Ultrasound question - heart chambers not visible

I had my ultrasound this morning. The baby is giving me a due date of
June 2 (I'm measuring 16 weeks, 5 days), which is a little later than I
had expected. The doctor still says I'm measuring at about 18 weeks,
which is closer to where I thought I was.

Anyway, it's a boy (which I was hoping for), and he sure looked normal
to me -- moving around, sucking his thumb, etc. But they said they
couldn't see the four chambers of the heart. His heart was beating
away like crazy, but they could only see two chambers.

How worried should I be? The doctor was very casual about it and said
for 17 or 18 weeks it's not abnormal to not see the chambers, and we
shouldn't be worried unless next month's ultrasound also doesn't show
the four chambers. Does anyone have experience with this? Despite the
fact that I keep telling myself not to worry and that everything is
fine, I'm really worried. Thanks.

-Carlye
DD 9-29-04
"Butterball" EDD 6-2-06

well if the doc isn't worried then I'd try not to be, it must be the angle
they are looking at. Also, as far I can recall having 3 heart chambers is a
much more commone defect than only 2, which very much sounds like you can't
make out the other 2 because of the way the baby is lieing. If they are
lieing in such a way you can see that perfectly, you probably can't see
something else, I know I was surprised how clear you could see the 4
chambers of DS's heart, but then we couldn't see his back or feet for ages.

Anne

Thanks, Anne. I actually just got off the phone with the head of
radiology. He said the radiologist who reviewed my report thought he
saw the four chambers, though he admitted they were faint. It was just
the tech's report that my OB was looking at that indicated the four
chambers weren't visible.

I'm telling myself that everything should be fine, but I really hate
the fact that I have to wait for four weeks, that they absolutely
refuse to do a transvaginal u/s as an immediate follow-up, even though
it's more reliable. I am not not NOT happy with this clinic/hospital
or my OB and haven't been since I started, but I may be
over-romanticizing the memories of my doc from my first pregnancy.

All I've said is I wanted a healthy baby... I really hope this one is
okay.

-Carlye
DD 9-29-04
"Butterball" EDD 6-2-06

Carlye,
Usually level II u/s's are not scheduled until 18-20 weeks, as that's when
all major organs should be large enough to get a good look, including the
heart and all chambers. It's completely normal to not be able to get a good
enough look at 16 weeks. They scheduled your u/s at this point because they
thought you were closer to 18, and you begged for it earlier, right? So
when you go back in a month, they should have a good view of everything.

When we were dealing with Nathan's diagnosis, we had our regular level II
u/s around 18+weeks, and besides the omphalocele it appeared that there were
issues with his heart. Since we were as yet undecided about whether or not
we were going to continue the pregnancy, we had an amnio and waited for the
results, and scheduled a fetal echocardiogram. We did that about two-three
weeks later, closer to 21 weeks. They liked that timing better, as
everything was larger and even easier to see.
--

Jamie
Earth Angels:
Taylor Marlys, 1/3/03 -- Little Miss Director, who says, "No Mama, you have
to do it THIS way!"
Addison Grace, 9/30/04 -- My Little Communicator, who, when asked if she was
ready to take a nap, shook her head no and said in Baby Signs, "Night night
all done, downstairs."

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"carlye" wrote in message
oups.com...
I had my ultrasound this morning. The baby is giving me a due date of
June 2 (I'm measuring 16 weeks, 5 days), which is a little later than I
had expected. The doctor still says I'm measuring at about 18 weeks,
which is closer to where I thought I was.

Anyway, it's a boy (which I was hoping for), and he sure looked normal
to me -- moving around, sucking his thumb, etc. But they said they
couldn't see the four chambers of the heart. His heart was beating
away like crazy, but they could only see two chambers.

How worried should I be? The doctor was very casual about it and said
for 17 or 18 weeks it's not abnormal to not see the chambers, and we
shouldn't be worried unless next month's ultrasound also doesn't show
the four chambers. Does anyone have experience with this? Despite the
fact that I keep telling myself not to worry and that everything is
fine, I'm really worried. Thanks.

