My Ultrasound

Today is the 5th anniversary of the one and only ultrasound I have ever had during both of my pregnancies (not counting the numerous Doppler u/s to check the baby’s heartbeat prenatally and during labor, which I didn’t realize at the time was ultrasound). One of the cool things about midwives (at least, the midwives I’ve chosen, although perhaps not most/all midwives are like this), is that they didn’t act as if my medical record were somehow a secret file that I shouldn’t know about. In fact, as I reached the end of my pregnancy, they gave me a copy of my whole record up to that point (and copied the most recent page at every visit, to make sure my record at home was as complete as theirs), just in case I needed to go to the hospital without them — that way the hospital personnel would have my complete prenatal file, if they had any questions or needed any clarifications. So, I have a copy of the ultrasound exam, both the hand-written scrawl of the doctor as well as the type-written one from that information. Just for kicks, I’ll put both of them up, so you can see the notoriously horrible “doctor’s scrawl”, as well as the one you can actually read. 🙂

u/s scrawl

u/s typed

I’m not totally sure what the different abbreviations are, but will comment on most of them anyway. I think it’s funny that “Indication” says that the baby is LGA or Large for Gestational Dates; however, the estimated fetal weight was 7 lb 3 oz at 37w5d, and his birthweight (nearly two weeks later) was 7 lb 5 oz. So they were both wrong; and unless I’m greatly mistaken, 7.5lb is about normal for a full-term baby. There was “none” comparison because I hadn’t had any other ultrasound; he was correct that there was one fetus who was in cephalic position. “BPD” is biparietal diameter — the measurement of the top of the baby’s head from side to side. I wasn’t sure about FL, HC, and AC, so looked it up — femur length (which I guess correctly), head circumference and abdominal circumference. As you can see, he estimated “GA” (gestational age) from each of those different measurements (I presume there are some sort of averages the computer is programmed with), and came up with remarkably consistent dates to each other as well as my actual due date — in fact, they are identical. But notice that it says “+/- 22 days” — three weeks give or take, from the ultrasound’s best estimate. This is why you should be wary of late ultrasounds used to determine your actual due date, particularly if they overthrow previous due dates based on accurate ultrasounds, known date of conception, regular menstrual periods, etc.

Not sure what the CI is that is 85%, but the rest of the things are ratios of the previous measurements, and are all within NR (normal range). “WNL” means “within normal limits” (had to look that one up too!); and the rest looks pretty straightforward — checked to make sure that the baby had kidneys, bladder, stomach, etc.

Note that the AFI (amniotic fluid index) is 19.8cm, which the “impression” says “is high for this gestational age.” I’ve read that a normal AFI is anywhere between 5-25 cm, so not sure why 19.8 is high. I guess it’s still within normal parameters, even if most babies/mothers do not have this much at 37 w 5 d?

The reason for the u/s was that my midwife, at that day’s appointment, thought she heard two heartbeats. She spent probably 90 minutes with me that day, with a large portion of the time trying to ascertain for sure that she was hearing only one heartbeat — at one point, she called in her labor assistant (who ended up being the one who was on call when I went into labor), and they were both listening to my belly, with an EFM aimed at one quadrant and the Doptone or fetoscope or whatever aimed at the other quadrant where she was also hearing a heartbeat loud and strong, and both were tapping their fingers in time with the baby’s heartbeat, trying to see if it was indeed one baby (just echoing), or two babies with two heartbeats. Not being able to satisfy the question to her liking, and being unwilling (or perhaps legally unable) to attend a twin homebirth, my choices that day were to have an ultrasound or plan a hospital birth. Oh, yeah, big choice. I weighed my options for like half a second. 😉 Anyway, after the u/s was complete, she said that it was probably the extra fluid that allowed the baby’s heartbeat to echo and sound like two different heartbeats.

“But what if the test is wrong?”

On one of my email lists, we were recently discussing amniotic fluid levels — how low is too low, what can be done for low levels, etc., and one woman told her personal experience. She had a non-stress test in which the technician said her amniotic fluid level was so low she’d have to be induced that day. Stunned, she said the first thing that came to mind — “What if the test is wrong?” That, in turn, stunned the technician, because no one had ever asked that question before. She said, “Let me check again,” and to her surprise, the second measurement was twice as high as the first one, and an induction was not indicated.

