Ultrasounds during pregnancy - Sequential and Quad Screening - Page 2

[Jaimee]

Well that's a whole other thread's conversation, but I would highly, highly encourage you to explore different birthing options.   You might surprise yourself.  All birth is life changing, but I have to say that unmedicated birth is amazing, transcendent. 

[2xy]

Originally Posted by Jaimee 

No sound on your vaginal u/s means lower power, so yes, that's better. 

Ultrasound, by definition, is sound above the range of human hearing. Humans can hear frequencies between 20 Hz and 20,000 Hz. Frequencies above 20,000 Hz (20 kHz) are ultrasonic. Audible frequencies are unable to produce an image on the screen. Diagnostic ultrasound is usually within the range of 2-18 MHz. One MHz is one million Hz.

When you hear things (such as heartbeats) during an ultrasound examination, that is a Doppler feature. Doppler ultrasound is used to convert moving objects within the body (such as blood or heart tissue) into something we can see or hear. Doppler ultrasound is not at a different power than regular ultrasound. 

All sorts of motion-detecting devices in daily life, like automatic door openers at the supermarket or motion-sensing alarm systems, are using Doppler ultrasonic technology.

[Jaimee]

Originally Posted by 2xy 
Doppler ultrasound is not at a different power than regular ultrasound. 

I think that there may be some confusion with the terminology (me included!) b/c the "common" names for these things do not exactly line up with the scientific names.  But in general, when laypeople say "doppler u/s" they are referring to an u/s that uses a higher intensity and has continuous output- not pulsed- so that it can record continuous movement like blood flow or the heart beating.  Regular ultrasound (sometimes called color flow) is image only and is pulsed or intermittent to avoid heating the tissue as much as possible. 

(Edited to correct)

This is all part of what we're talking about in this thread- whether the hand held doppler is worse than u/s because like the "doppler u/s" the hand held doppler emits continuous energy as well (though intensity is less than with an u/s).  I've been digging through a lot of articles that talk about doppler u/s but not so much hand held dopplers (still looking b/c I know I've read them!). 

Ultimately I feel that because some of these machines are not regulated and often even OB's are not fully trained in their use that you never actually know how much energy is being sent through your and your baby's tissues.  In addition, I feel that moderation is key and that less duration no matter what the type of u/s being used is best.  And in the end these tools have their uses and as 2xy noted there are a lot of things in our everyday lives exposing us to radiation (like flying in a plane).  So I feel when I have the choice to decline additional radiation doses, why not, especially when there are perfectly good alternatives like the fetascope.

Edited by Jaimee - 7/3/11 at 7:46am

[2xy]

Originally Posted by Jaimee 

I think that there may be some confusion with the terminology (me included!) b/c the "common" names for these things do not exactly line up with the scientific names.  But in general, when laypeople say "doppler u/s" they are referring to an u/s that uses a higher intensity and has continuous output- not pulsed- so that it can record continuous movement like blood flow or the heart beating.  Regular ultrasound or "diagnostic ultrasound" (sometimes called color flow) is image only and is pulsed or intermittent to avoid heating the tissue as much as possible. 

All ultrasound used for medical purposes is diagnostic ultrasound. Color flow is actually a Doppler feature. "Regular" ultrasound is only in shades of gray (also called B-mode). The pulsing in ultrasound is not to avoid heating the tissue. The pulsing is because there has to be a "quiet" time in between waves for the probe to pick up the echoes coming back from the tissue. Continuous-wave Doppler works because the probe has certain crystals for transmitting and others for receiving, and they can function simultaneously.

I may be wrong, but I'm pretty sure that pulsed-wave Doppler (color) uses higher power than B-mode imaging, and continuous-wave uses the same or lower power than B-mode. Yes, because it's a continuous wave, the patient will be exposed to more acoustic energy, overall....but not at a higher intensity. I believe that fetal heart Dopplers are continuous-wave.

Ultrasound radiation is non-ionizing. Rather like sunlight and radio waves. It's not like x-rays.

