- What to expect during ultrasounds
- First contact with midwife or doctor
- 6 week ultrasound in Ontario??? - Canadian Parents | Forums | What to Expect
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This is a huge milestone for us as we lost our last at six weeks so seeing the heart beat was amazing. Oh and she printed a picture off for us too. I went in for an US at almost 9w due to some heavy bleeding. The only thing on the screen was a white spot that flickered the heart. That's pretty much what was pointed out to me. Not sure I'd be told anything else because baby was just so tiny. I am going to my drs office on Duncan mill in north York, they have an ultrasound clinic there.
Did they point out these things to you? The tech did her thing and then she went and got my husband from the waiting room. Turned the screen so I could see it and she pointed out the heart and at the end what she thought would be the head end. She then zoomed in to give us a better look. I had one she was 6w2d, she looked like a mosquito larvae lol..
You can see the 4 valves of the heart pumping as they are developing, a fetal pole, the starting of a brain and the yolk. Now with that being said they don't always get a clear picture of these and be prepared that they will be doing an internal, called a trans vaginal ultrasound.. It does not hurt. I had mine in Mississauga and I was 7w3d.
She showed me the heartbeat but really it just looks like a bean and some pulsing. During a previous pregnancy I had a miscarriage, when there was no heartbeat they brought in a radiologist to confirm and told me the news there during the ultrasound. They will explain everything to you if things are going as expected or if they are not But there isn't a whole lot for them to show you.
At 12w you see more and at 20w they walk you through all the parts: I had one done at around 5 weeks and 8 weeks The doc came in I had the 5 week on in emerg and said everything seemed to be on track I'm now almost 36 weeks and things are good so just try to relax till the later ones where it's more of a baby and less of a yolk: I had one at 6 weeks and couldn't see it, but I seen it at 7.
I had a 6 week dating us with my first pregnancy. I also had spotting but they definitely will check for the baby's heartbeat. I had a dating ultrasound in ontario..
I could see literally a fluttering dot. I was somewhat concerned and worried.. I went back at 8w5d to have another one to make sure it was a viable pregnancy and to check for a heartbeat.
What to expect during ultrasounds
It was crazy what that little dot had become and it had a nice strong heartbeat.. If your weeks you will probably be able to hear the heartbeat and see a little baby but if you end up being weeks and don't hear or see a lot don't be alarmed! I had a dating ultrasound at 7 weeks. I believe it was a transvaginal procedure. Didn't tell you much, just the due date. In he introduced the abdominal circumference measurement AC at the level of the intra abdominal umbilical vein as a more reliable measurement and this has become a standard measurement since Campbell and Wilkin, As the AC measurement is at the level of the liver which is the most severely affected organ in IUGR the head circumference to abdomen circumference ratio was introduced as a means of recognising the brain spared IUGR fetus.
The value of routine screening of the obstetric population for accurate dating, early detection of twin gestations and placental location was first demonstrated by Lars Grennert and Per Persson from Malmo Grennert et al. For example Bang and Holm from the Copenhagen school reported identifying the fetal heart beat from 10 weeks gestation in Bang and Holm, The seminal work on early pregnancy assessment came from Hugh Robinson from the Glasgow school. In using an improved Diasonograph he produced the first detailed biometry charts of the fetal crown-rump length from 7 to 16 weeks gestation; his measurements were so meticulous that they are still in use today Robinson, He was the first to point out the prognostic significance of finding a fetal heartbeat at 8 weeks gestation in relation to subsequent fetal demise Robinson and Shaw-Dunn, This work had profound influence on the management of patients with threatened abortion.
Anecdotal reports of the prenatal diagnosis of congenital abnormalities in women with polyhydramnios in the late second or third trimester were made by Bertil Sunden in a case of anencephaly and William Garrett in who described a case of polycystic kidneys. Ultrasound prenatal diagnosis really began with the Lancet paper by Campbell and his group who in reported the diagnosis of anencephaly at 17 weeks which resulted in elective termination of pregnancy Campbell et al.