I’ve said it before and I’ll say it again — get a second opinion! (Sometimes even from the same person.)

One question to keep in mind with this sort of thing is always, “What’s the false positive rate?” Because if a recommendation is made to you to induce or perform a C-section or have some other intervention based on one thing alone, and that “thing” is wrong almost half the time, then how confident can you — and the doctor, for that matter — be in the diagnosis and subsequent intervention. If, however, there is a low false-positive rate, then you can be more confident that your diagnosis is indeed accurate. Getting a second opinion, or relying on two or more factors reduces the margin of error. Some doctors are more willing to err on the side of caution — after all, they’re not going to have to recover from abdominal surgery, and performing a C-section may make them feel lawsuit-proof. But it’s your body, your baby, and your choice, so you need to know how often they’re wrong on average.

Another question would be, “What are my options?” Some doctors might say, “You don’t have any.” But if you press and ask, “Can I wait a day?” or, “What happens if I refuse?” you may hear some different answers. Very likely, they’ll pull out a worst-case scenario in which it’s possible your baby may die. And they may be absolutely right; but they may just be exaggerating the situation to get you to go along. It comes down to how much you trust your doctor’s opinion. This is where it becomes important to get a second opinion, do your own research, find out your own options, etc. You may find out that declining the intervention raises the risk to your baby astronomically, and you would be stupid to refuse; or you may find out that your doctor was astronomically exaggerating the increase in risk, and you may be comfortable with the slight increase in risk to avoid the risks of the intervention.

Another question to ask includes questions about the rate of complications in the scenario. It’s one thing for doctors to say that having some medical condition or refusing some intervention “doubles your risk” — which sounds very bad — but it’s another to find out that the “risk” is still only 1 in 50,000 (which is double the risk of 1/100,000). Sure, nobody wants to be that one, but that means that 99,999 mothers and babies are subjected to an intervention which also carries risk. It’s about perspective — a balance — a trade-off between two different courses of action. Nothing in life is guaranteed (except death and taxes); and there are risks and benefits for every course of action. It’s up to you to choose which risks are acceptable for the proposed benefit.

And certainly remember to ask, “What if the test is wrong?”

Kick Counts — Fetal Movement

This is a very important subject, because many women who have had children stillborn reported a decrease in movement a few days prior to fetal death. Recognizing that your baby is not moving enough may save his or her life. If, for some reason, the placenta is not functioning properly, or if the umbilical cord is knotted, or if the cord is wrapped around the baby’s neck, then the baby may not be getting enough oxygen.

One of the natural mechanisms that the body has to keep itself alive, is to divert blood from less necessary parts (arms, legs, etc.) to the vital parts (heart, brain, etc.). We see this in adults who experience trauma or shock. So, when there’s a diminished supply of oxygen, the baby will typically move less — conserving energy as well as keeping the brain more fully supplied with oxygen.

Towards the end of your pregnancy, the baby may not kick quite as hard, or move more gently (less room inside for him or her to move), but there should not be a significant decrease in movement. Doing a “kick count” every day will help you to recognize if your baby is moving less. This isn’t to scare you — the stillbirth rate is low — but losing a baby at the end of pregnancy may possibly be able to be avoided by a little vigilance on your part. You can take the approach of bonding with your baby, and just concentrating on his/her movements, and feeling the connection you have with him/her while s/he’s still inside you.

Here is a great website that has a lot of information about doing kick-counts, and also about stillbirths in general. I hope that you will never need this information. Just as you will take every precaution to preserve your baby’s life and health after birth — always using a car seat while driving, making sure a blanket is not over his face while he’s asleep, double-checking medication dosages before giving him anything — so you can take this small precaution to help preserve your baby’s life and health before birth.

My husband’s best friend and his wife lost their baby to cord strangulation almost three years ago. She noticed a decrease in movements, but thought it was just the normal change in movements that happens before birth. Then she noticed no movement. On her due date. She is still afraid, almost three years later, to get pregnant again — afraid of going through the heart-wrenching loss of another child prenatally. Many causes of stillbirth are unknown — sometimes because an autopsy wasn’t done, other times an autopsy was done but there was no explanation for the fetal demise. Doing a kick count can’t completely eliminate stillbirth, but if it can prevent even one death, it’s worth it.