Posted on June 28th, 2017 by wombwithaviewblog.com
fetal feet, ultrasound photos, ultrasound images, 3rd Trimester

3rd Trimester Feet!

 

Okay, so what do all you moms-to-be out there do before Baby gets here? Show off your great ultrasound photos, right?!

Well, I’d love to see them, too. Email me those shots near and dear to your heart to wombviewerblog@gmail.com, and show off your little punkin’ to the world at the same time. Baby’s face, profile, 2D, 3D, hands, feet, or even your 4D video clips would all be perfect to post. And if you also have great shots of male or female fetal sex, send those, too!

I’ve personally taken some really great pics over the years..baby yawning, sticking out the tongue, puckering those lips..even flipping the bird! Who doesn’t love a cute set of baby toes? How about a ton of hair? If you got it, flaunt it! We moms like to brag on our cute kids, so it may as well start before they even get here.

Full disclosure! Uploading your images means you consent to my using them for promotion of my blog or future books. But, as always, I will always keep your privacy private!

Can’t wait to see them!

While you’re at it, please subscribe in the right margin to receive automatic posts (of course, you can always opt out). You can also follow me on Twitter @wwavbloggerRDMS. What’s more, my subscribers will receive a little free something when I publish as a way of saying THANKS for reading!

Say Cheese!

wwavblogger, RDMS
wwavblogger, RDMS

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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 3rd, 2015 by wombwithaviewblog.com

Just a little note here before jumping into the subject o’ the day!.. Please know I am a stickler for grammatically-correct sentences and proper punctuation! I know, I know..you probably don’t give a you-know-what but it seems to be a lost art in this generation of texters, acronyms and run-on sentences. I do re-read several times before publishing but still find errors later that I ultimately go back and correct but not before you’ve read it..much to my chagrin. Sheez..like typing “you’re” instead of “your” or “it’s instead of its”. You get the drift. If you find a dreadful error and feel I should know, please feel free! Sometimes this editor-in-chief is quite tired, leaving such cringe-worthy errs in my wake as I make a bee-line to bed. Since it’s my blog and I can say what I want to, I suppose I can still use things like “Sheez” if I feel like it, as well;) I’m not sure we’d find that one in Webster. Okay..enough of the English class!

I will post an email I received from an anxious mama regarding an image she was given by her doctor. She didn’t see a yolk sac and was concerned one may not be there. My last post was directly related to this  concern. If you haven’t read it yet, please do!

anxious mama:  Re: Ultrasound photo confusion

I recently got an ultrasound at 7 weeks 5 days. My doctor said everything looked great and we were able to see its little heartbeat. When I got home and looked at the photo a little closer, I couldn’t find a yolk sac. I will send you the ultrasound from my email account since I can’t figure out how to attach it here. Would you mind looking at it and letting me know if you can see a yolk sac or anything else you may notice? Thank you so much. This is my first pregnancy after having a miscarriage and I am slightly protective 🙂

7w5d embryo with no yolk sac in the image

 

wwavblogger: Thank you for reading, emailing me and subscribing! I hope you enjoy the blog and pass it on to your friends!

So, if you haven’t yet read my most recent post, please do. It explains (to the best of my ability without being able to demonstrate in person) how ultrasound cannot capture in a single image everything that is in your uterus. No, there is not a yolk sac in this image. That being said, the yolk sac may be positioned on either side of the embryo, in which case, it would not be seen in this particular image.

Also, if you look up information on the job of the yolk sac.. type in yolk sac in my search engine and you should find a couple of posts on that subject ..you will learn that it provides nutrients for the embryo until the placenta develops. No yolk sac, no embryo. Baby cannot grow to even this point without it! So, if your doctor said all looks good and you see a heartbeat, there has to be a yolk sac in there. Yay!

I will also add here that I understand how frightening it can be and what an anxious time it is for you to try again. No matter how early someone miscarries, it’s still a loss and emotionally draining. Scientifically speaking, it’s nature’s way of taking care of something that was not developing properly. From a human, spiritual or emotional view, I like to think of it as Baby wasn’t ready then but maybe is now:) I always say our babies don’t necessarily come to us when we are ready for them..they have to be ready for this great big world, too!

I hope I answered your questions and you find a little peace and comfort in my response. I know you will be a bit anxious until you are out of the first trimester but I wish you many blessings for a great pregnancy and beautiful, healthy baby!

Warm Regards,
wwavblogger

**

I’m glad she emailed the image to me. The “Ask Me” page is good for a short question or statement. It’s better to email me if your question or concern is long and if you have images to share!

