Two types of examination are generally used by radiographers and sonographers working in gynaecology. The first is a transabdominal scan, a procedure similar to an antenatal pregnancy scan, which is often able to produce high quality images, especially of the bladder, cervix, uterus, ovaries and fallopian tubes. The patient lies face up on an examination table, and a gel is applied to the skin in order to improve the transmission of ultrasound waves from the transducer into the body. However, if this does not produce a sufficiently high resolution or detailed image of the reproductive organs, then a transvaginal scan can be employed to compliment the transabdominal results. This involves using a specially designed transducer that can be inserted into the vagina in order to get closer to the uterus and ovaries, requiring a less penetrating and higher resolution ultrasound frequency as the distance is reduced, producing much more detailed images of the pelvic organs. A transvaginal scan is most commonly employed when seeking to diagnose problems with the cervix and uterus, and is significantly less invasive and uncomfortable than a manual gynaecological examination. Most women report the procedure to be painless. However, the fallopian tubes do not normally show up on a transvaginal scan, and must be imaged transabdominally.

As ultrasound scanning works best when imaging tissues with a significant liquid content, an accurate ultrasonographical image of the inside of the uterus can be obtained by filling it with fluid. This is often used in conjunction with transvaginal scanning to diagnose uterine deformities and abnormalities, such as neoplasms, Asherman’s syndrome, endometrial atrophy and polyps. This procedure is referred to as sonohysterography, and is commonly employed by gynaecologists when diagnosing the causes of infertility. In order to achieve similar results when scanning the bladder, patients are requests to try to retain its contents.

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The current practice of using 3D and 4D scans is controversial for a number of reasons. Firstly, despite a large amount of research into the subject, the effects of long periods of exposure to more intense ultrasound are unknown, and there is great difficulty in the regulation of the intensities and durations use in 3D and 4D scans. Secondly, because such scans are provided by private firms which may or may not include trained obstetricians and gynaecologists, mistakes can be made in the interpretation of the image which may be highly distressing for the parents. Operational error can also create distressing results, such as an image that shows false positives for various abnormalities and deformities, even though none are present. Sometimes large parts of the anatomy are shown to be missing in a scan performed by an incompetent operator. Of course, problems such as these can be alleviated if the firm is able to offer more comprehensive obstetric and gynaecological care packages. In addition, it can sometimes be upsetting or perturbing for parents to see a foetus in the early stages of gestation, although they do often appreciate it and find it interesting. It has been argued that seeing the foetus at an early stage both helps and hinders in the process of parents bonding with their baby, but this is of course a highly subjective matter and dependent of a great number of factors.

Ultrasound is typically produced by a piezoelectric crystal transducer, producing an arc of sound waves from its surface. The sound wave penetrate the body and are reflected back by the interfaces between tissue types of different densities to the transducer, which at this point acts in reverse as a microphone to receive sound and turn it into an electronic signal. Taking information from the strength of the reflected signal and the time it takes to return to the transducer, a computer is then able to build up an image of the interior tissues. In the field of pregnancy scans, there is a growing trend for more sophisticated computer programs that are able to build images using data from several different angles, creating a 3D image which is much more easily understood by someone without training in obstetrics. The most elaborate examples of these are able to show the foetus moving in real time, the so called 4D scan. These use a phased array of traditional 2D transducers. Despite the obvious attraction of this procedure for parents, it does not offer any great advantage over traditional 2D scanning for trained medical practitioners, and does not provide any enhanced detail.

The frequency used in an ultrasound scan always needs to be carefully considered. Although lower frequencies of around 2 MHz are more penetrative, higher frequencies provide a greater resolution and can image smaller structures in the body in more detail. For example, an early pregnancy scan or a detailed scan of the foetal spine to check for spina bifida require very high frequencies in order to achieve the correct resolution. When imaging is required to be both penetrating and detailed, one solution is to use the transducer is such a way as to produce a fundamental of a lower, penetrative frequency which will reflect back harmonics, providing the detail required for an improved image quality.