Subsequent to this he systematically examined the fetal spine in women with raised serum AFP and reported the diagnosis of spina bifida in By he was able to report on high risk pregnancies examined between 16 and 20 weeks in which ultrasound detected 25 of the 28 neural tube defects; 10 of the 13 cases of spina bifida were detected with the false negatives being low sacral lesions Campbell, In the USA, John Hobbins and his team at Yale in described the prenatal diagnosis of several abnormalities including limb reduction defects Hobbins et al. The widespread use of ultrasound in prenatal diagnosis came with the invention of the real time scanning machines.
Due to the huge advances in integrated circuit technology occurring at this time, the machines were small and moveable and as they were less expensive, a department would have several instead of the single large static scanner. Movements of the fetus could now be followed and the probe angle instantly adjusted to identify the plane of interest.
First contact with midwife or doctor
Sonographers and research fellows could be quickly trained and as complete fetal biometry could be achieved in a matter of minutes, screening the whole obstetric population was now feasible. Initially it had only 64 lines so the resolution was poor but the second version the ADR in had over lines and phased focusing and could compete with static scanners in terms of resolution. In Kretztechnic produced the first practical endovaginal mechanical sector transducer which was designed to improve the technique of oocyte collection in IVF. By , Aloka had incorporated colour Doppler imaging originally called colour flow mapping into their real time equipment and this was quickly followed by other major manufacturers.
By colour was available on the transvaginal probe for gynaecological investigation. Much of the credit for promoting this new technology must go to Bernard Benoit a French doctor working in Nice who published stunning 3D images of the fetus especially in the first trimester. The development of real time scanning was a great democratising influence in obstetric scanning which was no longer confined to an elite group of experts in a few major centres. Real time scanners being inexpensive were now widely available and many experienced practitioners of static scanning were surprised and not a little discomfited at how quickly their junior doctors, midwives and sonographers became experts in scanning almost overnight.
The ease with which the probe could be manipulated meant that many fetal structures were measured and a great number of charts of different planes and organs were developed.
6 week ultrasound in Ontario??? - Canadian Parents | Forums | What to Expect
For example charts of inter-orbital diameter Mayden et al. However the standard measurements CRL, BPD, head circumference and abdomen circumference which were developed during the static era remained the standard fetal biometric measurements for assessing growth with only the addition of the femur length which was now easier to measure incorporated into equations for fetal weight and growth predictions Hadlock et al.
Studies of fetal behaviour were inspired by leaders in development biology such as Geoffrey Dawes in Oxford and Heinz Prechtl in Nijmegan. The ability to follow fetal movements by ultrasound inspired much interest as to whether quantification of these movements and especially fetal breathing movements might be helpful in assessing fetal wellbeing. The time, incidence and number of movement episodes or fetal breaths were quantitatively assessed and behavioural states identified.
Although there was an association between reduced total activity and IUGR, the test had a low predictive value for a positive test due to the large physiological variation in the incidence of both breathing and motor activity Marsal, For this reason in Europe the measurement of fetal activity fell out of favour as a means of assessing fetal well being. In USA however Frank Manning and Larry Platt in incorporated both of these measures into a 30 minute fetal biophysical profile test Manning et al. This test with minor modifications became the mainstay of fetal wellbeing assessment in the United States for over 20 years.
In Europe however researchers turned increasingly to Doppler Ultrasound to solve the problem as to how to effectively assess fetal wellbeing and optimise the timing of delivery when there is fetal compromise. Fitzgerald and John Drumm from Dublin using 2D static scans to identify where the probe should be placed but neither of these two groups followed up their observations. Two groups initiated pulsed Doppler studies of the fetus.
In Australia, Robert Gill working with the Kossoff group measured flow velocity in the umbilical vein Gill et al. However the long path length of the Octason prevented the measurement of high velocity arterial flow and this system was impractical for clinical Doppler studies. He measured flow velocities from the fetal aorta and found that they were reduced in IUGR fetuses. It was found that absolute velocity measurements were inferior to waveform analysis especially the pulsatility index in the assessment changes in the fetal circulation to hypoxia. In Australia Brian Trudinger and Warwick Giles rediscovered the importance of the umbilical artery waveform and established the significance of absent and reversed end diastolic flow Trudinger et al.