-Carlye
DD 9-29-04
"Butterball" EDD 6-2-06

Thanks, Jamie. Yeah, this ultrasound was really supposed to just be a
dating ultrasound. That's what was on the slip when it was ordered
(although they did think I was at about 18 weeks and 2 days, judging
from earlier measurements). I don't exactly know how it turned into a
full-fledged level II, but I didn't really care when they started it
this morning.

I know they like to do these u/s a few weeks farther in, but my quick
research this morning through the internet and some medical journals
also showed the four chambers should be visible after about 13 weeks
with a transabdominal scan. So it's still scary.

And I only "begged" for an ultrasound because we really had no
indication of the due date, just a three week ballpark, really. I've
wanted the u/s since 7 or 8 weeks and never intended to get all this
extra stuff done -- I just wanted a reliable due date before we were
too far along. *sigh* I guess next time I'll just play the "good" and
"obedient" patient. God knows right about now I'd rather have a less
reliable due date but absolute confidence about my baby's health...

-Carlye

"carlye" wrote in message
oups.com...
Thanks, Jamie. Yeah, this ultrasound was really supposed to just be a
dating ultrasound. That's what was on the slip when it was ordered
(although they did think I was at about 18 weeks and 2 days, judging
from earlier measurements). I don't exactly know how it turned into a
full-fledged level II, but I didn't really care when they started it
this morning.

I know they like to do these u/s a few weeks farther in, but my quick
research this morning through the internet and some medical journals
also showed the four chambers should be visible after about 13 weeks
with a transabdominal scan. So it's still scary.

My guess is that it's not that they couldn't see them because they don't
exist, it's that the baby wasn't positioned correctly to get a good view.
And u/s techs are very literal -- part of their job is to look at each
organ, to see it, and verify that it's all there and in normal working
order, or not, as the case may be. To measure and verify. When they can't
get the right angle to do their measurements, they say that they can't see
it. Again, it usually doesn't mean that it's not there, it means that they
can't get the right angle to take the correct measurements.

And I only "begged" for an ultrasound because we really had no
indication of the due date, just a three week ballpark, really. I've
wanted the u/s since 7 or 8 weeks and never intended to get all this
extra stuff done -- I just wanted a reliable due date before we were
too far along. *sigh* I guess next time I'll just play the "good" and
"obedient" patient. God knows right about now I'd rather have a less
reliable due date but absolute confidence about my baby's health...

-Carlye


Excuse my French, here....**** playing good and obediant patient next time.
Next time you should find an OB that you don't have to fight with to get a
basic dating u/s. Heck, there is still time in this pregnancy to make the
switch to a new OB and have your level II u/s done at 20 weeks at a new
office with a new tech. I get the feeling that this is just how this
pregnancy is going to go at this office.
--

Jamie
Earth Angels:
Taylor Marlys, 1/3/03 -- Little Miss Director, who says, "No Mama, you have
to do it THIS way!"
Addison Grace, 9/30/04 -- My Little Communicator, who, when asked if she was
ready to take a nap, shook her head no and said in Baby Signs, "Night night
all done, downstairs."

Check out the family! -- www.MyFamily.com, User ID: Clarkguest1, Password:
Guest
Become a member for free - go to Add Member to set up your own User ID and
Password

16 weeks is too early to look at the fetal heart.

When the sonographer marks "four chamber view" on the u/s report, they
aren't just counting the chambers. They are saying that they could see
the valves and that they are normally inserted, they can see the
intraventricular septum is intact, they can see the relative size of
the heart chambers, and they can see the motion of the myocardium and
compare atrial contractions and ventricular contractions.

It is not at all unusual that one or more of those things would be
difficult to see at 16 weeks. In that case, the sonographer would mark
the report indicating that the four chamber view could not be seen.

It is also not uncommon that OB-GYN physicians don't necessarily know
much about ultrasound, especially as regards fetal anatomy screening.
Some do, but many do not. Fetal anatomic sonography is optional in
OB-GYN residency education: there is no required study in this area.
And of course many OB-GYNs were trained before OB sonography became so
widespread and may not have any formal training in ultrasound at all.