One of the earliest second trimester scans tends to be a nuchal scan. This is an ultrasound scan at between eleven and fourteen weeks of pregnancy to assess the amount of fluid around the neck of the foetus, high levels of which potentially indicating chromosomal abnormalities such as Down’s syndrome or Turner syndrome. With increased resolutions, a nuchal scan can be used to diagnose other less common chromosomal abnormalities as well as congenital heart defects. As ultrasound scanning is a non-invasive procedure, it does not pose a danger to either the mother or foetus. However, the procedure is only around 95% accurate, sometimes identifying false positives, a problem aggravated by operational error as performing the scan requires a high degree of skill. For this reason, a positive result generally has to be followed up with one or more invasive procedures to confirm or refute it.

An ultrasound scan at any time after around sixteen weeks can be used to determine the sex of the foetus, should the parents wish to know before delivery. This is normally included in the scan at twenty weeks which forms an major part of second trimester prenatal care. Obstetric ultrasonography at this stage can also check for multiple foetuses, miscarriage, and for other possible risks to the foetus and mother such as ectopic pregnancy, if this has not already been determined by an earlier scan, and the status of the umbilical cord, placenta and amniotic fluid. The scan will also check the status of the limbs and organs, in order to confirm that they are healthy or diagnose potential abnormalities, and determine the size of the foetus, normally a measure of the circumference of the abdomen. This is to check for intrauterine growth restriction, which can be caused by malnutrition of the foetus, and to closely monitor foetal growth in week by week scans. In addition to the more general checks, there are a number of specific malformations which can be diagnosed at this stage, such as hydrocephalus, cleft palate, dwarfism and club foot. A detailed ultrasound examination of the foetal spine can be used to check for spina bifida, but like the check for Down’s syndrome, an invasive procedure, normally amniocentesis, is required for confirmation, eliminating false positives.

An obstetrician uses an ultrasound scan as early as between four or five weeks to confirm gestation. This is done by looking for the chorionic sac – a spherical intrauterine structure containing the young embryonic tissue, appearing on the scan as a dark hypoechoic circle or oval surrounded by white ring, the different colours indicating different tissue types. After five or so weeks, the yolk sac can also be observed, a feature which reliably confirms a true chorionic sac. Detecting this is often a reassuring confirmation of pregnancy for patient. At these early stages, the correlation between the size of the dark area of the chorionic sac enables an effective estimation of the age of the gestation, especially in the period between five and seven weeks before the embryo becomes visible, generally with an error margin of as little as five days either way. However, it becomes a less effective indicator as soon as the embryo becomes visible on the scan because the correlation becomes less reliable, which is usually after about six or seven weeks.

From this point, the crown-rump length of the embryo becomes the critical parameter by which the age of the gestation is estimated, with a smaller margin for error. It will also be around this point when embryonic cardiac activity becomes observable. Determining the age of the gestation is an important part of the obstetric examination for a number of reasons, such as determining due date and perhaps the paternity of the foetus, and scheduling further examinations.

Of course, an ultrasound scan at five weeks can also be crucial in screening for gestational or developmental abnormalities. The positioning of the chorionic sac is the best way to diagnose an ectopic pregnancies, which is when the embryonic tissue implants somewhere other than the uterus, most likely in the fallopian tube. This will almost certainly mean the gestation isn’t viable, and can be extremely dangerous to the mother, so must be checked for and diagnosed early if present. Also, due to the early detection of the heartbeat of the developing embryo, an obstetrician is able to check for healthy cardiac activity. An ultrasound scan at eight weeks showing normal foetal development and size is a very strong indicator of a successful live delivery.

