does your fetus!  Show us what you’ve got.

If you don’t have pics but burning questions instead, just click the “Ask Me” page.  Remember!  I’m not your doc and cannot give medical advice but I’ll do my best to fill your brain with ultrasound knowledge.

This was a great profile of Megan.  She’s now about 6 with long curly locks and beautiful:)

SONY DSC

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Posted on February 2nd, 2014 by wombwithaviewblog.com

We start to see the very beginnings and ever-so-slight movements of Baby at about 8wks…when they look like the image below:

SONY DSC

 

You’ll see on the image that they are only about 15mm at this point!  If you watch closely, you’ll see the tiniest of movements which is so amazing to watch considering they are still just little gummy bears at this gestational age.  Each week after this they just keep getting monumentally bigger and movements become greater until they’re bouncing around like little jumping beans at about the 11-12wk time frame.

Most people do not get an ultrasound examination for every week of gestation in the first trimester.  If you don’t, consider it a blessing; it means your pregnancy is uneventful.  Uneventful in a pregnancy is a GOOD thing!  However, if you do and if you are 8wks or so, be sure to watch for Baby’s first wiggle:)  It’s so cool!

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Posted on January 29th, 2014 by wombwithaviewblog.com

For all of you who read the link below and got a kick out of trying to make heads or tails..or a wee wee..out of Giselle’s gender pic, read on for her update!  For those of you not familiar, click on the link below to see the initial post.

 

http://www.wombwithaviewblog.com/?p=543

 

Giselle wrote back with the happy update, and (might I say) a one hundred times better image of her baby boy than that 2D square of visual snowstorm she was initially given as a gender pic!  See the recent image below..

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Now, that’s a proud a little boy and a great ultrasound image to boot!

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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, it’s just that all the components of pregnancy did not develop properly enough for an embryo to start growing.

We, of course, perform a transvaginal ultrasound and what we typically see is a gestational sac with nothing inside of it.  We measure it which is the only estimation of gestational age we have without an embryo to measure but we know that at about 5 1/2wks we should see a yolk sac inside of the sac like below.

New Beginnings

5w5d gestational sac with a yolk sac within

Or an early twin pregnancy could look like this..

Yolk Sacs

 

But a blighted ovum would look something like this..

SONY DSC

You would see the sac with nothing in it.  If the sac is measuring between 5 and 6wks, we 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.  This is expected because the hormones of pregnancy are still there and that will cause the sac to continue to grow even if there is no baby inside.

For some patients, they 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 like to not think of it as a loss but instead that Baby changed his/her mind and decided to come later.  As I always say, our babies come to us when THEY are ready..not necessarily when we are;)

Best wishes for a healthy pregnancy to all!

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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 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 18th, 2014 by wombwithaviewblog.com

Yes!  We can see hair on ultrasound!  Especially later in the 3rd trimester and especially if it is long or thick, one can see it floating in the amniotic fluid as I apply and release pressure on mom’s belly with the probe.  We can see it easiest about the nape of the neck and back of the head.  Sometimes, you may also be able to appreciate some hair on top of the head with 3D images.  Mom’s can’t wait to show off their baby’s head full of hair when they come back in to the office for a check-up after delivery.  The baby below has so much thick hair!  It looks like the white fuzzy stuff where you see the arrows pointed.  I told mom to make sure she has tons of bows and I can’t wait to see her in color:)

unnamed

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Posted on January 14th, 2014 by wombwithaviewblog.com

You would vent, too, if it happened to you.  I know, I know; I just couldn’t resist.

So, it’s a RARE occasion that a patient really pisses me off.  Yes, I said it.  She is about 21wks and she was going on and on about gender after I said I couldn’t tell and baby’s legs were closed.  It was the usual rant..

“You’ve got to be kidding me I HAVE to know today I’ve been waiting all this time and I’ll just get up and run around or something but I have to know todayCan’t you move the baby aroundThis is ridiculous!!”  I think she spouted all this in one anxiety-ridden breath without pausing for air…one very looooooooooooong and irritating run-on sentence.

And then I go on MY usual schpiel (correction says this isn’t a word) about how determining gender is never a guarantee and we can’t always tell at this age and we need total fetal cooperation and we can push around and roll you to your sides but we can’t really make baby move and it’s not the purpose of the exam anyway.

Her response??  And might I add, the pièce de résistance..  