Sometimes we get the yolk sac in the same image with the embryo or fetus..sometimes not. If the yolk sac is parallel with the sound beam when obtaining a great shot of baby, it will be seen in the image. If not, it won’t! Check out the image of the yolk sacs on the twins below.

Yolk Sacs

Now here is an image below of the same pregnancy with just the embryos imaged.

6w6d Dichorionic/Diamniotic Twins

 

As providers, we don’t take special pains to give you an image of the yolk sac because it just isn’t as doggone cute as Little Sprout! 🙂

 

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Posted on January 2nd, 2015 by wombwithaviewblog.com

HAPPY NEW YEAR!!

I’d like to (again) thank all my readers, old and new, and hope you all find what you came to my site seeking in 2014 and in this new year, as well. I hope all your holidays were joyous and that your post-Christmas (or whatever holiday you celebrate!) scale didn’t demonstrate a “Please quit hitting the figgie pudding” alert.

Let’s hit the ground running with an answer to emails! Some I’ve received as of late include questions regarding what patients can or cannot see in an image given to them by their provider. I have been answering essentially the same way so I will address the subject in this post about how ultrasound works.

I have posted information at the start of this blog about the technology of ultrasound and how it works.  If you go to my first several posts, you’ll read on this subject to varying degrees.  First and foremost, ultrasound creates a two-dimensional image which is what you see in black and white images. However, when we look at any object, we are able to visualize three-dimensionally which allows us to perceive depth. When we look at an image on an ultrasound monitor, there is no depth. Example: Imagine looking at a tree. Its trunk is long and skinny, right? Now imagine cutting the tree down with an electric saw. When you look down at the stump, it’s round. All you can see is that one surface of the tree in that view. If you were to then cut 2mm slices of that tree trunk all the way down to the roots and you looked at every slice, this is essentially what we are doing when we look through your uterus when we move the probe up and down.

Now, if I look at the middle of your uterus and keep my probe still and take an image, I am obtaining one view of your uterus and that’s all. In that one plane, I can only see exactly where my probe sits. I have to physically move my probe all the way up and down to see to the top and bottom of your uterus and then from side to side to see all the way through your uterus to the right and left.  As we move through the organ we are scanning, we form a mental 3D picture of what is going on in the uterus. This means if we take a picture of your baby’s profile and the hand is resting near the ear, the hand will not be in the picture (and neither will the ear!). A profile can be defined as a side-view of baby’s face right down the middle, right? So all we would see is the outline of the forehead, bridge and tip of the nose and outline of the lips and chin. Now if Baby had his hand resting on his forehead, we would see it in that view. Make sense?? I hope so! See the image below of a great profile.

2D fetal ultrasound image Side view of Baby’s face

The utilization of 3D software has allowed us to capture the perception of depth. This technology aids us in more than just cute pics of the fetal face. A good example is how it helps us to see an IUD (hey, an idea for another post!). 3D allows us to take a sweep of several views at once when looking at Baby’s profile, for example, and put them all together to form a box of information which enables us to move through the information by turning a few buttons to see the front of Baby’s face all at once!  Below is the same baby as you see above in 2D. Where the face is cut off by black is where the box of information stops.

3D fetal ultrasound image

Front view of Baby’s face.

In conclusion, 2D imaging allows us to see in two planes only at one time..either top to bottom OR side to side but not both at the same time. This is why we can’t see everything in your uterus all at once! Now, hopefully, you understand a little better why we move the “camera” all over your belly. It also explains why we sometimes roll you onto your side or stand you on your head to get the angle we need!

I hope 2015 finds all of you with uneventful pregnancies and happy, healthy babies who sleep through the night! Many blessings to you all and I hope you keep coming back to my site to have all your ultrasound questions answered!

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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 July 30th, 2014 by wombwithaviewblog.com

I have some great images for you today of male gender.  This baby is about 19wks and the images are of the side view of baby and bottom view.  See below:

SONY DSC

This is a bottom view of baby if you imagine baby sitting on a glass table and you are looking up from underneath.  I have all the parts annotated for you.  The arrows, of course, are pointing to the wee-wee (my technical term).  This is about as straightforward a potty shot as one will find.  No guesswork, all boy.

SONY DSC

Now this is a side view of baby.  The head is not in the picture; imagine it to the left.  Again, all parts are labeled.  Now the legs are not in this image.  Not to be graphic but for demonstrative purposes, imagine slicing the body in half lengthwise; this is the view we have right down the middle of the torso.

