Pregnancy and Severe Illness from Covid 19

Pregnant women could be at a higher risk for Covid 19 compared to the general population. CDC advises that certain underlying medical conditions might increase the risk for developing a severe illness from a coronavirus.
Also, there is a higher chance of preterm birth or delivering the baby before 37 weeks. Therefore, pregnant women need to understand how to protect themselves from being infected with Covid 19.

Increased Risk of Severe Illness

Respiratory viruses such as Covid 19 can infect pregnant women easier because of the changes in the body the pregnancy causes. That could lead to hospitalization, intensive care, or a ventilator to help breathe normally. According to CDC updated data as of Oct. 14, 2021, some underlying medical conditions that put people at risk for severe illness from the virus could be chronic lung and liver disease.
In Sept. 2021, mental health disorders such as depression and schizophrenia spectrum disorders were added to the list based on evidence from published reports, scientific articles, and internal data. In addition, some factors can contribute to the risk involved of being infected, such as:
age (older than 25 years); living in a community with the higher number of Covid 19 cases or with low levels of vaccination; working in places where a social distance is less than 6 feet apart from people.

Covid 19 Vaccine and Pregnancy

Based on CDC recommendations, vaccination is recommended for pregnant women, breastfeeding, or getting pregnant. 
CDC also provides some help about vaccination during pregnancy with special service MotherToBaby.
Experts are available during weekdays to answer questions over the phone, email, or chat in English or Spanish.

For fully vaccinated people

The purpose of being vaccinated is to provide protection from variants, prevent severe illness, hospitalizations, and possible death. It also prevents spreading the virus to others and allows them to continue participating in activities involved before the pandemic.

To reduce the risk of not being fully vaccinated

Some essential recommendations to stay healthy from Covid-19: try to get the vaccine as soon as you can; wear a mask to protect yourself and others; keep a social distance of 6 feet apart from others who don’t live with you; stay away from crowds and poorly ventilated indoor areas; wash your hands thoroughly with soap or use sanitizer.

Stay healthy during and after your pregnancy

Don’t cancel appointments with your healthcare provider because of the fear of Covid-19. Try to keep all your scheduled appointments. If you are more comfortable staying at home, ask about telemedicine options such as Skype or Zoom with your doctor when possible. You might need help finding a healthcare professional. In that case, you can try to go to the nearest hospital or a community health center.
Don’t hesitate to ask your doctor about staying healthy and taking care of yourself and the baby; find out the best options for delivering the baby, including places and trained healthcare professionals; talk to your healthcare professional if you have depression during or after pregnancy.

It is important to get recommended vaccines during pregnancy, such as the flu vaccine.
CDC also recommends that pregnant women get the Tdap vaccine to prevent whooping cough. It is because the symptoms of whooping cough could be similar to symptoms of Covid 19.
If you have urgent material warning signs and symptoms such as constant headache, fever, chest pain, fast heartbeat, swelling of the hand, face, or legs, severe nausea or vaginal bleeding or discharge during or after pregnancy seek medical care immediately.

What to do if you are sick or think you’re exposed to Covid-19

If you have any symptoms of Covid 19 such as fever or chills, cough, shortness of breath, fatigue, muscle or body aches, headache, the new loss of taste or smell, sore throat, congestion or running nose, nausea or vomiting, diarrhea contact your healthcare professional immediately or at least for 24 hours.
In case if you are diagnosed with Covid 19 and breastfeeding, CDC provides some guidance caring for newborns. There is no current evidence that breast milk will spread the virus to babies.

Can Babies Smile in The Womb?

Images captured using a 4D scanner suggest that unborn babies exhibit facial expressions as a reflex in preparation for birth, Professor Stuart Campbell said. For some time 3d 4d ultrasounds have shown that babies smile, yawn, cry and blink inside the womb. Professor Campbell, who has observed such expressions since he first started using 3d 4d ultrasound, said it was previously believed babies learned to smile after birth by copying their mothers. “That may indicate the baby’s calm, trouble-free existence in the womb and the relatively traumatic first few weeks after birth, when the baby is reacting to a strange, new environment,” he added.