“WELL..(sigh), can you get somebody else??!”

OH..  NO..  SHE..  DIDN’T.  Like I didn’t know what I was doing and ANYBODY else would have been able to determine what I could not.  REALLY???  The sheer audacity.  Unbelievable.  I’m telling you that NOBODY in the country, right there in that moment, could have told her what she was having.  It doesn’t take years of experience to determine that the legs are closed, the feet are curled up under the butt and the cord is in the way.  The chic is very lucky I didn’t just set down my probe right then and there, throwing my hands up with a “DONE!”  But I didn’t.  I scanned her for probably ten minutes that I didn’t have to in order to try to find what she so desperately had to know.  Alas, I could never tell for sure.

My thanks?  ..A bitch “sesh” with the nurse because she still didn’t know her baby’s sex!  (I’m being told sesh isn’t a word, either.)

These are the kinds of people I have to deal with from time to time in my line of work.  They simply are the ones that no one can make happy…ever, no matter what you do for them.  These are the people I will not miss when I finally quit.

Welcome to a day in the life of a sonographer.

And if you like my blog, are a subscriber and avid reader and take my advice to any degree, take this tidbit, too, and PLEASE don’t ever be this person!

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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??

 

unnamed

 

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!

unnamed_2

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 10th, 2014 by wombwithaviewblog.com

Okay.  In all my years of scanning, I have to say this image from a reader takes the cake for awesomely bad ultrasound quality in the most EPIC of proportions.  Who taught this person to scan?  I’m totally serious.  Now, not only will my beloved readers at home appreciate the exquisitely limited value of this image but any sonographer for whom the resolution of an image is important would be absolutely ASTONISHED at how awesomely and epically and entirely bad this image is!  Read on from Giselle..

G:   First off – loved reading your blog – hilarious!

Seeing as you seem to be exceptionally good at your job, I thought I’d send you the image I received from my gender determination image from an elective u/s. I feel like the image is really confusing because I can see what are clearly legs and feet – and then I see the “penis” that the tech referred to – but it looks like it’s in the wrong place. It was a 15 minute scan and that included the 3D sneak peek where my baby looked like an alien lol (I was only anticipating the 2D images). He didn’t point out anything that we were looking at other than “100% Baby Boy Pecker” (yes he did indeed use the word pecker – in front of my mom and grandma no less!). I just thought his feet were at the top of the screen and couldn’t understand why the penis looked like it was far from where it seemed his legs meet his body lol… Is this even a good image to determine gender? I wish I could’ve gotten a good ole between the legs shot like the ones on your blog!

unnamed

wwavb:  Holy cow, Giselle!!

 That has GOT to be positively THE worst ultrasound image of gender I’ve ever seen! As I am reading this, I am laughing hysterically at your own hilarious comments AND in total disbelief of how awesomely bad this image is.  Let me count the ways.  Wow.  Before I go on, let me say THANK YOU for your lovely comments, thank you for reading and thanks for subscribing to my blog!!  I hope you’ll continue to enjoy hours upon hours of laughter and insightful words of wisdom. lol
First, the legs can barely be discerned from this so-called “pecker”.  And, it may very well be a pecker but you sure wouldn’t bet the family jewels on it (total pun intended).  Where he has the arrow pointed is likely the end of the “said pecker” and I am imagining that on each side is a bit of each leg but baby’s rear is not well seen which would be at the bottom of the image. So, it would make sense that the feet would be at the top of the screen, right?  I’m thinking this is supposed to be an underside shot like baby is sitting on a glass-top table and you are looking up from underneath so I’m doubting your baby will come out looking like a Picasso painting.

My best advice would be for all pregnant patients wanting to know gender to read my post below!
Since you’ve already had this done, though, my best words of wisdom for you would be to simply not paint a nursery yet!  Another bit of advice, ask for a different sonographer to do your next scan.  Just say you’d rather have someone else and you don’t have to say why.  And, I have to ask…was this in a hospital or doctor’s office?  I can’t imagine a male doing what I do in a private practice!  Or maybe it was one of those ultrasound drive-throughs?  Don’t get me started on those.. Well, hopefully, this guy doesn’t work for your doctor!
And as for ma and G-ma, it probably wasn’t the most professional standard of care and I do try my best to not say “pecker” in front of the grands.
Thanks, again, Giselle!  Oh, and keep me updated as to whether it’s really a boy when you get your formal ultrasound exam.  Take that image with you to your anatomy scan.  If she’s been doing ultrasound as long as me, she’ll get a kick out of it!
Best Regards,
wwavblogger
G:  I definitely have not purchased a single boy thing due to how little confidence the tech (and his images) instilled in me. Alas, t’was a “drive-through” elective u/s place lol. I will most definitely keep you posted as to the gender of my little bean (which will hopefully happen at the anatomy scan should the baby be cooperative), and you may absolutely use my email and images for a post – that’d be very cool!