SONY DSC

The penis and scrotal sac from the side resemble a turtle sticking out of his shell.  If you can appreciate the tiny dotted line, you will see it is drawn around the “turtle”.

You can see how parts look different from different angles.  These, people, are great images of baby boy stuff…no question, no nonsense, no guessing..  Just all boy!!

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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 17th, 2014 by wombwithaviewblog.com

..to blast everyone in your OB doc’s office.  The old adage that one can attract more bees with honey seems to be something we learn as we become more mature in this life.  Certainly, most of us can reflect on a time when we wish we had taken the higher road.  I guess when you’re unhappy with an uncooperative fetus, everything else in life just sucks, too.  Read below for what NOT to do in this circumstance..

Most expectant moms understand by now that the only way to obtain the totally precious 3D images they’re paying for is for Baby to be facing up toward Mom’s belly with nothing else in Baby’s face except a nice pocket of fluid.  If you didn’t know this, now you do!  I love to impart a plethora of informative tidbits to my beloved readers and future moms.  However, if Baby is facing down?  Forget it.  We can’t scan through your back (too many bones) and pretty much nothing usually changes Baby’s position.  But hell hath no fury like a mom jacked-up with pregnancy hormones.

My co-worker (who was her sonographer and a sweetie-pie, at that) did what I would have done..rolled mom to each side and jiggled the belly until the cows came home but this resulted in nothing.  She explained what we views we needed, what we didn’t have and why and offered for her to come back.  The patient seemed reasonable enough and agreed to come back another day (free of a second charge, mind you)…or so we thought.

The patient reaches the appointment desk on the way out and, I suppose, had just enough time for her blood to boil.  She unleashed a rash of f-bombs on the poor receptionist.  She made the appointment, left and called back unleashing a second wave by  bitching about my co-worker (who tried to make her pretty pictures), the receptionist, a phone nurse, the office manager and, by the time she was done, cursed out her physician.  Whoa, Nelly!  Too bad we couldn’t take her down with an injection of sedatives while she was still on the property.  Just kidding!  We’re legally not allowed to do this even though some patients need it when they start foaming at the mouth.

And what did it get her in the end?  The search for a new OB doc!

Note to self:  If I behave this way in a private practice, I WILL be fired as a patient..preggers or not!

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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.

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Posted on July 4th, 2014 by wombwithaviewblog.com

HAPPY 4TH!!!  I hope everyone enjoys some beautiful fireworks this evening to celebrate our freedoms!  (aka the ability to write this blog, for example!)  Enjoy some watermelon and bar-b-que..a must on the 4th:)  Now on to my post of the day…

***

I have responded to so many emails regarding this problem that I thought I’d address it with my next post!

First, ask yourself these questions. Does an embryo look like a baby?  Does an embryonic chick look like a chicken?  Of course, it does not. The same applies to fetal parts like the brain which is why we do not perform the screening of anatomy until 18wks or later. This is because the appearance of the brain is ever changing until that time. Even at 17wks, some of the intracranial structures have a slightly different appearance that make it difficult to document the parts we need in the way we need.

The same applies to external genitalia. It’s just starting to develop at 12wks so boys and girls can look alike. Over the next month, it is still developing and changing in appearance. That is to say, boy tissue starts to get bigger and girl parts shrink. Eventually, the scrotal sac and penis take a more recognizable shape and the labia and clitoris take on the appearance of three tiny white dots or lines.  Every baby is a little different, as all people are different.

Now, have I guessed gender at 16wks? Definitely! But it had to be someone I was scanning personally, baby had to be lying butt-up in a perfect position with legs wide open with perfect visualization otherwise. There are many factors that play into how well we can see at any point in a pregnancy. It just all has to be textbook perfect and not every patient/fetus is a textbook scan. We’re all made differently and such is life.

So, please take my word for it. Any guess at 12-14wks is simply a guess..you might as well flip a coin. 15-16wks is still a guess but I didn’t scan you so I cannot tell you even with an image if your sonographer was right. I might be able to confirm it if you are 17wks with a perfect potty shot!

Whew! That all being said, PLEASE PLEASE do not send me pics earlier than 17wks!! It’s not that I don’t want to help you when you have a less-than-pleasant sonographer. It’s just that I can’t technically provide any helpful information.  If your sonographer couldn’t tell enough to get a great shot, neither will I.

If you’re greater than 17wks and your sonographer has given you a potty shot where she’s annotated boy or girl, I’ll be happy to try and confirm!

Good luck at your next scan!

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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

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 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 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 10th, 2014 by wombwithaviewblog.com

…Boy!