As far as I can see, the common names DO add up with the scientific names. I'm not sure where the confusion lies.

The only doctors trained in ultrasound technology are radiologists. Even OB's who know how to scan do not usually know the principles and instrumentation behind the technology, besides the very basics. That's why they hire sonographers. :)

I do not agree with casual/frequent use of ultrasound when it comes to fetuses, but neither do I think there is any real risk to having the heartbeat listened to for a few minutes over nine months. JMO, and to each her own.

[Jaimee]

2xy... no you're right.  I was mistaken when I said that color flow was not a doppler technology.  Thanks for pointing that out.  I was reading through this textbook about sonography online and got a bit muddled.  And I didn't mean to infer that intermittent waves are used to avoid heating tissue b/c there is certainly an issue with heat with intermittent waves.  I was trying  to say with intermittent waves less energy is absorbed by the tissue than a continuous wave.  But again much has to do with duration.  I was typing too fast- sorry for any confusion.   

For anyone that's interested in what I was reading, here is more info...

B-mode (brightness mode): "regular" ultrasound 2D image (lower power, pulsed output)

M-mode (motion mode): often combined with B-mode to see movement like part of the heart

Color flow: a form of doppler u/s that allows movement like blood flow to be seen (higher power).  The color images are superimposed on the B-mode image.

Hand held doppler: produces audio only (continuous output)

Wikipedia breaks down the different types:

Several different modes of ultrasound are used in medical imaging.^[7][8] These are:

• A-mode: A-mode is the simplest type of ultrasound. A single transducer scans a line through the body with the echoes plotted on screen as a function of depth. Therapeutic ultrasound aimed at a specific tumor or calculus is also A-mode, to allow for pinpoint accurate focus of the destructive wave energy.
• B-mode: In B-mode ultrasound, a linear array of transducers simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen.
• C-mode: A C-mode image is formed in a plane normal to a B-mode image. A gate that selects data from a specific depth from an A-mode line is used; then the transducer is moved in the 2D plane to sample the entire region at this fixed depth. When the transducer traverses the area in a spiral, an area of 100 cm² can be scanned in around 10 seconds.^[8]
• M-mode: M stands for motion. Ultrasound pulses are emitted in quick succession - each time, either an A-mode or B-mode image is taken. Over time, this is analogous to recording a video in ultrasound. As the organ boundaries that produce reflections move relative to the probe, this can be used to determine the velocity of specific organ structures.
• Doppler mode: This mode makes use of the Doppler effect in measuring and visualizing blood flow
  • Color doppler: Velocity information is presented as a color coded overlay on top of a B-mode image
  • Continuous doppler: Doppler information is sampled along a line through the body, and all velocities detected at each time point is presented (on a time line)
  • Pulsed wave (PW) doppler: Doppler information is sampled from only a small sample volume (defined in 2D image), and presented on a timeline
  • Duplex: a common name for the simultaneous presentation of 2D and (usually) PW doppler information. (Using modern ultrasound machines color doppler is almost always also used, hence the alternative name Triplex.)
• Pulse inversion mode: In this mode two successive pulses with opposite sign are emitted and then subtracted from each other. This implies that any linearly responding constituent will disappear while gases with non-linear compressibility stands out.
• Harmonic mode: In this mode a deep penetrating fundamental frequency is emitted into the body and a harmonic overtone is detected. In this way depth penetration can be gained with improved lateral resolution.

And speaks to the confusion:

The terminology "Doppler ultrasound" or "Doppler sonography", has been accepted to apply to both pulsed and continuous Doppler systems despite the different mechanisms by which the velocity is measured.

Here's another site I was muddling through and found this excerpt of interest (well, at least to me):

1) Power and gain:Color flow uses higher-intensity power than B-mode. Attention should be paid to safety indices.