Thank you so much for your kind words and prompt reply!
Giselle

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Posted on January 9th, 2014 by wombwithaviewblog.com

So, I know that what results in a total disappointment for patients and the whole entourage is a very uncooperative baby.  Fetus, Jr. has a mind of his own and, believe me, you can poke until the cows come home but he will still likely not turn.  Yes, sometimes they’ll kind of fake you out..wiggle a bit and turn the face a quarter of the way..and then back down.  Mom, Grandmas and dads-to-be are all rooting him on, pushing on the belly and talking to him with English he doesn’t yet understand, as if any of this will make him magically move into the position of choice.  Most of the time, they’re not having ANY of it.

I’m talking about 3D scans.  They are a total blast when baby is in a great position and the best time to do them is about 27-28wks.  But it’s sort of all or nothing.  A great position is baby facing upward toward mom’s belly with a great pocket of fluid in front of the face and no placenta, limbs or cord in the way.  Any of the above-mentioned parts will obscure baby’s face in a 3D rendering so that it just cannot be seen, therefore, making a 3D image not possible.  Also, trying to attempt a 3D too far into the third trimester is a mistake.  Baby usually gets that head engaged quite low, obscuring part of the forehead and eyes, and fluid slightly diminishes as you get farther along so that will also make the probability quite low that a good 3D scan can be obtained later in pregnancy.  Now, let me disclose that I certainly have gotten some great images later in the 3rd trimester but it was totally by chance, not the norm and I just don’t recommend scheduling them that late!  And, I can’t really say for sure…  I’m assuming you are now asking, “Well, when is too late??”  I think after 30-31wks, you may be SOL.

If baby is cooperating, it’s tons of fun (as I have a love of photography outside of the daily fetus, uterus and ovaries) and I just click, click away.  Some of the best 3D scans will yield a good 50+ images.   And fun is had by all.  If baby is camera-shy or just plain obstinate, we blame dad and end up turning mom every way but on her head to no avail.  I usually just let her come back the next week to try again..

Try eating a good meal (not m&ms and a Coke -although both are delish, I can’t encourage that!) about 30minutes before your scan.  Schedule it right after breakfast or lunch.  Babies usually get more active after a meal and this may help your 3D be a success.  You don’t want your baby doing cartwheels after a sugar high..this can make getting images more difficult.

Good luck and email me your great 3D images if you have them!  I’d love to share them with everyone in a post and other moms will love to see them!

SONY DSC

What a cutie!

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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 3rd, 2014 by wombwithaviewblog.com

Well, of course not!  You are seeing cross-sections of the umbilical cord so that they look like floating circles and I get asked that question quite routinely!

I know after they think about it for a second, they must want to smack themselves in the forehead knowing that bubbles are made with air AND there’s no air in there!

Today’s post is short and sweet…and bubbly.

umbilical cord

Below, see Megan “blowing bubbles”.

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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

Let’s clear up a little misconception I heard a patient exclaim today..

‘If you’re told a boy, there’s more chance it’s really a boy and if you’re told girl there’s still a chance it could be a boy.’

No, no and no!  I’ll say it again.  If you have an experienced sonographer and if your baby is in a great position and if you are far enough along and if she can see really well, gender should be easily determined.  Of course, there’s no way for you, as the patient, to know all these things.  It’s a lot of ifs and no one will tell you to bet the farm.

Unfortunately, until we see the day that no one is ever told incorrectly and novice (or careless experienced) technologists quit doing the quasi sweep of the butt and taking a wild guess, patients will continue to question.

