Dr. Warner Huh: Hello, everyone. This is Dr. Warner Huh again, the Chair of the Department of OB-GYN here at UAB. And I want to welcome you to this month's episode of Women's Health with Dr. Huh. So today, we're going to talk about something that is central to obstetrical care, which is ultrasound or ultrasonography. And the topic today is really, you know, what's the role in pregnancy and what patients need to know.

Host: I want to first start off by saying that we have an incredible core and group of ultrasonographers. By far, in my opinion, the best in the state of Alabama, if not beyond the state. And some amazing ultrasound expert providers in the department of OB-GYN. And so with me today on the podcast are Dr. Sheri Jenkins, who is in the Division of Maternal Fetal Medicine and Nikki Marsh, who is one of our amazing ultrasonographers and supervises this incredible core of ultrasonographers here at UAB. So, Dr. Jenkins and Nikki Marsh, welcome to this month's podcast.

Nikki Marsh: Thank you for having us.

Dr Sheri Jenkins: Glad to be here.

Host: So, I think a lot of our listeners probably just need a quick intro. I thought maybe one of you could just talk about what exactly is ultrasound. And is it used routinely during pregnancy?

Dr Sheri Jenkins: So, ultrasound is basically using sound waves from a machine that go into the maternal abdomen, and are used to tell us what various structures or tissues are. So essentially, in pregnancy, we're able to look at the mom's uterus or womb as well as her ovaries, and then we can look at fetal structures as well and fluid around the baby and the placenta. So, it can give us a lot of information about pregnancy. In addition, it is used routinely in pregnancy, typically in the first and second trimesters. The first trimester is used to give us information about the dating of the pregnancy, how far along a patient is. And in the second trimester, we're primarily looking at some of the fetal development, the anatomical structures. And then in third trimester, it can be used routinely with various maternal and fetal indications.

Host: So along those lines, I think a lot of our pregnant patients come in for an ultrasound that's called an "anatomy scan". I thought maybe, Dr. Jenkins, you could just share with listeners what exactly does that mean when patients undergo an ultrasound for an anatomy scan?

Dr Sheri Jenkins: Sure. So, an anatomy ultrasound is typically done between about 18 and 22 weeks of pregnancy, and what it does is look at a couple of different things about the baby. One is it assesses the baby's growth to determine if it's appropriate for that point in pregnancy. And secondly, it looks at the anatomical structures of the baby. So essentially, evaluating the baby from head to toe literally; evaluating the baby's brain and facial structures, the structures in the chest, including the heart and the structures in the abdomen, which can include the stomach and intestines as well as kidneys and bladder. And then, we look at arms and legs. And then importantly, patients always want to know what the gender is, so we're able to assess the baby's gender as well.

Host: And just to confirm and I want to make sure the listeners understand that that's probably not going to be their first ultrasound, right? They're probably going to have an ultrasound preceding that. Is that correct?

Dr Sheri Jenkins: Typically, the first ultrasound is done when the patient presents for prenatal care. So, most of the time that's in the first trimester, and that's actually the most accurate time to date a pregnancy or determine a patient's due date. So, they usually have had a first trimester ultrasound for dating prior to the second trimester ultrasound for fetal anatomy.

Host: Yeah. And I think you bring up a good point, which is a lot of our patients want to know what the gender of the baby is. And so, again, at that anatomy scan, it sounds like that's probably the best time to do that, is what you're saying, right?

Dr Sheri Jenkins: It is. Gender can sometimes be determined late in the first trimester. But that's probably the exception. And then, there are actually maternal blood tests that can assess gender as well, even potentially prior to being able to determine it by ultrasound.

Host: Great. So, Ms. Marsh, I thought maybe you can comment on what a patient should expect when they have an ultrasound examination. Like, what do they need to think about when they come in? What happens during the exam? What happens after? I thought you might want to share those details with this group.

Nikki Marsh: Yes, absolutely. So when patients present for usually that dating ultrasound or determining how old the pregnancy is, how old the baby is, we like a full bladder. It helps us see a little bit better. In the second and third trimester, they don't have to do that. It can be torture for our patients if they come in with a full bladder during those exams. But we'll bring them into the exam room. We'll tell them what we're doing and why we're doing it. And of course, everything that we're doing is based off of what their doctor is needing to know about their pregnancy.

