Posted on April 28th, 2017 by wombwithaviewblog.com

Factual ultrasound information can be hard to find. No one knows that better than a newly-expectant mom with loads of questions! How do you know what’s accurate and what’s not? With so much info at our fingertips, too much Googling just seems to lead to more unanswered questions, doesn’t it?

As a sonographer (ultrasound technologist) with formal training and twenty-five years experience in OB/GYN, I am amazed by what I read on other sites about ultrasound. And it’s not just from blogs and forums filled with personal opinion. Misinformation also comes from parent/child sites and even some of the most popular pregnancy books that the general public would expect to be reliable. These articles or posts or books, I realize, are written by authors with no obvious medical training or experience. But their information should be coming from reliable sources. If they have interviewed someone who is in the medical field, some facts seem to get a little lost in translation from interviewee to print.

Five years ago, I ran across a blog about ultrasound…the uses, technical details, what we can see, and how we can see it. The level of wrong in this post left me dumbfounded! It was clear to me that this person had absolutely no medical knowledge whatsoever. It’s not too hard to spot when they use the terminology incorrectly in nearly every sentence. What bothered me the most was that someone left a comment thanking this so-called author for the “valuable” information. It struck me then that many people actually do believe anything they read on this crazy web thing.

So, Where Can You Find Accurate Ultrasound Information?

If you have a curious knack for researching ultrasound on the internet, just be sure to check out someone’s bio. Look at the author’s credentials. Do they reference their experience and knowledge in the field? You can determine whether that individual’s level of experience with a particular subject before taking the information at face value. If an author is not a sonographer, physician, or medical professional with ultrasound knowledge, just know that what you are reading may not be entirely accurate. And if you have questions about what you read relative to your pregnancy, ask your doctor! She or he is always going to be your most reliable source for credible advice on your health and that of your baby.

My Pledge to My Readers

My desire to create a platform where an excited new mom can find accurate info about ultrasound drove me to create this blog. Hopefully, expectant couples with curiosity about their scans can find a little general info here. Please feel free to email me at wombviewerblog@gmail.com. Ask me your questions; tell me your ultrasound stories. Remember, no blog, no site, no forum can replace the healthcare professional! We are not your doctor, we do not manage your pregnancy, nor do we have any knowledge of the health of you and your baby. Carefully consider what you read, and direct any concerns to your doctor for the best advice you can follow:)

Stay tuned for the release of my first book about first-trimester ultrasound!

Coming Soon!

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9 Week Embryo, ultrasound information, 9 weeks pregnant

9 Week Embryo

Thanks for reading! And best wishes for happy and healthy!

wwavblogger, RDMS
wwavblogger, RDMS

 

Comments: 6 Comments »

Posted on April 27th, 2017 by wombwithaviewblog.com
3D, 9 Weeks, ultrasound facts

3D 9 Week Embryo

Ultrasound Facts About General Stuff

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

 

Ultrasound Credentials for Sonographers

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

 

Ultrasound Facts About Performing Your Exam

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

 

Ultrasound Facts About Fetal Sex

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

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

Ultrasound Facts About Your Ultrasound Results

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

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

Thanks for reading!

wwavblogger, RDMS
wwavblogger, RDMS

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Posted on 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 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

***

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

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

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

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

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

Best wishes for a beautiful experience,

wwavblogger

 

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Posted on May 24th, 2014 by wombwithaviewblog.com

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

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

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

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

SONY DSC

 

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

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Posted on May 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!

Comments: No 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 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 6th, 2014 by wombwithaviewblog.com

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

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

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

Comments: 1 Comment »

Posted on March 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 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 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 7th, 2014 by wombwithaviewblog.com

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

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

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

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

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

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Posted on February 1st, 2014 by wombwithaviewblog.com

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

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

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

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

Until next time..

wwavblogger

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Posted on January 23rd, 2014 by wombwithaviewblog.com

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

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

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

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

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

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

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

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

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Posted on January 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 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 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 15th, 2013 by wombwithaviewblog.com

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

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

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

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

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

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Posted on November 23rd, 2013 by wombwithaviewblog.com

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

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

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

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

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

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

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

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

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Posted on November 19th, 2013 by wombwithaviewblog.com

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

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

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

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Posted on June 21st, 2013 by wombwithaviewblog.com

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

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

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

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Posted on March 4th, 2013 by wombwithaviewblog.com

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

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

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

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

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Posted on February 23rd, 2013 by wombwithaviewblog.com

first trimester ultrasound 11wks

first trimester ultrasound 11wks

So a little more time has passed and we are now about 11wks!  Babies are slightly bigger = about 4.3cm now or almost two inches!  The second trimester starts at 12wks so the first trimester, thought of as the most crucial one for growth and development, is almost over.  Babies can be seen doing a lot of quick jerky movements at this point.  They can be quite active and actually mimic little jumping beans in there!  In the second image, you can see little legs quite distinctly.

Until next time!

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Posted on February 1st, 2013 by wombwithaviewblog.com

About a week has passed and my friend, the pregnant mom, has decided to become a little less neurotic and not asked to be scanned every other day!  I must add here that this waiting has, indeed, almost killed her but she did it and I am so proud:)  The babies are doing great!  They are now each 8wks and referred to as a fetus.  You can see in the first image that Baby A is a whopping 15mm.  Wow, a future linebacker, maybe?  Just kidding.  All babies grow about the same rate right now.  They are just beginning to sprout little arm and leg buds and look just like a little gummy bear.  So cute!  

In the second image, you can see both babies together and each in their own gestational sac.  Again, this means they can be different sexes and likely not identical.

In this last image, you can see what is more of a side view of Baby B.  Stay tuned in..they’re changing every day!

 

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Posted on December 16th, 2012 by wombwithaviewblog.com

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

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

Merry Christmas!

 

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