The gender of your baby can usually be observed after around sixteen weeks into your pregnancy when you have an ultrasound scan. The ultrasound scan produces an image of your growing baby and is used to check up on its development and positioning in the womb. There are different types of ultrasound scans and they can be performed in 3D or 4D. A three dimensional scan will produce still images of your baby which can be put together to create a video image. A four dimensional ultrasound scan is able to display live images of your baby and can show any movement or expression displayed by the unborn baby. It is during these routine checks that the sex of the baby can be observed and revealed to the parents.

Knowing whether you are going to have a son or a daughter can add to the excitement of the pregnancy and can help you to plan properly for the birth and first stages of your baby’s life. Simple things such as what colour clothes to buy and how to decorate the baby’s bedroom can all be decided if you know if you will be having a boy or a girl. Finding out earlier on in the pregnancy also means that you have more time to dwell on the important decision of what you are going to name your baby. Names are very important and stay with us our whole lives and so for this reason it is important to put some serious thought into the decision. Having more times means you can go through various options and take your time without any pressure to quickly settle on a name after the birth.

Not all parents however want to be told the gender of their child until the event of the actual birth itself takes place. You may be one of those who prefer to wait for the moment of birth and then the sex of your baby will be a surprise. Whatever decision you settle on when deciding to know the gender of your baby it is an exciting time and you can make all sorts of plans and arrangement for your new baby regardless of its gender. If you do decide that you want to find out if you are going to have a baby boy or a baby girl then you can make additional plans for the birth and also start thinking about possible names for your new baby.

A foetal sexing scan can be performed in order to determine the gender of the unborn baby. Many parents like to know what the gender of their unborn child will be. Knowing the gender of a child can make it easier to plan for the birth of the child and to plan for the years of childhood. Choosing simple things such as clothing and toys can be made easier when you know the gender of your child before it is born and many parents decide to have the scan carried out for this reason. Other parents, however, decide that they don’t want to know the gender of their child before the birth and it is a personal choice whether to know this information or not before the baby is born.

Whilst pregnancy is mostly a time of great joy, excitement and anticipation it can also be a worrying time and many pregnant women have concerns about the health of their unborn baby. One of the main concerns is about the possibility of Down’s syndrome. A nuchal translucency scan is carried out to determine whether the baby has a high or low risk of having Down’s syndrome. A nuchal translucency scan is carried out is a similar manner to a normal ultrasound scan but focuses on the baby’s spine and neck and looks at levels of fluids. Concentrating on these areas allows doctors to determine the risk of the baby having Down’s syndrome. All pregnant women are offered the chance to have an early pregnancy scan at their local hospital. This scan is usually carried out after eight weeks of pregnancy and is carried out to check the stage of pregnancy and also to look at the development of the foetus. It is important to establish that the baby is growing in the right place and position and to check on the development. These scans are also used to show if the mother is expecting to have more than one baby.

There are a range of different scans available for expectant mothers and they each perform different things and have different aims. All of the scans are carried out with no pain and little discomfort for the mother. Ultrasound scans are an important stage of a pregnancy and are used to carry out important checks on the development and wellbeing of the unborn child. It is important to know if the baby will be healthy when it is born or if any operations will be necessary. Having these scans can help reduce any stress and worry about pregnancy and make it an exciting experience.

The first scan a mother-to-be can have is an early pregnancy scan which takes place between the eighth and fourteenth week; this is at the end of the first trimester and the start of the second. At this point the baby is likely to be only 8cm long. The early pregnancy scan will identify how many foetuses are inside the womb and whether development is proceeding normally.

Also around this time, in the eleventh to thirteenth week, a nuchal translucency scan can be undertaken. The nuchal translucency scan is used to identify the risk of the baby being born with down’s syndrome. The scan measures the thickness of tissue fluid found at the back of the baby’s neck (the nuchal translucency). This is then used in a calculation along with the mother’s age and the length of the baby to identify the risk that the baby may have Down ’s syndrome. It is helpful to know if a baby will suffer from Down’s syndrome early in the pregnancy so the parents can prepare to alter their lives and how to best care for the child.

