Ovarian masses vs. fibroids

A couple of weeks ago, I scanned a 60 year old patient for an annual follow up of her fibroids.  I observed large bilateral masses in the adnexas, which appeared to be ovarian in origin, but with her history of fibroids, I couldn't be sure.  I had the physician come in the room to view the masses live with me; he agreed with my suspicion and informed the patient that she may have ovarian masses, but we needed to do a CT scan.  After he left the room, as I led the patient to the restroom where she could get dressed, she turned around and hugged me.  She was very frightened and I felt horrible about what must be going through her mind.  It was the first time I had to console a patient on my own; the patients are usually given the results of the ultrasound in the doctor's office, not in my scan room.

She had a CA-125 drawn, which came back abnormal at 223.  The CT results were inconclusive, stating that the radiologist was also not able to determine the origin of the masses, ovarian or uterine.  She is being seen at MD Anderson currently and will have surgery within the next two weeks.  I will post an update.

Fetal Practice Breathing

I received a question from a reader yesterday: "When I'm doing a biophysical profile, does seeing the fetus hiccup count as the breathing motions?"

The physicians at my office do not consider hiccups counting as breathing movements, however, I did some research and found that this opinion varies from doctor to doctor.  The Institute for Advanced Medical Education believes that hiccups do count (see this link for more info: https://iame.com/online/bio/bio.html)  so the answer to this question would be to find out what your facility counts as breathing and abide by their policies.  During my research, I also came across some other interesting information on PrenatalAnswers.com:

Believe it or not, your baby has been practicing its breathing since the end of the first trimester!  Of course the baby is not really breathing yet, it is surrounded by fluid and does not ‘breathe’ the fluid—it is only pushing the fluid in and out of its mouth and throat. The baby gets its oxygen from the mother who supplies fully oxygenated blood to the baby via the placenta and the umbilical cord.  Read the full article here: http://www.prenatalanswers.com/fetal-respirationspractice-breathing/

My book is published!

Great news!  Quick Reference Guide for Ob & Gyn Sonography was published Friday and is available on Amazon.com by following this link: http://www.amazon.com/dp/1470054582

I'll be highlighting some of my favorite Key Points from time to time on my blog...stay tuned!

Uterine Window

Today I learned a new term: "Uterine Window."  My last patient was a work-in from one of the nurse practitioners at my office: a 30-something mother of three with irregular periods, pretty routine, no big deal.  We were casually chatting about her cycles as I inserted the probe, and suddenly, tiny legs came into view on my monitor.  This completely surprised us both!  She was 12 weeks and 3 days pregnant according to the crown-rump measurement.  However, this is not the most shocking part of the case.  According to her history, during the c-section of her last pregnancy, it was discovered that she had a very large "uterine window" and was told never to get pregnant again.  I hadn't heard this term before so I consulted one of doctor's at my office.  A uterine window refers to a thin area of the myometrium and is at risk for rupture during a future pregnancy.  My patient was scheduled for a consultation with a doctor to discuss her options. I will post updates as I receive them.

Normal posterior fossa = no spina bifida?

On the first Friday of every month, I attend the Fetal Boards meeting at our hospital.  It's actually intended for the residents, but I like to sit in on them because it's a great way to learn what the doctors do with the information we give them from an ultrasound.  A few months ago, the meeting was on spinal anomalies.  I found this meeting particularly interesting because I am always worried about missing a neural tube defect.  After the meeting, I asked the doctor, "If the cerebellum and cisterna magna appear normal, what are the chances that the fetus will have a spina bifida?"  His reply was "None."  Now, I have learned in this profession that when it comes to fetal development, never say never.  However, it is reassuring to hear that even if I cannot get perfect views of the spine, a normal posterior fossa of the brain will virtually eliminate the chance of missing a spina bifida.

IUD with pregnancy

Last week I got to tell a couple that they were having twins!  I love being the one that gets to tell them :)  It's probably as good as getting to tell someone they are going to have a baby, which I've only gotten to do once.  I was really scared because they weren't planning it.  The patient was being seen for pelvic pain and TV ultrasound showed her IUD was in her cervix...and a little tiny pregnancy was up in the fundus.  The couple was surprised, but happy, and the doctor was able to remove the IUD without a problem.  The pregnancy continued normally and a healthy baby was delivered about 7 months later.