There is also an elaborate fiction in OB circles that sonographers
don't really know what they are looking at, they are just taking
pictures like a technician, and that it's the physician who interprets
what the images mean. This is very rarely the case. Usually, the
sonographer knows what is going on and fills out an initial report,
which becomes "finalized" when the physician uses his/her magic pen to
sign "MD" on the report.

Due to this fiction of physicians' omniscience and sonographers'
uncritical production of images, it often occurs that the person who
does not understand what is going on (the physician) is relating the
results to the patient, and explaining what those results mean, when in
fact they know very little about fetal sonography. And the person who
does know what the images mean (the sonographer) can't tell you what
they mean. It is a very unsatisfactory situation and produces a great
deal of miscommunication.

I think that's what's going on in your story. I don't think your baby
has a two chamber heart. I think you had an incomplete anatomy screen
due to the scan being performed at too early an age, and now that news
is filtering back to you in a distorted form.

carlye wrote:
Thanks, Anne. I actually just got off the phone with the head of
radiology. He said the radiologist who reviewed my report thought he
saw the four chambers, though he admitted they were faint. It was just
the tech's report that my OB was looking at that indicated the four
chambers weren't visible.

I'm telling myself that everything should be fine, but I really hate
the fact that I have to wait for four weeks, that they absolutely
refuse to do a transvaginal u/s as an immediate follow-up, even though
it's more reliable. I am not not NOT happy with this clinic/hospital
or my OB and haven't been since I started, but I may be
over-romanticizing the memories of my doc from my first pregnancy.

All I've said is I wanted a healthy baby... I really hope this one is
okay.

Relax! This is like not hearing the heartbeat
with doppler when you're at the borderline of when you'd
expect to be able to hear it. It doesn't mean anything
other than that you're straining the limits of the
technology. It's perfectly reasonable of them to
wait to do a follow-up. By doing so, they dramatically
increase the odds that they'll be able see something
useful when they do look. It would be silly of them
to waste the time and money to do an immediate followup.
Yes, a transvaginal u/s is a bit clearer, but you're
still dealing with a very small, rapidly moving structure
that's hard to adequately evaluate. I know it's not
fun to wait, but really, their actions are perfectly
reasonable and there isn't a darned thing you should
be worried about at this point.

Best wishes,
Ericka

Excuse my French, here....**** playing good and obediant patient next time.
Next time you should find an OB that you don't have to fight with to get a
basic dating u/s. Heck, there is still time in this pregnancy to make the
switch to a new OB and have your level II u/s done at 20 weeks at a new
office with a new tech. I get the feeling that this is just how this
pregnancy is going to go at this office.

(feeling properly chastised) I know, I know... I don't really mean
that I want to be the good and obedient patient. I mean that after all
my stupid fighting for this stupid ultrasound for a date, they took the
thing about 5 steps too far and ended up scaring the living sh!t out of
me. If I'd just gone along with everything they wanted, chances are
the ultrasound I'd have gotten in a few weeks would show a normal
heart, though the dating may be even less reliable than this one (since
I think almost 17 weeks is still on the less reliable side for a dating
ultrasound).

We aren't happy with this OB or this hospital. Unfortunately, there
really are no other options for hospitals for about 200 miles. I
initially tried to find a general practitioner out of the hospital's
family practice clinic (I had a GP for my first pregnancy, and he was a
-wonderful- low-intervention great bedside manner type) but there is
only one GP in this whole hospital system who takes OB patients, and
after our initial interview, I found out she was a high-intervention
"scary" type. There are no birthing centers here. I'm pretty well
stuck. I am considering switching to a different OB, but it is more
than the OB. This hospital has been less than ideal in many respects.
(e.g.,pediatrics failing to tell us DD had Fifth's Disease when they
knew she did, even though I was pregnant).

I honestly don't know what to do.

-Carlye
DD 9-29-04
"Butterball" EDD 6-2-06

Thanks, Ericka. I really needed that. :-)