After the eighteenth week an anatomical survey scan, or detailed anatomy scan, is usually conducted. This scan is used to check the baby is developing properly and to identify major health defects such as spina bifida and missing or shortened limbs. The whole of the foetus is examined and the majority of serious congenital issues can be detected. However, some issues like major heart problems cannot be seen. Down’s syndrome can be detected in some cases but a nuchal translucency scan is more accurate at identifying this. The sex of the baby is also identifiable at this time should the parents wish to know. This scan can only be conducted until the twenty-second week of the pregnancy cycle.

Finally, a mother can have a foetal well being scan any time after the twenty-fourth week right until the end of the pregnancy cycle, although not many mothers have scans this late in the pregnancy. The foetal well being scan is used to determine the age, size and weight of the foetus in the third and final trimester. The foetal well being scan can also measure the position of the baby in the womb and the amount of fluid surrounding the baby; these are very helpful things to know before the baby is born as it can reduce the risk of unexpected complications during labour.

The anatomical survey scan takes place between 18 and 22 weeks in the middle of the second trimester as this is the best time to get accurate views of both the uterus and the foetus. It is conducted using standard ultrasound technology where ultrasound waves move through flesh and tissue and reflect back off of solid, dense surfaces to create an accurate image of what is inside the womb. Several things are identified and measured during the anatomical survey scan. After the foetus is confirmed to be alive by testing for a heartbeat, each part of the body is examined. The technician will check the development of the head and the brain and major organs like the bowels, heart and lungs. The technician will also be able to check the limbs of the foetus. The fluid around the baby will also be checked as well as the position of the placenta to try and predict any complications that may occur at the birth.

The anatomical survey scan can often identify serious physical defects while the baby is in the womb. For example, Spina Bifida, a condition caused by the backbone and spinal canal not closing before birth, can be spotted in 90% of cases. Anencephaly, where a large part of the brain or skull is missing, can also be spotted during the detailed anatomy scan. Other defects like major heart problems or down’s syndrome are more difficult to spot and other tests may be conducted to identify them, such as the nuchal translucency scan for down’s syndrome. However, the anatomical survey scan cannot detect problems such as cerebral palsy and autism.

An anatomical survey is very important to ensure that the foetus is developing properly and healthily and to try and minimise the risk of unexpected problems during and after birth. The scan can be very reassuring to parents to be as they will be able to find out if everything is going as it should be and, in the case that there is a problem, it allows them to better prepare for any changes they will have to make to their lives and to see if they will need extra help caring for the child.

One of the main jobs a gynaecologist does is to perform a smear test, or cervical screening. A cervical screening is used to examine the cells of the cervix, the lower portion of the uterus, for any abnormalities or changes and to ensure that the cervix is healthy. While the test is not a test for cervical cancer itself it does provide information that shows whether cancerous cells are present in the cervix. In England, women between the ages of 25 and 64 years old are invited to have a cervical screening on the NHS, although in Scotland this applies to women between 20 and 60 and in Wales any woman between the age of 20 and 64 can receive free smear tests. The government recently refused to lower the age limit for cervical screening in England to 20 years of age following a campaign after celebrity Jade Goody died from cervical cancer at only 27 years old.

Many gynaecologists today are also obstetricians. An obstetrician is a doctor who specialises in pregnancy and guides a woman through the pregnancy cycle. Midwifes are experts in obstetrics and as well as guide a woman through the pregnancy cycle they will also help her with giving birth and post natal depression. Post natal depression currently affects 10 to 15% of women after they have given birth and causes women to feel irritable, tired, depressed and unable to enjoy anything. However, with the help of a midwife and an obstetrician it can be easy to overcome.

A gynaecologist or obstetrician will also help conduct scans throughout the pregnancy from the first scan which can take place at only eight weeks right up to the last scan which can take place at forty weeks. While an ultrasound technician is likely to conduct the scan, an obstetrician will analyse the findings and talk through the images with the mother, explaining any problems that may have arisen in the pregnancy cycle.