Ultrasound

Now that we've hit week 18 (or 20 by the medical establishment's reckoning), it was time for the standard 18-20 week ultrasound appointment (I skipped the early one because I had no reason to suspect an ectopic pregnancy or any other troubles). (I'm not a worrier and not high risk for much of anything, so I'm keeping the interventions to a minimum.) Ultrasounds are considered pretty "non-invasive" but that doesn't mean you need to go nuts with them...so for the most part, I feel it's best leave a healthy baby alone, and let nature do its thing.

At 18 to 20 weeks, the doctor is looking for congenital malformations because the fetus is large enough for an accurate survey of the fetal anatomy. This is also a time to discover multiple pregnancies, and check the accuracy of the due date. The fetal growth rate, size/age correlation, and the presence of conditions such as meningomyelocele, congenital heart disease, kidney abnormalities, hydrocephalus, anencephaly, club feet, and other deformities that can be easily determined by this point in pregnancy. By 18 weeks, your little bundle (or bundles if you happen to have multiples) of joy has a clearly formed skeletal system and many easily visible organs (brain, heart, etc.) that can clearly be seen at this time. If your recall of anatomy is good, you'll actually be able to understand most of what you see up on that screen. If you can, be sure to bring someone along to share the joy with (partner, best friend, mother, sibling, etc.) because you'll want at least one other person to share the moment. For men, especially, this is the first time that the pregnancy will be "real" for them. And if God, forbid, you get some unexpected bad news, you'll benefit from having someone supportive with you.

This was my first "fun" ultrasound (I've had them for less fun reasons), so the process was a familiar routine. You chug a bunch of water (since you have to have a full bladder for an abdominal scan--not fun when you're pregnant), put on the hospital gown (at some places you can wear your regular clothes, but at Kaiser, they have you put on a hospital gown for everything), go into the fairly dark room and hop up on the padded table. The technician covers you up with blankets so you don't get too cold, then the sonographer comes in to warm up the machine, and squirts goop on your belly (they actually warm it for you first) so it's not such a shock of cold. Then they whip out the transducer (which vaguely reminds me of a checkout scanner for some reason) and push it around over your abdomen and start looking for various things for about an hour or so. (If you're getting an earlier ultrasound, they'll likely use a vaginal transducer--uggh! Those aren't fun...) The nice thing about this particular facility is that not only does the sonographer have a screen, but they also have a nice big LCD flatscreen monitor up on the wall so that you (and anyone you've brought with you) can easily see everything that's on the tech's screen. Usually when you're getting an ultrasound, they ask you to lay still, be really quiet, and hold the questions 'til the end, but on this occasion, there was an intern in addition to the sonographer. Since the sonographer was in "teaching mode", she kept a nice running narrative while she was working which was a nice bonus. We didn't have to sit there in dead silence wondering what was going on--she told us everything!

The information obtained from the transducer scans appears as a picture on the monitor. Even in black and white, it's a pretty inspiring moment when you see your child for the first time. I was amazed how clearly I could see Sprout moving around (I guess the technology's improved a lot because I few years back, I remember people showing me their ultrasound photos, and I couldn't decipher anything whatsover in those blobs). When the transponder passed over the abdomen, you could see the heart beating. You could see most of the bones--right down to the tiny carpals/tarsals and phalanges in the tiny hands and feet It's a pretty amazing experience to say the least. Sprout was moving around in utero like it was Dance Dance Revolution time, squirming, kicking, twisting around, moving those arms and legs up and down. My goodness, no wonder I've been feeling some fetal movement--there's an active little squirm worm in there!

While I sat there in awe of the tiny being who was putting on such an acrobatic show, the sonographer was busy looking at things like location and size of the organs and bones to take a variety of measurements that will be interpreted to assess gestational age, size and growth of the fetus. Thanks to all the anatomy review I've had in the past year working as a sub working at the middle and high school level, I was able to follow along quite well. Some of the things they were looking at during the ultrasound included: The placenta location, blood flow rate (doppler with color enhancement) and heart rate, crown-rump length (CRL-used to assess age), biparietal diameter (BPD-the diameter between the 2 sides of the head.), femur length (FL-measures the longest bone in the body and reflects the longitudinal growth of the fetus), abdominal circumference (AC-reflects the fetal size and weight to monitor growth), head circumference (HC), nuchal skin fold (to diagnose Turner's syndrome, Down's syndrome and a number of chromosomal abnormalities.); and sizes of the cerebellum, heart chambers, and kidneys. Apparently many abnormalities can be reliably diagnosed by an ultrasound scan, such as cleft lips/ palate and congenital cardiac abnormalities. The sonographer isn't supposed to interpret this information (that's the radiologist's job) but I inferred from her behavior that she didn't see anything particularly alarming or worrisome, and I didn't see anything on that screen that alarmed me, so I'm going to assume everything's fine. Based on that, and my general instincts and intuition, as far as I can tell, Sprout seems to be doing just fine.

At the end of the session, they print out some of the more interesting shots (profile, head, hands, feet, etc.) and send you home with something you can show your friends and family (and random strangers if so moved). Brian stopped at Walgreen's on the way home to get a photo album to stick them in, so he could take them to work to show off to co-workers. Pretty exciting stuff!