In my mind, I’m looking for mm (millimeter) abnormalities and I consider myself very technical and detail-oriented so if I am so bold as to say pink or blue then commence with the embroidered bloomers or sailboat motif!  Nothing gets my goat more than spending several minutes looking for gender, pointing it out with detailed explanation of fetal position and anatomy, marking it with arrows and taking multiple images…only for the patient to say “Yeah, but I guess it could still be a boy.”  No, in cases like this, unless your baby boy has a micropenis, no scrotal sac and labia, it’s a girl.  And, no, penises don’t automatically sprout at 25wks.

There lies the patient who had her heart set on sailboats.  Sorry, lady, I see lots of shoe shopping, tu-tus, truckloads of hair ties and a wedding in your future.

 

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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 30th, 2013 by wombwithaviewblog.com

I’m asked all the time by the patient if she has enough fluid or if fluid is too low or too high because either this was the case in a prior pregnancy or a friend had the problem. I’m going to speak very generally here!

There is a large range of normal for amniotic fluid volumes!  For most of the pregnancy until about the third trimester, the amount of amniotic fluid is basically “eye-balled”.  It’s a very subjective assessment, as is most of what I do, but we can basically determine whether baby has enough just by doing a quick sweep around the uterus.  We should basically see a decent amount of fluid or “black” around baby.  In the third trimester, we’ll start to quantify the amount of fluid.  It’s usually about this time that we’ll start to see more or less.  We divide the uterus into four quadrants and measure the deepest pocket of fluid in each one.  This gives us a number in centimeters, called the AFI or Amniotic Fluid Index.  Your doctor decides if the amount is too much or too little.  Sometimes we see excessive fluid in women who have gestational diabetes.

Whether too much or too little, usually it warrants a follow-up in some way and your doctor will probably want to monitor the amount.  Routinely, we will do weekly Biophysical Profiles (or BPP) for patients who fall into this category.  I could have sworn I posted something about BPP’s in the past but I can’t find it!  OK, so tomorrow I’ll explain that one in more detail.  For now, as a quick explanation, it’s just an ultrasound that examines baby’s movements and measuring AFI is part of that exam.

Check out the images below of an AFI.  Hope this helped!  Until tomorrow..

SONY DSC

SONY DSC

 

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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 11th, 2013 by wombwithaviewblog.com

If I’ve heard this once, I’ve heard it a million times.  As a matter of fact, I wish I had a dollar for every time I’ve heard this phrase in my career!  For the images below?  Heck, no!  There is just no way to be sure these images are of a baby boy and I’m totally not convinced!  Read on in an email from Kayla..

 

K:  Stumbled upon your site looking for answers of why I had “3 white dots” and told boy and why other moms I knew were told girl. Here is the image taken at 15 weeks 1 day. Was told boy and I believed it till I saw others with similar images and saying they were having a girl. None of my other two boys looked like this so just curious 🙂

Thank you,

Kayla

unnamed_2
wwavb:  Hi, Kayla!

Thanks for visiting my blog and subscribing!

And now about your images..first, 15wks is still a bit early.  Not that I’ve never been able to determine gender at 15wks but sometimes parts can still look a bit equivocal.  And since I didn’t scan you real-time, I just cannot determine based on these images!  Therein lies the problem with trying to guess sex too early and this is where mistakes are made.  I’ve seen the tip of a penis look this way early on and I’ve also seen the clitoris (middle white dot) still appear a little prominent in females at this gestational age.

My best recommendation is time!  Your anatomy screen which is usually performed between 18 and 20wks should reveal much more information PROVIDING baby is in a great position to see between the legs. I hope this helped somewhat and please upload images at that scan to keep me posted on what you find then!

“His Pee Pee” may turn out to be “Her Hoo Hoo”..hoo writes this stuff anyway?

Until next time!

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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!

unnamed

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 27th, 2013 by wombwithaviewblog.com

Today’s message is short and sweet..I just love it when a precocious three-year-old be-bops into my room and says things like “Excuse me, Doctur (which is how he pronounced it), can I hear the heartbeep again?”  Heartbeep.  How doggone precious is that??!!

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Posted on November 26th, 2013 by wombwithaviewblog.com

So, if you all refer to the blog I posted with above said name on November 16, you’ll see a cute little sprout at 12 wks with mom, Jena, pondering my thoughts on a gender guess!  Let’s compare images..was I right?