It’s all whales, snails and puppy dog tails for the grandma who was so excited to find out pink or blue but was too early.  See the link below for the whole story.

http://www.wombwithaviewblog.com/but-but-but/

Not much question here!  Congrats!

20140508_103714

 

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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 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 May 1st, 2014 by wombwithaviewblog.com

I am always absolutely astounded..flabbergasted..when people ask me my opinion about gender and then don’t believe it.  They keep asking. And asking. And asking. They continue to ask the same question over and over but in a different way.  It. makes. me. CRAZY!

This is especially true when it’s just too darned early!  Consider this..does a fetus at 8wks look like a baby?  No.  Does a baby chick embryo curled up in an eggshell look like a chicken?  No.  The same applies to external genitalia on a fetus!  It’s not completely developed yet so one just cannot discern boy or girl very early in the pregnancy.  In fact, TOO early in the pregnancy they both have itty bitty parts that stick out and can all look the same.

Read the emails from the grandma-to-be below who just didn’t want to take “It’s too early” for an answer.

g-ma:  Hi, I subscribed to your blog. I love it. These are my grand baby at 12 weeks 2 days. Any guesses?  The baby’s legs were crossed at the 16 week ultrasound.

12 Week Fetus

12 Week Fetus

Too early for sex guess!

12 Week Fetus

 

wwavb:  Hi! And thanks for reading and subscribing! So glad you are enjoying the info!

Okay, so if you’ve read any of my posts on the subject, you know that guessing at 12wks is like flipping a coin. Just too early. An accurate guess can be made at 18 wks IF baby is cooperating!
Any guess any earlier is simply a guess and I just wouldn’t invest in paint.

Best wishes for a healthy grandbaby!

g-ma:  Thank you for your response!  It’s just driving me crazy wondering what those two white ovals are in between the legs.  Doesn’t look girl or boy. Could it be fingers or an umbilical cord?

wwavb:  No, haha. It’s definitely external genitalia but boys and girls look the same at that age! Over the next several weeks, girl stuff shrinks to form labia and all her girly parts; boy parts get bigger to form the scrotal sac and penis. It’s all still developing on the outside even though chromosomally it’s already determined on the inside.

g-ma:  Thanks for being so helpful. I would think it’s a boy for sure if it’s genitalia!  But, not if they look alike at 12 weeks.

 wwavb:  Sounds like you’re not too far off from finding out. Happy shopping!
g-ma:  Really… No guesses? I know it would be a guess. I thought the pics looked pretty clear. Everyone thought boy.

wwavb:  Wow.  You’ve earned a spot in a post for your persistence.  But it doesn’t change the facts.  You can either believe what you and your fam think you see in the images OR you can believe someone who has seen tens of THOUSANDS of fetuses at this age.  Up to you!

The professional verdict is that it’s simply TOO EARLY to determine gender on any baby at that age.  It’s just not all formed yet!!!
Let me know what you end up having!
***

People have a tendency to believe only what they can see or understand.  As long as sonographers guess too early and continue to be wrong, I will have to persistently defend my determination until the cows come home.  My advice when it comes to gender is that you have to entrust the word of an experienced sonographer..or just buy neutral!

Comments: 3 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 11th, 2014 by wombwithaviewblog.com

Let’s attempt to clarify what constitutes a GOOD image of little boy or girl fetus parts and delineate from BAD images of said parts.  If you guys read my blog on a regular basis, you KNOW how many emails I receive from parents wanting a second opinion on gender images only to get a “huh?” out of me.  Most of the time, their sonographer gave the nod for male or female only to follow that up with a snowstorm quasi-leg/cheek shot with a ? in the middle…not quite the validation I can support.

I’ve posted other great gender shots throughout the site but let me add a couple more.

SONY DSC

Hello!  Any guesses?  I’ll give you one..one guess!  THIS is the boy shot patient’s want to see.  This is the holy-cow-look-at-that-wee-wee-he-is-so-proud shot we are after.  Is there REALLY any question in anyone’s mind here?  I didn’t think so.  This baby boy is about 20wks in this image.

 

SONY DSC

Anybody not see three lines here?  There’s a little dotted circle around the labia..three lines..girly..enough said.  She is about 22wks here.  She really didn’t want to move her legs for us but I could still see it quite well enough to reconfirm baby girl for this couple.

