Sonogram Secrets

By Trimester

Most expectant parents will tell you that during pregnancy, the ultrasound was one of the most exciting moments in their life. I began practicing ultrasonography at a time when ultrasound technology was just starting to develop. I have been quite fortunate to witness the revolutionary changes in this amazing diagnostic tool.

I also realized when I decided to start my own practice that expectant parents deserved to fully understand what they were witnessing. Ultrasound is the first time that the parents will meet their baby in the most basic human form. I would like to break down the experience by trimester and give insight into what most expectant parents should expect out of a prenatal ultrasound.

First Trimester

  1. 5 weeks is the earliest we can typically see a heartbeat. This ultrasound is usually performed endovaginally. It’s important to know that an Endovaginal exam does not and should not hurt. This ultrasound does not require a full bladder contrary to popular belief.
  2. A gestational sac can be seen as early as 4.5 weeks and a yolk sac is typically seen at 5.5 weeks.
  3. It is important to remember that even though a heartbeat can be seen as early as 5 weeks, most miscarriages occur between 8-9 weeks. Therefore, I prefer to perform viability sonograms at 8-9 weeks to date the pregnancy and to confirm the viability of the embryo and rule out multiples.
  1. The Nuchal Translucency (NT) exam can be performed during the first trimester, starting as early as 11 weeks and 3 days. This scan is a Sonographic prenatal screening to help identify higher chances for chromosomal conditions such as Down syndrome in a fetus. The sonographer measures the back of the baby’s neck and also checks for the presence or absence of the nasal bone. An underdeveloped nasal bone or absent nasal bone may indicate that the baby has a higher chance of having Down syndrome. An increased thickness measurement can also be associated with a congenital heart defect.
  2. The NT exam requires no special preparation on behalf of the expectant mother. My recommendation is that the pregnant mom be well hydrated prior to the exam. A full bladder is not necessary for this exam and can be tortuous for the future mommy who is probably already experiencing overactive bladder symptoms.

Second Trimester

  1. Gender determination – what everyone wants to know! How soon can I find out the sex of mybaby
  2. I perform a gender reveal exam as early as 14 weeks! Yes you heard correctly, 14 weeks! The 14-week exam is the perfect time to not only screen for gender but to perform a detailed anatomy scan.
  3. Unfortunately, typical insurance plans in the United States do not cover the cost of a 14-week ultrasound. They typically only cover that first screening (around 12 weeks) and another scan around 18-20 weeks.
  4. I feel that it is not only easier at 14 weeks to visualize arms, legs, fingers, toes, early brain, heart, stomach and bladder but it is a great time to rule out any anomalies. If anomalies are found early,parents have more time to seek out appropriate medical care.
  1. Now since most patients have to wait until 18-20 weeks to find out the gender and to have that anticipated anatomy scan, I have some suggestions to make the most of this exam. Come well hydrated to your exam. I am a firm believer that “fluid is our friend” and that a well-hydrated mommy equals a well-hydrated baby. You do not need a full bladder!!!
  2. Eating or drinking caffeine or sugar does not make a difference in the baby’s movement. Many expectant moms will try this trick in hopes of producing more movement for the ultrasound. This is not necessary since the baby is in a big amniotic fluid swimming pool and moves quite a bit on their own regardless of stimuli. A skilled sonographer knows how to get a baby to cooperate to obtain the necessary images.

Third Trimester

  1. The third trimester is the most common time for patients to request the 3D/4D sonogram. This is considered an elective ultrasound session since most insurance companies do not cover the cost of an ultrasound beyond the 18-20 week scan.
  2. Besides the cool pictures that come along with the third trimester scan, this is an important time to review the baby’s world one last time.
  3. I perform a detailed exam during the 3D/4D scan, which I affectionately call the baby’s first “in utero”pediatric visit. I go over the position of the baby, the weight of the baby and review the anatomy in detail.
  4. The position of the baby at this point is key because if the baby is breech (meaning feet first or butt first instead of head down) than there is still time for the mom to try to get the baby to move.There are lots of great techniques to get a breech baby to flip and often a chiropractor or acupuncturist can help. It is much easier if you find out before 34 weeks to try to get the baby to move. A breech baby at term is almost a guaranteed C-section.
  5. The ideal time for the 3D/4D scan is between 28 and 34 weeks. You can do it later than that; in fact I have performed some terrific exams at term. The reason we wait until the 3rd trimester is that babies have finally laid down fat in their cheeks. I like 28-32 weeks because if there are last minute issues we still have at least 8-10 weeks to make management changes.
  1. Don’t be upset if your sonographer cannot get those classic pictures you always dreamt of or seen on the Internet. Ultrasound companies advertise images for 3D/4D that are often difficult to reproduce. Many times the babies are in a position that they find to be comfortable and won’t move. If the baby has his or her hand in front of the face, well that is how they like to be. A baby learns early on where they like to be in the womb. You can’t expect them to pose, in fact 3D is going to reveal your babies personality and that may be with a foot, an arm or even the cord in front of the face.
  2. Speaking of the umbilical cord, when I mention it patients go crazy, “is it around the baby’s neck”? Even if it were around the baby’s neck, that is not a bad thing, it is time for us to stop vilifying the cord!
  3. If you pay for a 3D/4D exam out of pocket, you should never be rushed. The reason most parents come to see me is because they felt like no one answered their concerns or only spent 5 minutes with them during their ultrasound.

Secrets to Remember

The person performing your prenatal ultrasound is a Sonographer! We hate being called Ultrasound Technicians. If you are paying for an elective sonogram, ask the Sonographer about their training. They should be registered (RDMS), ideally in Obstetrics and Gynecology. They should be compassionate and patient. Pregnancy is a very exciting time and no one should be unkind or impatient during the ultrasound.

You do not need a full bladder, the Internet is filled with horror stories of women “holding their bladders” and this is simply torture! Pregnant women need to be well hydrated, and this means ingesting up to half your body weight in water a day (not sugary drinks). This does not mean wait till the day of to drink! If you are well hydrated throughout pregnancy, your bladder will fill frequently. Adequate hydration during pregnancy ensures better ultrasound images and reduces contractions and headaches.

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