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Ultrasound Questions


So let me address a couple of things that people tend to ask about when we talk about ultrasound — some common questions. First of all, how many ultrasounds am I going to get? Well generally, in a lot of our institutions, if we have any questions about dates early on in the pregnancy, in the first trimester, or if we’re not sure about the timing of your last menstrual period, or you know, various other reasons why we’re not certain about dates, sometimes we’ll do an early ultrasound to confirm the dates and make sure that we know because that’s the best time to date a pregnancy. And then we will do, if you want, this a basic screening ultrasound for everybody in the 18–20 week timeframe usually. And then, how about others? Well, usually that’s it.

Once you’ve seen the baby’s anatomy and we know that things look normal, then we’re done pretty much as far as anatomy goes. Because really then it’s about growth, about size. And we’ve gotten pretty good at being able to tell how big the baby is by just measuring your tummy. You know, if you take a tape measure and you put it on your public bone and you measure up to the top of the uterus, interestingly enough after 20 weeks it’s about a centimeter per week. So if you’re 20 weeks along, it’s about 20 centimeters and 22 and etcetera, all the way up to 40. And when you get to the very end, then it gets off a little bit because the baby starts to settle into the pelvis and sometimes, you know, it’s plus or minus a couple of centimeters. But it’s pretty accurate. So normally that’s how we tell if the baby’s growing well and doing fine.

And, of course, we listen with the Doppler when you come into your visits, or we can take a quick peek with ultrasound. There are some people who need other ultrasounds. Let’s say if we found an abnormality on that first ultrasound, then we might need to follow up and see how things are going. Or, in some cases, in moms who have high risk for babies not growing well. So if you have a problem like high blood pressure or some autoimmune diseases that make it a little more likely that babies don’t grow well, then we will do ultrasounds, sometimes as often as every month or even as frequently as every two weeks. Okay. But those are not just screening — now we’re into doing those for a specific reason. And of course if you had two babies or three in there, then you can’t really measure how big the baby is by measuring your tummy because what if one is big and one is little? So that’s why we might do multiple ultrasounds.

Now, a couple of other questions. What about ultrasound for fun? You know I’ve got this fun 3D picture up here of this baby. So how’s that? Should we run downtown and get a picture… you know pay the money at the mall and get a picture? Well the question is, are there any risks to that? And I think there a couple of things that you should know. One is that those ultrasounds aren’t really designed to be detailed or medical, so it may be falsely reassuring. They may also find minor abnormalities and make you nervous because the doctor isn’t sitting there to tell you what all those things mean, and so that might make you nervous if they see something.

And then the other question is what about the sound itself? Is it risky at all? Do you think so? Now I can tell you this. First of all, before I make anybody nervous about this, we don’t know of babies ever being harmed from ultrasound when we do ultrasound the way that we’re supposed to, when we use it, because we control the power and so forth. But if you think of those sound waves, you remember how I was telling you those sound waves come down through the tissue and they hit the tissue and then they bounce back? Well, what do you think happens to the tissue when they bounce off of it? It vibrates. It vibrates, exactly. So, if that tissue vibrates and, in fact, if you vibrate it too much … it’s heat right? So we actually have ultrasound equipment that we can use to cook things on the inside, you know which is kind of cool that people are going after tumors in the brain by focusing sound waves and getting rid of the tumor. So that’s good, but of course you wouldn’t want to hurt the baby with heat, right? So we limit the exposure. We do the ultrasound when it’s indicated.

That’s why the FDA has come out and said we really shouldn’t be supporting or doing these ultrasounds just for fun. There should be a reason to do them. So we don’t really support doing them just for fun. Now, we’re not going to beat you up about it. If you go downtown and have your ultrasound and have some fun with it, but just keep in mind that that’s why the FDA and the American College of OB/GYN and the American Institute of Ultrasound and Medicine don’t really support that.

All right, any questions about ultrasound? I have a question. Yeah, Jen. Because of my age, I’m in a higher risk group so I’ve had several more ultrasounds than two. Should I worry about continuing those? Please don’t. Please don’t worry about it. Yeah I didn’t want to make you nervous about that whole thing because if we’re doing ultrasound the way it’s indicated. You know there are women who have had multiple ultrasounds, sometimes every few weeks, sometimes even every few days. If we’re doing them for a purpose, we try to limit the exposure and we use the equipment properly, that’s not a problem. So it’s not really a big deal. We have not detected any risks in situations like that. Try not to worry. Okay?

Can I ask one more question in the same vein? Sure, please, yeah. What about the duration of a single ultrasound? Is that something that they’re conscious of? Yeah, I mean people generally do what they need to do and usually get on with it. So if they’re going a long time, it’s probably because they’re trying to find something specific. And if there are clinical indications for it, don’t worry about it. It’s okay.

So, any other ultrasound questions? I have one. Sure, Jenny. So with the whole ultrasound — if our family has a history of either heart disease or any kind of a heart condition, will this be a good kind of indicator for us or kind of give us help with results? Great. Thank you for asking that. The screening ultrasound exam tends to look at the four chambers of the heart and the two main blood vessels that come out of the heart. And that’s a pretty good screening exam. But if we have a family history and we need to look carefully at the baby’s heart, sometimes we do a fetal echocardiogram — a special extra ultrasound where we are looking specifically with colors and flow and a little bit more detail. Ultrasound is pretty good at getting the big heart defects, but little tiny ones — it’s not great at getting. So we do extra ones.

Now that reminds me of one big point to make. Here I’m generally talking about the screening ultrasound that we’re offering “just because,” for anybody. Okay? If you have a medical reason, an indication for an ultrasound, age related, family history related, we found something already related … that’s a different story. Those are no longer screening exams per se, but those are being done to follow or evaluate specific conditions. So thanks for reminding me to share that. I appreciate that.

All right. Any other ultrasound questions or other questions? I have one. Sure. Sure. Candace. I am actually diabetic and so I’m just wondering, are there additional ultrasounds that I’ll have to have because of that or any other testing? Great question. So there are certainly medical conditions that indicate that other ultrasounds be done and diabetes is one of them. So when you sit down with your provider at the next visit, they will outline for you a plan for additional tests and ultrasounds and things like that. But that’s a very good question. Again, back to the main issue, which is we’re talking about doing a screening ultrasound but there are lots of other indications for ultrasounds including diabetes or screening for heart defects. Good. All right. You guys are ultrasound experts.