 

And this one I’ve posted before!  Labia are much more plump closer to that Estimated Date of Confinement.  This baby girl was about 38wks here and probably THE most clear female image I’ve ever obtained.

unnamed

 

See the difference?!!  Now compare to some of the images readers have emailed.  The only kind of gender images I like to gift to patients are the ones where anyone who reads ultrasound can take one look and say “Oh, yeah! No doubt!”  Even the most ultrasound-challenged won’t argue with these textbook images of fetal genitalia.  In my room, it has to be unequivocally wee wee or three lines/labia or you get the dreaded “I’m sorry but I just can’t tell today!”  My advice?  If you don’t have a shot similar to these, hold off painting that nursery!

Comments: 3 Comments »

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 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 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 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 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 23rd, 2014 by wombwithaviewblog.com

Okay, so we’ve talked about how some 3D images are impossible due to fetal position.  When Baby is facing Mom’s back, there is almost nothing you can do to get them to flip over!  These moms (and all family who joined in for the festivities) are totally bummed that Baby wouldn’t show off.  Often times for these exams, that’s all they show..their bums.

However, SOMEtimes babies are just in a fabulous position for 3D images so that obtaining them is just effortless..and beautiful!  This is one of those times!  Mom and Dad were a cute young couple who were so excited to get these great shots and had no problem with me sharing with the world:)

Here’s hoping your baby cooperates like this!

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She is so precious!

 

 

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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 8th, 2014 by wombwithaviewblog.com

Most sonographers will print images for you to take home.  How many you get really depends on the person doing your scan and how nice she wants to be (seriously!) and then after that, totally dictated by Baby’s position.  So if Baby doesn’t want to play, we can’t get an image of anything cute whatsoever no matter how nice we are or how hard we try.  Most of the time, if Baby is facing your back, you’re pretty much toast for cute images that day.  Unfortunately, we simply cannot change the properties of physics by which ultrasound works.

If you get lucky and are given lots of pics, you’re probably very familiar with the paper on which the images are printed.  It’s thermal paper, quite thin and easily creases.  I’m sure most patients have found that they do not photocopy very well.  With today’s technology, it’s very easy to share these images with everyone in God’s creation.  Most of you have already figured out that all you have to do is take a photo of the image with your phone in order to save a jpeg.

A couple of tips for those of you that edit:

  • Make sure your flash is off.
  • Make sure you’re adequately focused and the image appears sharp.
  • Crop out the white edges.
  • Make the image black & white with effects.
  • Increase contrast and sharpness.
  • Use your eraser or otherwise edit out stray spots and lines.

 

Voila’!  A great jpeg of an ultrasound image.

Happy editing!

 

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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:)

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Posted on February 1st, 2014 by wombwithaviewblog.com

I added images to this post I made the other day for your comparison.  Check it out!

http://www.wombwithaviewblog.com/womb-3d-view/

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Posted on January 29th, 2014 by wombwithaviewblog.com

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

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

gestational sac, yolk sac

5w5d Gestational Sac with a Yolk Sac Within

 

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

Yolk Sacs, dichorionic twin pregnancy

Twin Gestational and Yolk Sacs

 

But a blighted ovum would look something like this:

gestational sac, blighted ovum

Gestational Sac/Blighted Ovum

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

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

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

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

Best wishes for a healthy pregnancy to all!

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

wwavblogger, RDMS
wwavblogger, RDMS

 

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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 19th, 2014 by wombwithaviewblog.com

Read the email below from a reader who was really hoping for some estrogen in the family after two boys!  Sometimes, wishful thinking prevents us from seeing what is really there..

kb:  At my 17 week ultrasound the tech took a photo saying the baby was a boy pointing to what is clearly the foot in between the legs. She also said the umbilical cord was between the legs. At my 21 week ultrasound the baby was breech with cord between the legs. When asked what we’ thought we saw 2 lines and nothing else… Girl we guessed. The next view she said boy. The one photo has two dots next to each other on the top and one dot directly under the second like this . . . I have two boys already and you could see the scotum and tip clearly. I feel different and not even pregnant . The heart rate was 170, 171, 157. I can’t shake that it’s a girl. Am I wrong and just hoping . What do you think?

wwavb:  Thanks for reading my blog and sending your question!  Hmm, what do I think..  First of all, I think I have not nearly enough information.  Did you mean to upload an image?  I can certainly tell you what I think about the photos but without that it’s really and truly anybody’s guess!  I wasn’t there, didn’t see your scan real-time and don’t know anything about who did your scan or how experienced they are.

As far as “feeling” different, each pregnancy is a different universe in and of itself.  The way you feel with one has nothing to do with how you “feel” in another.  People historically want to contribute that difference to gender but there just is no relevance there.  And baby’s heart rate can vary quite a bit, just as ours does with respect to activity, so you can’t go by that, either.