Jena's Sweet PeaSweet Pea 20wks

Of course, I was!!  Well, okay, it was really less me and the fact that the criteria was correct for a girl guess.  I HAVE seen it wrong ONCE!  So it does have a fairly good rate of accuracy.  Read on for our conversation!
Jena:
Great news!! You were right – It’s a girl!!I was having such bad anxiety and excitement all at the same time that I decided to go get a 3D/4D ultrasound during my lunch break on Monday and it was very clear it was a girl.

Good thing I did it before the thanksgiving holiday because my second appointment got
Rescheduled now for the beginning of December.

We can tell our families at thanksgiving – yay!! I will email you the updated u/s photos as soon as I possibly can.

Go TEAM Pink!

Thank you,

me:
Congrats!! Yes, I’d love to see the images and upload them to the blog!  I hope you will enjoy all those dance recitals as much as I did:)
Jena:
I’m assuming by 20 weeks its very obvious if there’s a predominant penis or vagina, right? I’m just still in shock. It looked very obvious to me to be a vagina. So a very little swollen clitoris and the side lines were very thin.
me:
Sounds like what you are describing matches what we look for in girl parts.  By 20wks, external genitalia is very easily seen providing baby is in a great position!  And, yes, a small scrotal sac and a penis should be easily seen in boys and the labia and clitoris (we can’t see the vagina!) usually look like 3 white dots or lines at that gestational age.  Baby has very little fat in her skin right now so her labia will plump up and she will have much more recognizable girl stuff later!
Jena:
It’s been such a blessing to have crossed paths. I truly LOVE reading your blogs and I would have to agree you capture a readers attention just like Carrie Bradshaw. Lord knows, most girls / women love some good ol’ Sex and the City!
me:
So sweet of you to say and I’m SO happy to help!  And, yes, the image you sent could not look any more girly than it does!!  Congrats again!!!!!!!!

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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 November 16th, 2013 by wombwithaviewblog.com

Aw, shucks.. It warms my heart when a patient specifically asks for me and wants me to perform her scan.  Especially, when that patient is a physician..and her husband is a physician who are both super intelligent and I scanned them throughout their last pregnancy and they want me again for this one.  They greet me with hugs.  We talk.  They ask me questions about ultrasound, I answer them.  They thank me profusely and say, ‘Sorry! You are stuck with us forever!’ It’s a great feeling.

I was there for her miscarriages; I was there when she was anxious at the start of her next pregnancy; I was there again when she needed weekly scans in her third trimester.  It’s not just another patient, it’s a relationship.  It’s NOT just another patient, it’s a relationship.  That was worth typing twice.  It’s patients like these that reaffirm I’m good at what I do (we all need this affirmation, don’t we?) and justify that I’m still where I need to be..for the time being.

When someone says ‘I can’t imagine anyone else doing my scans’, it’s the highest compliment a sonographer can receive.

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Posted on November 16th, 2013 by wombwithaviewblog.com

My readers are just beginning to send me emails which is fabulous!  I love to get feedback.  Read Jena’s email and my response below:

 

Hi –

Any thoughts on the gender of our little one? This is around the middle of week 12. We’ll be going in for the anatomy scan next Thursday at 20.4 weeks. I look forward to your response.
jena hartman, mba 
***
Hi, Jena!

Congrats on your little one!  Great pic and he/she looks like a keeper;)
Well, let me say that both boys and girls each have similar external genitalia at that gestational age but the thought is that the tissue in a boy sticks up and the tissue in a girl sticks out (parallel with the spine).  We started to perform scans at 12wks on a regular basis a few years ago.  And I have to say that criteria held true for almost two years..except for one patient!  I said “girl” at 12 wks but there was a very definite penis there at 18wks and she did deliver a boy.  That was the ONLY case that had been wrong!  So, ever since then I won’t guess for my patients at 12 wks.  Nothing’s 100%!  Even an amnio is 99% reliable for gender.  HOWEVER, if we base a guess on the above criteria, I’d have to say pink tu-tus may be in your future!
Let me know what next Thursday reveals!!
Many blessings for you all..
wwavblogger
***
(From Jena)
Thanks so MUCH for your response! I will definitely keep you posted and appreciate your honesty. Have a great weekend! 🙂
***
(From me)
Awesome, thanks!! And please fill me in on gender next week.  Attach another pic and I’ll add it to the post so readers can compare the images.  If you haven’t already, I would love it if you would subscribe to my post!

Best regards,
wwavblogger

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