So, are you trying to figure out what to expect through your pregnancy as far as ultrasounds go?
Looking for tips on what each appointment may bring, what you should expect?
Look no further.
I’m here to share the news.
My “Monday thru Friday” is a Sonographer at an outpatient radiology facility.
I scan just about anything from head to toe, from a baby in utero to an elderly person.
You name it, we scan it.
But, for the most part, everyone thinks I just scan babies all day.
Far from it, but I’m happy to share some baby sonogram information with you.
First off, just know that the words ultrasound and sonogram are the same thing, they’re interchangeable.
I’ve had people come in and say their doctor gave them an ultrasound in office but it was inconclusive so they are sending them here for a sonogram..and they try to tell me it is two different kind of exams.
It’s the same thing, same machine, same concept, same exam.
It’s like saying that you’re a getting a CAT scan or a CT scan, they are the same thing. Or like saying you need to take out the trash or the garbage– same thing.
Let’s get to the information!
Why do I need ultrasound exams?
Please know that every doctor is a little different with what exams they’ll send you for.
Also, depending on your history, family history and pregnancy so far, will determine what exams are medically necessary.
You’ll need an order from your doctor for each exam.
What do I expect?
The order tells the Sonographer exactly what needs to be done and what they are expecting in a report from the Radiologist.
Each exam to be done has a protocol that the technologist has to follow.
Keep in mind that every ultrasound you are sent for is a diagnostic exam to see the growth and health of the baby- not just to show you a picture of the baby.
Do I need to prep?
With that in mind, please do the best you can to prep properly for the exam if you are told a prep.
During the early scans of your pregnancy, it is important to have a full bladder.
I know it sounds like a pain, but, Sonographers use the bladder as a “window” to be able to see.
A full bladder pushes the uterus in the proper position to see the best of what we can that way.
It also helps to view the ovaries, the cervical canal and bilateral adnexa of the pelvis.
What can you see and when?
Know that once you have a positive pregnancy test, you will still have to wait a few more weeks to have an ultrasound.
The pregnancy needs time to grow and be large enough to see.
The first scan that your doctor usually sends you for is a viability scan, somewhere around 7 weeks (may be done slightly earlier, but, around 7 weeks is our mental cut off where we would like to see a viable intrauterine pregnancy).
How is the exam completed?
This exam usually has two parts, depending how far along you are and how well the technologist can see.
The first part is the transabdominal exam – the external portion of the exam.
Depending how well the images come out, you may need an internal exam to get a closer look at everything, especially the earlier you are.
Don’t worry, you get to pee first!
The tech will then prep you for the internal.
This is called a transvaginal or endovaginal ultrasound, where a probe is inserted into the vagina for a closer look at everything.
This helps see more detail.
Think of the external exam as if you’re taking a picture with a normal camera, you’re getting a broad view. T
hen when you do the internal, it’s like using a camera with one of those big zoom lenses that see more detail.
It sounds worse than it is. I promise.
We had to practice on each other in school PLUS, going through fertility treatment, you get them allllll the time.
Why two parts? Isn’t the first part enough?
These exams work together to give the doctors the most information possible.
This viability scan may give you a heart rate of the baby and they should be able to give you a computer estimated due date and size of the fetal pole.
Keep in mind that if you are being sent super early, you may need another scan in a week or so time.
We are talking about measuring a little fetal pole (baby) that is only a few millimeters in size.
So, sometimes, even waiting a few days for a scan can make a huge difference.
If you do get to see an image, keep in mind that it will not look like a “baby”.
It will most likely look like a little blob and in order for you to be able to see it, the technologist will have to zoom in a lot for better detail and resolution.
What’s next after the viability scan?
The next most common exam is the 12 week Nuchal Translucency Exam.
Not all doctors order this exam on every patient.
Depending on your history and findings with this pregnancy, you may have this exam done or you may not.
You will start with a full bladder again to help the technologist see.
The tech will do the normal uterine, cervical, ovarian measurements and then they’ll go for a specific measurement on the baby’s neck.
Please know this exam is very baby dependent. I can’t stress this enough.
By that, I mean the baby has to be in a specific position for the technologist to measure the skin on the back of the neck.
It is important for the baby to be in that position because an incorrect position can create a false positive or negative measurement.
The measurements from this exam get sent along with your lab work which must be completed the same day as the sonogram.
The measurements and lab work, work hand in hand to create a risk percentage for the pregnancy having Downs Syndrome.
The technologist can not give you any results on the measurements alone.
They really can’t give you any results in general.
The radiologist has to read the images and they will dictate a report and send it to your doctor. Usually, once I get the images that I need with a full bladder, if the baby isn’t cooperating for the nuchal measurement, I will let the patient pee.