It’s entirely possible that your sonographer could tell it was a boy but it wasn’t clear to you because the cord was in the way which made it not a textbook image of boystuff and more difficult for you to appreciate as someone who does not read ultrasound.  It’s also possible that you just want a girl so much that it’s hard for you to really “see” boy parts in the image.  If you would like to email me your images, I’d be a happy to try and give you another opinion!

Best Regards,

wwavblogger

KB then emails me the images below:

Image 1:

kb:  This is the first picture where I saw the dots

unnamed_3

wwavb:  This is not a great image but consider it sort of like a side view.  Baby’s boy stuff sort of looks like a snail.  Where the arrow is pointing is the tip of the penis which resembles the snail coming out of his “shell”, the scrotal sac.

 

Image 2:

kb:  Where the tech pointed as a pee looks like a foot to me

unnamed_2

wwavb:  

No foot here!  Where I have the arrows of the legs you are only seeing part of the thighs; the rest of the legs and feet are not in the image.  See edited image below..

babyboy

Image 3:
kb:  I don’t see the scotum because she said the cord was between the legs.
unnamed

wwavb:  Holy cow, Krissy, this is totally a boy!  I don’t see any cord there.  All boy!  See my edited image attached below..

unnamed

Congrats;)  I always say it takes a special woman to be a mom of all boys!  Little boys love their mamas and you have a the perfect opportunity to teach them to be loving, respectful and helpful to their future wives.  Your daughters-in-law will thank you!

Best wishes!

wwavblogger

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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:)

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Posted on January 16th, 2014 by wombwithaviewblog.com

Okay, readers, if you are searching for the perfect shot of female genitalia in the 3rd trimester, check out this photo.  This image is shouting “Am I a girl or what?”

 

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This is a great image of labia as seen later in the pregnancy.  Baby has more fat in her skin now and looks nothing like the “3 dots or lines” you saw at halftime.  Now, granted, not every baby girl looks exactly like this one.  We are not all built EXACTLY the same, right?  However, I think no one can argue that this looks nothing like any little boy I’ve ever seen.  This mom and dad are so excited for their second precious baby girl and were so happy to share:)

Now, THIS, people, is a GREAT ultrasound image if I do have to say so myself!!  Doggies (thanks, Dr.C), I just LOVE a great ultrasound image.  I’m such a geek.

 

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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 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

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 28th, 2013 by wombwithaviewblog.com

Here is an email from Ruby who may have very early twins.  This early, only time will tell what will develop!  Read on for her emails and my responses..

Ruby:  I had a dating sonogram and it was determined that I was about 5 1/2 weeks along. I have two other children but never had a sonogram before 11 weeks. Basically, my OB performed the sonogram, and she did not deny or confirm twins. She simply scheduled me for a repeat sonogram in 2 weeks. From your experience, can you tell me what exactly I’m looking at and is it two babies in the gestational sac? Thank you so much for your time and knowledge!

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wwavb:  Hi, Ruby!  Thanks for reading my blog and subscribing!  By the looks of your image, I would have to agree with the 5 1/2wks estimation of dating.  So, you know the gestational sac is the bigger black area.  Your doctor scheduled another for 2 weeks because there’s just no way to determine right now whether you really have two babies in there yet!  The image is not a great one but you can sort of appreciate and get the impression of two smaller circles inside of the sac.  The smaller circle may very well be a second yolk sac but it is just too small and too early to say for sure.  The usual progression is that we see the gestational sac first, then a bigger gsac with a yolk sac within it.  If two yolk sacs are questioned, two babies are questioned but we just cannot really see the embryo until about 6 weeks but it’s still really tiny then.  Your doctor wanted an additional week so she could feel sure about whether there are two!

Good luck and keep me posted!

Merry Christmas!
wwavblogger 🙂
Ruby: 

So from what I understand, you’re saying that there could be twins but it’s just too early to know for sure? And if there is not twins what possibly could be the second structure in the gestational sac? Based on your expertise, what percent chance is there that it will be twins and what kind of twins? So sorry for all the questions, but according to doctors, I shouldn’t even be pregnant right now because of the damage that stage 4 endometriosis did to my ovaries and tubes. So I’m a little nervous and worried, and ANY information really helps ease my mind.
Thank you so much for responding! I think what you are doing is amazing, and I definitely will tell all the ladies I know about your blog! Thank you again and look out for more sonogram pictures from me! :)Merry Christmas!!!
wwavb:

Thanks, Ruby!