And a mention of continuous vs pulsed from this site:

Continuous wave Doppler is often available as a separate small hand-held unit containing discrete transmitting and receiving piezo-electric crystals.  This allows for simultaneous transmitting of ultrasound waves and receiving of returning Doppler shift signals, which are converted to audible frequencies over a loudspeaker.  No image is produced.  This technique is often utilized at the bedside to demonstrate patent vessels or fetal heart tones in pregnancy. Pulsed-wave spectral Doppler shows the “spectrum” of the returned Doppler frequencies in a characteristic two-dimensional display.

[SilverMoon010]

Originally Posted by Jaimee 

Well that's a whole other thread's conversation, but I would highly, highly encourage you to explore different birthing options.   You might surprise yourself.  All birth is life changing, but I have to say that unmedicated birth is amazing, transcendent. 

To be honest, home birth has crossed my mind here and there. (I actually told my husband it has been crossing my mind this morning and he thinks I'm nuts! But then again, since when do we ever listen to a man when it comes to childbirth?! - LOL) Are there other options besides home birthing when it comes to more natural alternatives?
 

I've read some posts on here last night from the past regarding home birthing and I realize it may not be as scary as I think it is.   I just have soooooo many questions that I would need answered first.  I haven't looked into yet and am just spouting off some questions I have to you guys here first. By the way, if these questions seem like I have no clue about home birthing, it is because I don't

1. What if there are complications with me? Hemorrhaging? Blood pressure?

2.  What if there are complications with the baby prior to delivering or after?

3.  Is there a pediatrician of some sort to look over the baby too?

4. What if the midwife doesn't arrive in time and my husband has to catch the slippery baby! OMG! I can't see him being comfortable with that?

5.   Will I insurance cover it? I don't think it would but not sure.

6.  What about episiotomy? I'm guessing they do that with home births, too.  I had that done with my DS in the hospital.

7. Most importantly, HOW PAINFUL IS IT??

So many questions.  Maybe I need a new thread with all these questions!

[Jaimee]

I would suggest starting another thread for this discussion with a new title for better responses.  Also I would suggest posting in the homebirth forum so you can get answers from women who have been there and (hopefully) get less anti-homebirth responses.  But to answer your first question, a free standing birth center would be an in between option.  I don't know where you live so I'm not sure if you have any free standing birth centers in your area.  They face a lot of legal challenges b/c  of our messed up maternity system so they aren't everywhere.

As for your other questions, these are great things to ask the mw's that you interview.  Yep, it is standard procedure to interview potential mw's before selecting one. Choose one with solid answers/statistics and one that clicks with your personality.  Ask around for references as well.

1. What if there are complications with me? Hemorrhaging? Blood pressure?

HB midwives are trained to handle complications including hemorrhaging.  A competent mw will be able to spot the signs of a bleed even there is not a noticeable hemorrhage.  There are several things that can be done at home and some carry pitocin and oxygen.  Otherwise you would be transferred immediately.

2.  What if there are complications with the baby prior to delivering or after?

Again mw's are trained professionals.  When complications do occur a mw is able to handle most things.  If she cannot handle a particular complication she will refer you to a professional who can.  If there are complications that she cannot handle during labor or directly after, you will be transfer to the hospital immediately.  Many mw's are well trained in dealing with things that OB's are not like breech presentation and shoulder dystocia. 

3.  Is there a pediatrician of some sort to look over the baby too?

Some (but not many) pediatricians will do house calls and come examine the baby the next day.  Otherwise you might feel the need to take baby into your pediatrician a few days after the birth.  Your mw will do a normal newborn exam and will also check in on you and your baby shortly after the birth and usually 1-3 more times after that.  Mw's can also administer any of the typical newborn protocols like vitamin K, eye antibiotics, genetic screening, etc. if you want them.

4. What if the midwife doesn't arrive in time and my husband has to catch the slippery baby! OMG! I can't see him being comfortable with that?

One of the questions you'll want to ask the  mw's you interview is how many births they take on each month and how many they miss.  Many mw's only take on a few births so that they do not miss births.  Mw's generally have constraints on how far they will travel as well so that the risk of missing the birth is less (usually 1-2 hours).   Unless you have a very fast labor it is unlikely that your mw AND her birth assistant (if she requires one) will miss your birth.  But it can happen and if this is a concern you could consider hiring a doula with lots of experience to be present at the birth as well.  Otherwise, I have to just say this, my dh caught his son while the mw was in the next room (by our request) and he says it was the most amazing experience of his life.  Utterly amazing.  If you're interested in the whole story, just let me know. 