We'll get them situated in the exam room. In our department, we have these nice screens on the walls and our patients can actually watch the entire examination live. So, they're seeing everything that we're doing. And during that exam, we also get to tell the patients, you know, what we're seeing. We can tell them that this is their baby's head, this is their baby's face. And it really helps engage our patients and gives them the opportunity to bond with their unborn baby. All while we're doing this, we're making sure that their baby's healthy, it's growing normally, that the heart rate looks good, that the fluid looks good. So, we're doing a lot of these things in the background that they don't quite see. Because for them, it's more of that experience, that their baby's in there and growing and doing well.

Host: And can you comment on like how those images are typically shared with patients and their families? You know, like I go visit a friend and the ultrasound pictures are on the refrigerator. And I think we've come a long way in terms of how we shared digitized images. Can you comment on how that's done?

Nikki Marsh: Yeah, absolutely. So right now, we are still printing photos. And the reason we're still doing it in that way is because we want to make sure that when we take leap to go to the digital approach, that, one, our patient prefer that experience over having those pictures that they can take home and hang on their fridge. We also want to make sure it's safe and secure, that there's no possibility of someone else receiving their information. So before we take that leap, we want to make sure that those are in place. So, we're still printing those photos in addition to them getting to watch the exam live. We print all those special keepsakes, particularly the face, hands, and feet when babies let us, sometimes they don't let us do that. And then, of course, if someone in the room notices that the baby has grandmother's nose, we're certainly going to print that for them too, because that's a special moment when they can see that their little one looks like a family member, something like that.

Host: Cool. That's awesome. So, just two quick additional questions. One is how long does an ultrasound examination typically take? And now, that we're officially out of COVID, I'm assuming that we usually have other people in the room with the patient. Is that correct?

Nikki Marsh: Yes, absolutely. So, an ultrasound examination can vary greatly on how long it takes. Sometimes it can literally take no more than a couple moments. We may be checking out baby's heart rate or determining gestational age. For those studies that Dr. Jenkins was describing earlier where we're looking at the anatomy, those can take substantially longer, sometimes even up to 30 or 45 minutes, depending on baby's position or if there's twins or if we need to do other studies in addition to it. As far as visitors go, we typically have one to two, visitors with our patients. Oftentimes it's a spouse or a grandmother to be super excited to see their new grandchild. They get to watch and ask questions, and it's usually a good support person in the room.

Host: That's great. I appreciate you answering that because I think those are things that run through our patients' heads all the time, is how that works. And I know it was tough during COVID because some of the restrictions of visitors, so it's actually nice to see us relax those restrictions and have people come in and participate in that process.

Nikki Marsh: Absolutely.

Host: So, Dr. Jenkins, let me ask you this and I think this is really an appropriate question for this podcast. Could you just comment briefly how ultrasound has changed the overall practice of obstetrics?

Dr Sheri Jenkins: Yeah, it's changed it greatly. So, ultrasound first came out in the 1970s and it was not very good at the time. There was not much detail to be able to be seen. And of course, prior to that, prior to having ultrasound, women didn't know much about their pregnancies. They weren't exactly sure how far along they were or if they were having one or even two babies. Sometimes a second twin would deliver after the first that was unexpected to the parents. So, obviously, ultrasound has changed that a great deal.

But just little things about ultrasound. One is it helps us have a very accurate way of dating a pregnancy, so that we know exactly when the baby is due, which helps us time various tests and interventions that we do over the course of the pregnancy. So, for instance, there are genetic tests that mom can opt for, that are done at various times of pregnancy that can help us identify babies that may have a genetic abnormality. There are maternal tests, so things like blood counts or diabetes screening that are done at certain points in pregnancy. So, we need to know how far along they are in order for that testing to be done.