I KNOW how hard this time is for patients.  Two weeks seems like forever so you desperately search the internet for some reassuring bit of information.  The truth of the matter is that only time will tell what will unfold in a very early pregnancy.  There is no way to predict the outcome and there are no statistics that I could provide to make you feel better and I’m sorry for that!  As I’ve told my readers before, just looking at one frozen image from a scan I didn’t perform myself means I don’t have a complete picture but one gestational sac means both babies would be in the same main sac.  Somewhere around 8 – 10wks or so can a separating amniotic membrane be seen between the babies.  So, there’s really no way to determine right now what kind of gestation this is.
First, your doctor will want to establish heartbeats and how many, then she’ll determine what kind of twin gestation it is a bit later if twins.
And, I’ll tell you, I’ve seen patients with prior tubals and those with post-snipped hubbies get pregnant so a determined little soul will not let Stage 4 endometriosis get in the way.  I always say our babies come to us when THEY are ready, not necessarily when we are!  What special holiday news!  At least you know now you can get pregnant!

The waiting is the hardest part…I think there is a song out there about that?  Best wishes to you and keep me posted!  I’ll always answer what I can about ultrasound and defer medical advice about your specific case to your doctor. I truly wish you all the best and many (or maybe two) little blessings!
Merry Christmas!
wwavblogger
***
I later sent Ruby another image from a post in February 2013 of early twins in separate sacs.  See the image and click the link below to read the post about these 6w6d twins.
Yolk Sacs 6w6d Dichorionic/Diamniotic Twins

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Posted on December 24th, 2013 by wombwithaviewblog.com

So here’s an update from Kayla!  Remember?  She sent two pics and I just could not determine pink or blue.   Go back to the post entitled “Are You Sure?” dated December 11, 2013 and now check out her most recent email and pic to see what she is having!  Drumroll, please………….

image

 

 

 

 

 

 

Hello! Just wanted to update you with my recent scan. It’s a boy! Super happy to be having our third boy 🙂
Take care,
Kayla
wwavb:  Congrats, Kayla!  Now THAT looks like a boy:)  Merry Christmas and enjoy your baby boy!
 

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Posted on December 17th, 2013 by wombwithaviewblog.com

..which is precisely the feeling my patients sometimes have when coming back for another scan later in the second trimester, especially if baby is not in a good position.  We regularly will follow up an anatomy scan that is performed at 18-20wks.  We have a long checklist of fetal detail to document and whatever is not seen the first go ’round will usually warrant a second attempt about a month later.  It’s great if baby is on his/her back and looking up, not so much if he or she is curled up in a ball, facing mom’s back or practicing diving skills in the pike position.  In those cases, parents have a hard time recognizing anything on the monitor because all I’m observing is parts.  This is fine for me because I scan in 3D (mentally) so I know how baby is lying and know what the parts individually look like.  For parents, it’s a bit of a let down, especially if the face wasn’t well seen on the last scan and if they can’t make out the face, it looks like nothing to them.

Think about it..the face is pretty important.  Isn’t that how we greet one another?  We relate to each other by looking at each other’s faces and this is also true during an ultrasound.  When people meet their babies, they want to see his or her face and the profile is the best way to see it.  At this angle, you can see soft tissue features like the nose and lips.  So cute!  From the front, only bony features are seen so it looks a little more skeleton-like…a little scary for most!

Ya know, they all just have their own personalities in and out of the womb.  They are either posing for or hiding from the camera..NO paparazzi, please!

It really stinks to send someone home with only a pic of the foot :/

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Posted on December 15th, 2013 by wombwithaviewblog.com

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

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

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

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

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

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Posted on December 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!

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

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

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

 

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Posted on 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 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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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!

Comments: 13 Comments »

Posted on March 3rd, 2013 by wombwithaviewblog.com

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

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

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

 

 

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Posted on February 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!

Comments: 3 Comments »

Posted on February 22nd, 2013 by wombwithaviewblog.com

I have a question..  What in the world makes anyone presume he or she can narrate an ultrasound examination??  I have to laugh but I do try so hard to keep it smothered.  No, that’s not the eye blinking or an ear when I’m looking at the brain.  How can I tell that’s a penis?  Well, it looks like a penis..and scrotal sac.. and little girls don’t usually have those things.  You know you’ve heard it a thousand times, my fellow OB sonographers!!  LOL  It takes us months of training to be able to decipher this stuff but some patients and/or their family continually point out things on the screen like they know what they are seeing but, alas, are entirely wrong.

