1. That Bladder! We have all seen the pregnant pee pee dance… While sometimes uncomfortable for our patients, this is the key to the first trimester transabdominal approach and also to 2nd trimester cervical measurements. Sometimes it just can’t be avoided, your patient is going to dance! However, in the 2nd trimester, it can be helpful for your patient to get what you need with the bladder full and to let them empty it out before completing the rest of your study. Often this can also improve the position of the fetus and help you to get better images with a relaxed mama and a relaxed baby!
3. Outflow tracts… the sound of that might scare some sonographers who are not used to looking at the fetal heart or evaluating this on a regular basis, but it’s much easier than you might think. Remember there are two main blood vessels that exit the heart – the aorta and the pulmonary artery. That’s it… just two. So how do you tell which is which? Most of the time (unless in a case of transposition of the great arteries or double outlet right ventricle), the aorta exits the left ventricle and the pulmonary artery exits the right ventricle. It’s important to note that the aorta will arch around after it leaves the heart and extend into the thoracic/abdominal aorta. The pulmonary artery will typically split into two branches.
Yes, there are many variations that can happen with cardiac pathology and unless you specialize in maternal fetal medicine or fetal echocardiography, you may not know the specifics of every congenital heart disease you might encounter, but if you know the basics and what that looks like, you should be able to know when it’s just not right and alert your reading physician. If you’re not scanning this on a regular basis, it would be a good idea to add this to your daily protocol.
4. Amniotic Fluid Index – how do you know your measurements are accurate? Many sonographers are not aware of how to properly measure fluid for an AFI. One key tip is to scan with color Doppler flow on – this allows you to identify umbilical cord that might be floating within the pocket of fluid. Another best practice tip and proper way to perform AFI measurements is to be sure your patient is lying flat on the table and keep the probe/ultrasound beam perpendicular to the floor. Also, keep your measurements perpendicular as well. This helps to ensure that the fluid pocket is not falsely enlarged.
5. Gender! We’ve all been there, where it seems that everyone is there for the show. While somehow you ended up being the entertainment for the expectant parents, don’t forget how exciting it can be to know how to plan for your little one. Yes, it’s often a pain with the dad, grandma, grandpa, sister, brother, niece, nephew, the mailman, the neighbor, the sister’s boyfriend’s mother-in-law and everyone else trying to squeeze into the room to catch a glance of the precious cargo and whatever package the baby might be sporting… so take a deep breath, don’t lose it on grandma and remember to SMILE 😊. Oh and scanning, well you know how that goes… get those pesky diagnostic measurements and anatomy evaluations out of the way and then... turtle or hamburger… take your pick!
Lara Miller, RDMS, RVT, RDCS, RCCS