It makes the rest of it a little more comfortable and enjoyable.
After the NT exam, what do I expect?
The next ultrasound you will get for a “normal” pregnancy, is an anatomy scan.
This is done around 19-20 weeks gestational age, for the most part.
This is crucial to make sure you wait until you are this far along in the pregnancy because this is when the baby has developed enough for the technologist to be able to see all of the anatomical structures they need to see.
I know everyone gets excited and wants to go as soon as the doctor mentions it but you have to be far enough along.
The heart, brain and other organs have to be big and clear enough to see.
Again this exam can be very baby dependent. The tech may ask you to roll to one side or another to get baby to move.
I’ve also had mothers go for a walk around the parking lot with super stubborn babies.
This is also the exam that, if the baby cooperates and is in the correct position, you can find out the gender if you would like.
Notice how I said if the baby cooperates….. it’s all about baby positioning.
This exam is exactly what it’s called, the anatomical exam. It is to check the anatomy from head to toe on baby.
Sometimes you’ll have to come back if the tech isn’t able to get all of the required images, it is up to your doctor.
Gender is NOT a required image in the anatomical studies.
The most important thing is to check the health of the baby, please keep that in mind.
As a Sonographer, we have a long laundry list of images we must obtain for this study.
I know this exam can be a very exciting one for expecting parents, but, as a Sonographer, there is one thing I can speak for all of us in general….
Please limit the amount of people who come in the exam room with you, if possible.
The more people you bring in, the more questions are going to be asked, the more distractions will be going on and all of this increases the chance that we could miss something or do something incorrectly.
After all, this is a diagnostic exam and we need to concentrate to get the best quality information for you and your pregnancy.
Depending on where you go for your exams, some facilities don’t even let anybody except the mother and one other person in the room.
If you want to share the excitement with a group of people, have a party or go to lunch afterwards.
Also, on this note, please know that taking videos and photographs are NOT permitted.
There are some machines that cell phone technology can mess with.
Taking photographs and videos can also violate patient privacy and sonographer privacy.
Most facilities ask that you do not do this. You will be given a couple of pictures of the baby at the end of the exam— and please remember, the whole purpose of this is a diagnostic exam.
I can’t stress this enough.
For some patients, that will be the end of it.
Anything after the anatomy scan?
But for others, a doctor may order a third trimester growth scan.
A doctor may order this as well if your belly is measuring different than your due date/week progression.
This is a much less extensive exam than the anatomical exam.
The tech will do the normal third trimester measurements, measure baby and get a computer estimated size, weight and dates and get the radiologist to send a report to your doctor.
Any other scans?
Also, depending on how your pregnancy goes, your doctor may order a biophysical profile in the third trimester.
This is a specific test that the baby gets scored on for each accomplishment.
For the ultrasound portion of the test, your baby can get up to 8 points.
The baby will get two points for practice breathing, two points for showing muscle tone, two points for showing a broad movement and two points for having enough amniotic fluid.
The tech may also get measurements of the baby and take the normal position and cervical images.
This is a timed test, baby has thirty minutes to perform all of the requirements.
With, this biophysical exam, the doctor may also order a Non-stress test, aka, NST.
This is not an ultrasound exam but the baby gets scored two points for passing it as well.
This is when your belly is hooked up to two monitor.
One monitors for or contractors do the other belt monitors the baby movement and heart rate.
This is pretty relaxing for you. You just have to sit in a comfy chair and let baby do its thing.
Closing thoughts on ultrasound examinations
A couple of things to remember in general about your ultrasound appointments.
Try to follow the prep the best that you can, the tech will do the best they can to let you pee as quickly as possible.
This prep is to help them see the best and get the best quality of diagnostic images of the baby as possible.
At most facility’s, the technologist will have some printed pictures for you to take home at the end of the exam.
They will also try to show you things about the baby throughout the exam, but remember this is a diagnostic test, not a baby show and tell game. 3D imaging is NOT a diagnostic procedure, it is an elective. Some facility’s have the transducer to use for this imaging and some do not.
Most of the time, it is only used if there is a diagnostically covered reason.
Sometimes, if time permits a tech may use it if they have it.
But, you should never expect to have 3D imaging, unless you pay out of pocket and go to one of those show and tell baby facilities. Most exams are baby dependent.
Most importantly, the technologist is not trying to withhold information from you, they are just not supposed to legally tell you how everything looks.
That is what the reading radiologist does. That is why there is a dictated report that gets sent to your OB, who will go over everything with you.
Thanks for taking the time to read these reminders to remember as you prepare for your ultrasounds throughout our pregnancy.
Congratulations and we wish you all the best!
*** all ultrasound imaging is used with permission, as these are my personal ultrasound images of my daughter. These images can not be shared without my disclosure. Thank you ***