“They make breathing movements inside the uterus, but there is no air, and they blink, but there is no light, so it seems they are making preparations for birth. “They make breathing movements inside the uterus, but there is no air, and they blink, but there is no light, so it seems they are making preparations for birth,” he said.

Reflexes or Result of Stress-Free Environment?

Babies do not usually smile after birth until they are about six weeks old.That may indicate the baby’s calm, trouble-free existence in the womb and the relatively traumatic first few weeks after birth, when the baby is reacting to a strange, new environment. Smiling, however, cannot be interpreted as preparation for birth but maybe a reflex.Prof Campbell said: “What’s behind the smile, of course, I can’t say, but the corners turn up and the cheeks bulge … I think it must be some indication of contentment in a stress-free environment.”

Some Factors That Contribute to a Stress-Free Environment.

A stress-free environment would include a baby’s perception of the surroundings, mother’s emotional and physical conditions, external or outside sound, audio, and some other effects. An interesting observation should be made regarding an ultrasound technician’s role when performing the 3d 4d ultrasound session. The professional skills, knowledge, and experience of the sonographer would distribute to the confidence of the expectant mother that decent ultrasound images would be produced. If she is feeling relaxed and calm, the baby would also feel that and reflect positively. That is an essential factor in the stress-free environment. We strongly believe that is the main reason why at Ultrasound Baby Images, we were able to create so many images of smiling babies. You can check them out for yourselves right here.

The 4D scanner, which produces detailed 3D images that move in real-time, has shown that babies start making finger movements at 15 weeks, yawning at 18 weeks and smiling, blinking, and crying at 26 weeks.

3D 4D Ultrasounds Facts.

In 2012, Prof. Kawakami had observed five-hundred-sixty-eight fetuses at a clinic by using 4d ultrasound, and 31 fetuses who showed smiles were selected. The range of conceptional age was from 156 days to 214 days. The participants exhibited 51 smiles in 62 min of recording. The average duration of smiles was 3.21s. That must be the first study that collected fetal smiles intensively. The age effect on the frequency and duration of fetal smiles was not examined in this study. The fact that fetuses show a lot of smiles makes us reconsider the meanings of spontaneous smiles; fetal smiles must not result from social effects.

Fetuses, observed within the womb with a 4D ultrasound smile from at least the 23rd week of gestation. But other studies show that even newborns do smile on rare occasions – at most once in every four minutes for some one-day-olds.

Are Newborns’ Smiles Real, or Just Reflexes? Baby smiling at the researcher in the lab.

It was a long time acceptable, that newborn smiles could be a result of positive emotions coming from the physical or other outside interactions that influenced behavior. Smiles have been noted in the first few days of life as a response to stroking the cheek or the belly. Newborns also smile in response to sweet tastes and smells.
Newborn babies often even smile back, making for the parents to believe that the babies’ smiles are real. Meantime, even textbooks tend to regard neonatal smiling as a reflex rather than an actual expression of joy and happiness. The behavior of newborns is still considered mostly reflexive. Scientists even have assumptions that newborns have a limited ability to feelings, emotions, and could not interact with their caregivers because of their lack of social experience.

The mystery of Newborns’ Smiles.

We don’t know and need to find out yet, since when newborns can be accepted as socially competent beings. In majority views, newborns smiles were considered only in response to muscle twitches, penile erections, bowel or bladder movements, or as spontaneous reflexes. Many scientific publications express opinions that the first “social smile” occurs only after the second month of life. Behavioral studies regarding neonates are relatively scarce and require more analyses to interpret the meanings of a particular behavior. However, there is a high likelihood to assume that these early smiles have a social purpose. It is also showing that these smiles are more than just a reflex.


How obesity and the position of the fetus influence the quality of 3d 4d ultrasound images.

3D Scans, even on advanced ultrasound systems, could produce poor results.

Images appeared to be blurry and non-usable for a visual evaluation of primary organs and also seeing a baby’s face.  

The accuracy of the ultrasound scan depends on many factors such as skills of the ultrasound technician, proper training, right protocol of the examination, women body mass index (BMI), time of the session, quality of the ultrasound equipment, and a fetus position.  