5.   Will I insurance cover it? I don't think it would but not sure.

This really depends.  It depends on your state, you insurance, and your mw.  Legal mw's are often covered as "out of network providers" if you have a POS or PPO.  So if your mw is willing to file the insurance you could get it covered quite well.   Sometimes pre-authorization is needed, sometimes a bit of a fight is needed.   Illegal mw's sometimes can still file insurance using out of state billing companies.  When I mention illegal mw's it is because some states do not recognize CPM's (a national license) and some do not recognize CNM's that are not overseen by an MD.  CNM's at birth centers are almost always covered by insurance.  Otherwise you pay out of pocket and IMO it's worth every penny.  Keep in mind that most hb mw's charge between $1800 and $4000.   Total.  And many have payment plan options.

6.  What about episiotomy? I'm guessing they do that with home births, too.  I had that done with my DS in the hospital.

NO!  Episiotomies have many cons and virtually no pros (if any?).  You can read up on that easily.  Tearing is better than getting cut. A mw is going to work with you to birth your baby in a way that helps prevent tearing.  I had extremely minor tearing with my first and none with my second.

7. Most importantly, HOW PAINFUL IS IT??

There is a recent thread about the pain of birth, which you could check out HERE.  You can see my responses.

[justgonnadoulait]

My midwife just uses a stethoscope.  I like that quite a lot because it means no doppler, AND I get to hear!

One of my concerns with ultrasounds and dopplers is pain for the baby.  My understanding (could be wrong) is that when ultrasound machines are used therapeutically on a bony place like an elbow, they don't put the wand directly on the elbow because it will hurt due to the lack of soft tissue.  So they submerge the elbow in a tub of water and bring the wand as close as possible without causing discomfort.  Now I know babies are in fluid, but they really lack body fat and muscle density.  Babies are often seen pulling their arms up to their heads during the ultrasound, and perhaps they are just reacting to being poked at, but it looks like a defensive position to protect the head from pain.  

I got this information from a DONA international conference a few years ago, so I might not remember all the info correctly, but that is what I remember from what the speaker saying.

[dot1]

Just thought I'd chime in.

Re. genetic screening.  I'm 39 and dh is 49.  I declined the blood test/nuchal folds ultrasound...because I knew that I did not want the risk of mc that comes with amniocentesis (in case of positive or false positive), plus I knew that I could never make a choice to abort a fetus with downs or spina bifida.  I'd rather just hope that pg goes well, keep stress levels low, instead of the worry and anticipation of a child with a disability.  Having the "reassurance" of a negative test just wasn't worth the risk if I found out the blood test was positive and I had to go through all that extra testing and stress.  I'd rather just deal with things as they come and let nature take its course.  The clincher was that there is no treatment that can be done for the fetus - basically the purpose of the screening ends up being giving parents the opportunity to choose to abort or not.  I have no judgement on that whatsoever - just me personally couldn't deal with that type of decision.

Re. early ultrasounds.  I personally am pro-early ultrasound simply b/c that's the most accurate way (unless you know your exact date of conception) to get an accurate due date.  Like another poster said, it can be the difference between having to undergo labour induction or other interventions that are determined by the due date.  Plus if I did have a complication, I'd like to know with some accuracy how many weeks gestation I am. 

This pg (I'm 26 weeks) I opted for the standard 20 week ultrasound since it had greater chance of picking up problems that could be potentially treatable, e.g. heart defects, etc.  I won't go for any more, unless absolutely necessary (e.g. to confirm if baby is breech, transverse, etc).  They're not really that accurate at estimating baby's size or amniotic fluid levels.  I had gestational hypertension at the end with dd1 (turned into preclampsia by 40 weeks and I needed inducing).  Ultrasound revealed very low amniotic fluid levels and underestimated my baby's size by almost 2 lbs!  She was fine, apgar 9/10 and has been perfectly healthy for the past 4 yrs.

