The second trimester anatomy scan is a comprehensive evaluation of the fetal anatomy in which we evaluate numerous fetal organs to demonstrate that they appear structurally normal. This is a critical examination to evaluate the fetus for anatomic differences in development. We will also evaluate the position and appearance of your placenta. While a normal examination is reassuring to most patients, some sonographic findings may trigger concerns. The results of each sonogram will be shared with you at the end of the examination and reported to your obstetrical care provider. In the case of a concerning fetal finding, we may recommend additional genetic counseling, genetic testing, fetal echocardiography or referral to a fetal care center for further evaluation. It is important to recognize that a prenatal ultrasound does not diagnose all structural anomalies or genetic conditions.

Your obstetrical care provider may refer you for a sonogram in the third trimester for a number of different indications, including but not limited to assessing fetal growth, amniotic fluid volume or fetal well-being.

We will assess fetal growth according to national standards by utilizing various biometric measurements of your fetus. The estimated fetal weight is a guide to the size of your fetus and has a 15% error rate. Interval growth is not reliably assessed in fewer than 14 days between scans. We evaluate fetal well-being by assessing fetal movement and tone, amniotic fluid volume and fetal practice breathing movements. This examination may take as long as 30 minutes, but anecdotally, may be completed in a shorter period of time if you have recently eaten. This study can be done as  frequently as desired by your obstetrical provider.

We will provide you a few selected ‘keepsake’ photos of the ultrasound examination. Throughout pregnancy, we are always willing to perform a 3D image IF it is technically feasible. Keep in mind, this is not always possible due to fetal position, the gestational age, and difficult imaging conditions.

Sonographic imaging of the pelvis includes the evaluation of the uterus, ovaries, and adjacent structures. This examination is typically the only imaging modality necessary to evaluate patients with abnormal bleeding, pelvic pain, bloating, infertility, and other gynecologic symptoms. Our clinicians specialize in evaluating patients with subfertility and complex gynecologic conditions including uterine, ovarian, and pelvic masses. We utilize augmented ultrasound techniques to perform a detailed evaluation of the pelvis including 3D mapping of the uterus for fibroids and uterine shape abnormalities. We perform dynamic ultrasound assessment for adenomyosis, ovarian and deep endometriosis and  pelvic adhesive disease.  Additionally, we are certified by the International Ovarian Tumor Analysis group (IOTA) in characterizing and assessing pelvic and ovarian masses for risk of malignancy.

The ultrasound typically begins transabdominally to acquire an overview of the pelvis. In most patients, a transvaginal evaluation is recommended to obtain a more detailed look at the pelvic organs. For those individuals in whom a transvaginal examination is not possible, a transrectal evaluation may be offered.

A full bladder is not required; however, we request that you don’t empty your bladder for about an hour before your scan. We will suggest that you empty your bladder between the transabdominal and transvaginal or transrectal portions of the examination.

If you are premenopausal, a pelvic ultrasound is optimally performed early in the menstrual cycle (days 5-9) when the lining of the uterus is thin, and the ovaries are quiescent. The only exception is if you are referred for a 3D evaluation  of the uterus due to a concern about a uterine shape abnormality or fibroid location in which case imaging is better later in the menstrual cycle when the lining of the uterus is lush and can help us distinguish the anatomic features.

Sonohysterography is a procedure in which a flexible catheter is inserted into or through the cervical canal and a small amount of saline is infused into the uterus. This allows us to distend the walls of the uterus thus providing an optimal image for the detailed evaluation of the lining of the uterus. We are able to diagnose polyps, fibroids impinging on the lining of the uterus, endometrial scarring, and abnormalities in uterine shape. This procedure is most often used in patients with abnormal bleeding or subfertility.

In premenopausal patients, it is performed on days 5-9 of the endometrial cycle when the endometrium is as thin as possible. This allows us to visualize small irregularities with greater precision and ensures that you are not pregnant. The procedure is associated with mild cramping, but most patients do not report it to be painful. Some patients find that taking Ibuprofen before the procedure is helpful.

HyCoSy, is a procedure which allows us to evaluate the fallopian tubes without the use of radiation or dye. Initially, a sonohysterogram is performed and after the uterine cavity is evaluated, a mixture of saline and air is introduced into the uterus. Air bubbles can be visualized exiting the fallopian tubes confirming patency. If no air bubbles are seen traversing the fallopian tubes, it may be due to tubal occlusion, tubal spasm or imaging challenges (e.g. fibroids). If tubal patency assessment is not diagnostic, we may use an air bubble contrast material or FDA approved foam bubbles to assess the fallopian tubes. These studies are often performed in lieu of the hysterosalpingogram and provide more information since they also include a complete evaluation of the pelvis.