The most common reasons for poor ultrasonic visualization during a second-trimester, with all other factors to be equal, are a “bad” fetus position and a beam distortion based on overlying fatty tissues.

A number incomplete scans because of an unfavorable fetal position.

The wrong position of the fetus for viewing would result when shadowing from overlying bones and structures obscures the location of the fetus. The only solution to that problem is to change the position of the fetus. That could take some extra time that is not always available during a scheduled session. The follow-up session would often cure that problem.

The survey was conducted on pregnant women from Altamedica Fetal-Maternal Medical Center, who were evaluated for prenatal testing. Out of 4000 women, only 169, or about 4.2% had to come back for the second examination. That fact shows that only a small percentage of all exams were affected by a “bad” fetus position. However, even superior sonographers’ skills could not solve the problem.

The biggest problem during the scans was the bodies’ physique of the women who were overweight. 

According to the World Health Organization 

 body mass index (BMI) of 30kg/m2 or higher is a definition of obesity in a person. The number of obese people, especially for developed countries, is continuously growing in increasing rates. That trend affects pregnant women as well. The obesity rate in the US among pregnant women ranges from 18% to 40%. 

During a session, subcutaneous, just under the skin, tissues absorb ultrasound beams.

That makes it difficult to evaluate visualized data. Tissue Harmonic Imaging (THI) 

helped to improve a contrast resolution and tissue difference. As a result, the quality of the images was much better to compare with conventional 2d ultrasound.

Having said that does not imply that all women with a high BMI would not get good photos and visa versa. The problem is not just obesity but the type of non-uniform fatty issues that compound of fat with unequal density. Bad quality images could be taken from women with low body fat but having a layer of that tissue. And women with high BMI could receive almost perfect photos of the fetus. However, the trend is that women with high BMI would be less likely to receive perfect images as opposed to women with low body fat.

Educational benefits for pregnant women in explaining how the scan works.

Many pregnant women do not have a clear understanding of how the ultrasound session works, and why the images could be of not perfect quality. As a result, expectant moms-to-be would blame a sonographer or the ultrasound equipment of the imaging center. Some could take it personally when an ultrasound tech would suggest that obesity was a patient-related factor in the failure to produce decent photos. Then, it is essential to explain before the session how obesity factors would influence the result of the scan. 

Non-Diagnostic 3D 4D Ultrasound v. Medical 2D Diagnostic Ultrasound

In the previous blog, we were discussing the safety of ultrasound sonograms, the quality of ultrasound equipment, and the qualifications of sonographers. Assume that you have already booked an appointment with a licensed technician, and the studio is using advanced 3d 4d ultrasound equipment.

Can pregnant women trust a sonographer in 3d imaging center with their health?

Some people would say that a technician who performs a session for non-diagnostic purposes would not reflect on the condition of a pregnant woman. They say that a technician would only pay attention to the quality of images and videos while performing a session. Those critics need to understand how the session is performed.

Some techniques a technician will use to render 3d images.

During their pregnancies, women naturally have experienced physical changes in their bodies. Some of them might gain extra weight, the others would suffer dehydration if they don’t consume an adequate amount of liquid. Those conditions create additional obstacles for the sonographers to obtain clear ultrasound images. The beam of the machine via a special obstetrical probe or transducer has to penetrate the body’s extra fat tissues. That could lead to poor quality of the images. One way to get around that problem is to apply some extra pressure on the stomach of a pregnant woman, which could be painful. That is why every experienced sonographer would always inquire from a patient how she feels at every moment during a time of rendering images.

Medical diagnostic 2d ultrasound appointments environment.

During a diagnostic medical ultrasound session a sonographer less concerns how a woman feels during the appointment. The main goal here would be taking some important measurements of the baby’s organs as quickly as possible. That is especially true during the first trimester of the pregnancy when the fetus is under 13 weeks of development. At that time, every baby’s movement would make a technician re-set a starting point to continue the measurements. Women also tend to bear with any unpleasant feelings and cooperate during a medical ultrasound because they believe it relates to their babies’ health.