I never had issues with the doppler - it's only once a month for a couple minutes...but by 20 weeks we were able to hear the heartbeat with a stethoscope.  I'm exposed to radiation sitting next to this computer - really am not sure what's worse...an hour or two daily of electromagnetic radiation close to a computer (or sitting in Wi-fi internet cafe) versus 2 minutes once a month or every few weeks (granted much closer exposure).  However, if all was going well, I was gaining weight and girth, felt lots of baby movement, I don't really see what the big deal would be in skipping the doppler heartbeat checks.

Good luck :)

[SilverMoon010]

Originally Posted by dot1 

Just thought I'd chime in.

This pg (I'm 26 weeks) I opted for the standard 20 week ultrasound since it had greater chance of picking up problems that could be potentially treatable, e.g. heart defects, etc.  I won't go for any more, unless absolutely necessary (e.g. to confirm if baby is breech, transverse, etc).  They're not really that accurate at estimating baby's size or amniotic fluid levels.  I had gestational hypertension at the end with dd1 (turned into preclampsia by 40 weeks and I needed inducing).  Ultrasound revealed very low amniotic fluid levels and underestimated my baby's size by almost 2 lbs!  She was fine, apgar 9/10 and has been perfectly healthy for the past 4 yrs.

I never had issues with the doppler - it's only once a month for a couple minutes...but by 20 weeks we were able to hear the heartbeat with a stethoscope.  I'm exposed to radiation sitting next to this computer - really am not sure what's worse...an hour or two daily of electromagnetic radiation close to a computer (or sitting in Wi-fi internet cafe) versus 2 minutes once a month or every few weeks (granted much closer exposure).  However, if all was going well, I was gaining weight and girth, felt lots of baby movement, I don't really see what the big deal would be in skipping the doppler heartbeat checks.

Good luck :)

Thank you for your response.  I am going to get the 20 week ultrasound as well. I know that for a fact.  Like you mentioned, I don't see a harm in it here or there for a very short time.  I also had preeclampsia with my first and I do remember having several ultrasounds towards the end to check the amniotic fluid level as well.  I guess my plan is to avoid as many U/S in the beginning as I can in case I have to have some at the end, which I hope I don't! I also had to have my DS's heartbeat checked for like a half hour when I had the preeclampsia, like twice a week! It was part of the NST.  I remember them leaving the monitor on me for that time period.  I didn't know much about it all then, but I hope I don't have to go through that again, knowing what I know now. I am very thankful my little guy is healthy as can be, especially given the pregnancy complications. I guess it is all a matter of keeping everything in moderation as much as possible because we all know too much of one thing is never good.

Still going back and forth on the Doppler thing.  I was going to wait until they can use the fetoscope but I just found out the midwife is never at the office, only at the hospital, so I won't get to see her.  I'll have to deal with the "regular" doctors - LOL!  I guess I'll talk to the doctor about my concerns and see if we can wait to hear it with the fetoscope.  Just part of me wants to check in real fast and make sure everything is okay.  So confused on what to do!

[Jaimee]

I say now that you're aware of the pros and cons, just go with your gut in the moment.

[2xy]

Originally Posted by justgonnadoulait 

One of my concerns with ultrasounds and dopplers is pain for the baby.  My understanding (could be wrong) is that when ultrasound machines are used therapeutically on a bony place like an elbow, they don't put the wand directly on the elbow because it will hurt due to the lack of soft tissue.  So they submerge the elbow in a tub of water and bring the wand as close as possible without causing discomfort.  Now I know babies are in fluid, but they really lack body fat and muscle density.  Babies are often seen pulling their arms up to their heads during the ultrasound, and perhaps they are just reacting to being poked at, but it looks like a defensive position to protect the head from pain. 

Therapeutic ultrasound and diagnostic ultrasound are worlds apart. The pulses in diagnostic ultrasound cannot be felt at all.