I’ve talked about this before but I just HAD to say after a recent experience that an amniotic sac does not contain bubbles (it’s cross-sections of the umbilical cord that look circular) and a fetus cannot burp or “fart” because Peanut cannot ingest the air that is required to create such bodily functions since a fetus lives in fluid and does not actually use the lungs in utero.

Also, it’s called a placenta.  What is it??  It’s a temporary organ that feeds the baby until delivery…what’s that?..no..the cord is not attached to mom’s belly button.  Sheez.

REALLY?? Is this REALLY something I HAVE to explain?  To all those who did not know the above information, it’s called Biology 101.  Take a class!

One more for the road…”What are labia?”  Yeah.  You know this came from a man.

 

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Posted on February 21st, 2013 by wombwithaviewblog.com

This is again a 9wk image.  I just wanted to point out that the amnion can be seen early in pregnancy.  This is the thin membrane that kinda looks like a little bubble around the baby.  It can be seen around each fetus and it’s what most people know as the amniotic sac, amniotic fluid, sac of fluid or “liquor” if you have a sonogram done in the UK!  (I read a report one time from a transferring patient who had an exam done in England and I just thought that was comical.)

Anyhow, the babies can be seen doing some little wiggling now.  So cute..  More soon!

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Posted on February 17th, 2013 by wombwithaviewblog.com

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

9wk fetal ultrasound

 

9wk fetal ultrasound

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Posted on 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 January 29th, 2013 by wombwithaviewblog.com

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

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Posted on January 27th, 2013 by wombwithaviewblog.com

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

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

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

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Posted on December 9th, 2012 by wombwithaviewblog.com

One of the things I love the most about this time of year and my job is how people come up with inventive ways of finding out their baby’s gender around Christmas.  Of course, most people who want this surprise will have me determine gender as they look away and then have me write it down for them enclosed in a sealed envelope.  They wrap it like a gift and place it under the tree to open Christmas morning!

What’s fun about this is that usually the couple is so excited and the anticipation is almost too much to bear, just like a kid who can’t wait to find out if Santa is bringing his favorite toy or game.  These parents could care less if they get anything material this year..  In my opinion it is the greatest gift they could give one another and share together during this holiday season!

Happy Holidays!

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Posted on July 27th, 2012 by wombwithaviewblog.com

People, we as medical professionals KNOW you are excited about your sonogram.  Believe me!  We are moms, too, and we know you have counted down the days and lost sleep just waiting to find out the gender.  Visitors during your sonogram are allowed but PLEASE also realize your entourage of 20 friends and family are NOT welcome!!   This is not a family reunion or a party.  This is first and foremost a medical examination.  Ask anyone who has made a career of OB sonography; we are attempting to essentially rule out approximately 200 abnormalities and disease processes in one fell swoop.   It requires lots of concentration to make sure we are including all of the internal organs, limbs and structures requiring documentation.  Sure, we can make small talk and usually I do.  But when five family members or three kids or even one other person is providing non-stop and unwanted chatter buzzing about my head, it can make a bitch snap.  (Okay, I know that was unprofessional but it was also funny so I kept it.)

Nana playing gaga googoo with your 18month old whose pounding on a musical toy with the volume all the way up is a distraction.  The friend with both your mother and mother-in-law comparing and contrasting all of their labor and delivery experiences during the ENTIRE scan is a distraction.  Everybody’s fingers all over my monitor asking what is this and that while the toddler is getting into my cabinets of betadine and syringes and the five year old nephew is playing his DS and the 3 year old is taunting the baby in the stroller by stealing the pacifier thereby making it scream it’s little head off and little Ashley and Jack are chasing each other around the room and Jack then sees the “cool pictures” coming out of my machine so he has to pull them out…you get the picture.

Most places have limits on how many people you can take into the room.  So you are not disappointed on your big day, call your doctor’s office and ask about their policies.  It’s a good idea to let mom come back with one person for the initial scan.  It is because we like to make sure there is a heartbeat and nothing seriously wrong so you are not getting terrible news at the same time as Uncle Erwin.  This is a private matter we are sure you would not want to share with an audience.    After the initial medical exam is performed is a good time to let everyone else in.  At that point, I really don’t care how many are in there because it is play time, it will only take a couple of minutes and I’ve already done my real work.

So, all you moms with your first big sonograms coming up, I hope you enjoy your experience!  I hope you have a sonographer who is really nice and engaging who will point out all the little parts for you and give you some great pics!  And I hope your baby cooperates so you can find out what you’re having.  If you can give your sonographer a few minutes of pin-dropping silence, she will love you for it!  And if you bring another adult with you who actually takes the screaming baby outside, she’ll love you forever.

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