In Campbell and his group described the uterine artery waveform and the appearance of notching which together with a high resistance index was associated with pre-eclampsia Campbell et al. His group subsequently used this finding to screen the pregnant population at 24 weeks gestation to predict the subsequent development of preeclampsia. The advent of colour Doppler as an integral part of the ultrasound machine made visualisation of fetal vessels much easier and studies of virtually every fetal artery such as the renal, splanchnic, cerebral was investigated and charts made of the gestational changes of PI under different clinical circumstances.
Although these were useful they were no better than the antenatal CTG in determining the optimal time to deliver the compromised fetus. This led to several groups investigating the venous side of the fetal circulation. Initial studies concentrated on the inferior vena cava but in in a landmark Lancet paper, Torvid Kiserud from the Eik-Nes group in Trontheim, Norway described the measurement of the pulsatility of the ductus venosus Kiserud et al. With modern equipment, Doppler evaluation of the fetal circulation especially umbilical and middle cerebral arteries and ductus venosus is now established as a fundamental requirement in the assessment of fetal wellbeing and the timing of delivery of the compromised fetus.
A further important use of Doppler was its use as non-invasive method of diagnosing anaemia in Rh immunised fetuses which was popularised by Giancarlo Mari and the group at Yale University following a paper in the New England journal of Medicine in Mari et al.
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The prediction of pre-eclampsia and IUGR by uterine artery Doppler was further explored by Nicolaides in a very large multicentre studies. One of the problems is that prevention by agents such as low dose aspirin does not seem to be effective. Nicolaides and others are now exploring the possibility of screening for pre-eclampsia in the first trimester when preventive therapy appears to be effective using uterine artery Doppler and biochemical markers such as PlGF and PAPP-A Akolekar et al. Preterm labour is the greatest cause of neonatal death and handicap and the care of the preterm baby is hugely expensive.
Although the causes of spontaneous pre-term labour are many and not fully understood, a common final pathway is shortening and effacement of the cervix. Frank Andersen from Ann Arbor Michigan was the first to draw attention to the superiority of transvaginal scanning Andersen et al. Unfortunately cervical cerclage does not appear to be effective in extending gestation in these women but two major studies from the Nicolaides group in London and the group of Robert Romero at Wayne State University, Detroit have demonstrated that following universal screening between 19 and 24 weeks, a significant prolongation of gestation in women with a sonographic shortened cervix can be achieved with daily vaginal progesterone treatment Romero et al.
Following the introduction of real time scanning there was a large number of review papers documenting the experience of tertiary centres in diagnosing a wide range of abnormalities of virtually every organ of the fetal body. Many of the studies published at this time were invalid because of low ascertainment of anomalies in the newborn the prevalence should be between 2 and 3 per cent.
Multicentre studies as a rule had lower detection rates than those from single centres. For the first time the diagnosis of cardiac abnormalities was now possible. In her classic study Allan Allan et al. In S-J Yoo Yoo et al. In Beryl Benacerraf and her group in Boston first described that an increased nuchal skin fold measurement in the second trimester was associated with Down syndrome Benacerraf et al.
For the first time younger women could be offered amniocentesis on the basis of a combination of markers. Nicolaides, With CVS being offered as the diagnostic test to women at increased risk, this screening programme has been adopted throughout the world. However this is likely to change with the advent of cell-free DNA testing Lo et al. Furthermore in the future cfDNA is likely to be able to screen for a wide range of chromosome and genetic disorders.
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The importance of identifying the position of the needle during amniocentesis was first highlighted by Jens Bang in Copenhagen in Bang and Northeved, during the static scan era but few practitioners used his transducer with a central hole and scans at this time were usually used to identify a placenta-free accessible pool of fluid prior to the procedure.