In addition, as we talked about, it allows us to see twin or triplet or even quadruplet pregnancies. And there are a lot of ultrasounds that are done during those pregnancies to keep a check on the health of those babies. And in addition, the anatomy ultrasound that we do allows us to see if there are potentially fetal structural abnormalities that warrant potentially interventions during pregnancy. So, there are actually fetal surgeries or interventions that can be done that we can make referrals for if indicated based on the baby's anatomy. It also helps us determine if a patient can deliver in their local environment or if they need to deliver at a tertiary care center such as UAB, because the baby's going to potentially have a complicated medical course after delivery. It allows us to make referral for those babies to pediatric subspecialists ahead of delivery, so that the parents know what to expect for their baby after delivery and how long the baby may be in the hospital. So, that's just a small list of some examples and ways that ultrasound has dramatically altered the course of obstetrics over the last 50 years.

Host: So, I guess it would not be an exaggeration for us to say that ultrasound really has become the cornerstone of how we practice OB now because we gain so much more information than we did like a hundred years ago. And it seems like you can't practice obstetrics without ultrasound, maybe that's a better way of putting it.

Dr Sheri Jenkins: Yeah, absolutely. I have been in a prior center that did not use ultrasound much in pregnancy, and it just made it very, very difficult because we didn't know exactly how far along they were, when the appropriate time for delivery was. We know that babies are optimally delivered, if they're routine, around 39 weeks of pregnancy. So, we can time an induction of labor for that point. So yeah, it's greatly, greatly helped us in our management.

Host: Thank you. And as I mentioned at the beginning of the podcast, you know, really think that we have an incredible group of ultrasonographers. But, you know, Nikki, I thought you may want to comment on whether the ultrasound practice here within the Department of UAB Medicine is accredited, and what does that accreditation mean to the pregnant patient that comes in. Why is that important?

Nikki Marsh: Yes, absolutely. We are accredited and have been since 2000, so more than 20 years now through the American Institute of Ultrasound and Medicine. It is something that we do for our patients. We do it to give them the reassurance that we have gone above and beyond to exceed the national standards for ultrasound. We apply for reaccreditation every three years. And when we do that, we have to prove a lot of things, that we're worthy of that accreditation. Some of the more important things is that our machines are taken care of appropriately, that the settings on our machines are set to a safe threshold for our moms and our babies. We also really hold all of our staff, so all of the sonographers, all of the physicians who read our ultrasounds have to prove that they are up to date on all certifications, on all licenses, that they're doing their continuing education, and that there is continuous quality assurance and checks to prove to our patients that we are the best and that we are providing them with the absolute best care. We are actually one of four practices in the state who are accredited. Of those four, we are accredited in the most subspecialties of OB-GYN and the only one accredited in infertility ultrasound.

Host: Yeah. I think that's important because I know you're not going to say it and I'll say it for you, is I know that you all do a great job doing ultrasound for our women that have relatively straightforward pregnancies or what we describe as low risk. But you all take care of some of the highest risk pregnancies, particularly mothers who unfortunately have babies with anomalies or problems and you're sort of the front line for that in many ways. And so, I just wanted to personally just recognize and thank you for all that you guys do. And it's that level of expertise that really kind of roots this program as I think one of the best, not just in the state of Alabama, definitely in the country. So, thank you.

Nikki Marsh: Absolutely. Thank you.

Dr Sheri Jenkins: Agreed. Thank you.

Host: I don't know if you guys have any other comments that you want to make to the listeners about ultrasound.

Dr Sheri Jenkins: I think just in general, just know that if you come to UAB for your obstetrical care, you're going to be in great hands in terms of obstetrical ultrasound and delivery. We have staff who love doing their job. I know I personally feel very fortunate to work here at UAB and be able to help these moms and babies be as healthy as they can be at the time of delivery. So, we're just fortunate to have the job that we have and the expertise that we have here at UAB.

Nikki Marsh: I have to second that.

Host: Yeah, I do too. I mean, I think you stated that beautifully, Dr. Jenkins. I want to thank both Dr. Jenkins and Ms. Marsh for discussing ultrasound in obstetrics and its central importance in obstetrical care. This is a really important topic. I think we could probably talk at least for another half an hour on this, easily.

But anyway, as always, please rate this podcast, and we welcome any comments, particularly on topics that you're interested in. And as Dr. Jenkins mentioned, you know, we're proud of the obstetrical care that we deliver here at UAB. But if you would like more information on the care that we provide and other clinical services, particularly women's services that UAB Medicine provides, please check out uabmedicine.org. And until next time, I hope you have a wonderful day. Take care. Thanks a lot. Peace out. Bye-bye.