Non-diagnostic 2d, 3d, 4d ultrasound session’s environment.

During a non-diagnostic session, and 3d 4d ultrasound session in particular, pregnant women experience a very different environment. Instead of being calm and speechless, the women expect to enjoy themselves while viewing their babies, often on a big-screen TV. Most of the time, women feel in command during ultrasound sessions for non-diagnostics purposes.

Some false facts regarding 3d 4d ultrasound sessions.  

In some blogs, we could find the following information. “If they [sonographers] see something they are uncomfortable with, they may not be prepared to provide you with information, support, or follow-up. In those cases, you may need to go to your doctor for another ultrasound. This can result in unnecessary anxiety and concern.”
That is strange reading because ultrasound technicians in doctors’ offices aren’t allowed to talk to patients regarding the procedure at all. That is entirely different from the environment during taken 3d keepsakes. Moms-to-be and also dads-to-be will try to use all time during the session to ask questions about everything that they see on the screens during the sessions.

Treatment rooms in commercial non-diagnostic imaging centers are usually spacious and would accommodate many people as an opposite to a treatment room in a doctor’s office. As a result, any member of a family attending an ultrasound session is allowed to ask some questions. Experienced sonographers have completed hundreds and even thousands of 2d and 3d sonograms during their practice. They are licensed and competent to answer questions during the scanning session. However, it is essential to understand the purpose of 3d sonograms. The objective is to see the babies before they are born. Every pregnant woman is supposed to be under the medical care of the professionals.

In some unfortunate cases, when a fetus has some abnormalities, sonographers, generally, would advise a woman to go to her doctor for a re-check. The fact that a technician detected some abnormalities and made a notice of it should only benefit a woman.

What Are 2D, 3D, 4D Ultrasound Waves?

Many factors influence the quality of ultrasound images. However, before discussing the quality of ultrasound images, it is essential to know the ultrasound physics of how those images are produced.
According to ultrasonography, sound pulses penetrate through material tissues or media. Reflections from the objects in the media return to the transducer and appear as images on computer screens, recording devices, or printers.  The source of sound waves is the ultrasound machine and a transducer.

what are 2d, 3d, 4d ultrasound waves

Sound waves basic.

waves visual presentation

Parameters are characteristics of a sound wave.

There are seven parameters, such as period, frequency, amplitude, power, intensity, wavelength, and speed.

Pulsed ultrasound with a fixed period value

The period is the time for a wave to vibrate one cycle. The value is ranged from 0.1 to .05 microseconds or 0.0000001 to 0.0000005 seconds.
Frequency is the number of cycles of ultrasound waves during one second. It measures in Hz. In imaging ultrasound, frequency is in a range from 2MHz to 10MHz or 2-10 million per second. The name ultrasound is related to humans’ ability to hear sound waves. The audible frequency of the sound waves that people can hear lies between 20Hz and 20,000Hz. The frequency over 20,000Hz is called ultrasonic and gave a name to ultrasound waves. 

Ultrasound Frequency

Amplitude defines how big a sound wave is. Its value decreases as the wave goes through the medium.Power is another parameter that is the rate of the energy transferred. A technician can adjust both of these parameters.Intensity is the concentration of the energy in a sound beam. It determines how the power of a wave is distributed in space.

Ultrasound scan

Amplitude, power, and intensity are directly related to each other and define the strength of the wave. When intensity increases, amplitude and power also increase. The wavelength, as the name suggests, defines the length of the sound wave. It measures from 0.15 to 0.8 mm.
Speed is the distance that sound wave travels via a medium in 1 sec. Speed measures in from 500m/s to 1,500m/s for soft tissue in a body for a typical clinical ultrasound. During an ultrasound session, settings, or parameters of the ultrasound system could be adjusted to achieve the best result when rendering images. 

Why the medium is important for rendering clear images.

Sound cannot travel in a vacuum; it has to travel via a medium that could be of a different matter. For example, during an ultrasound session, the beam from a transducer has to penetrate tissues of the woman’s body. When a woman is obese, then the sound waves have to penetrate more body tissues. That would cause more interference, and the rendered images would have less quality under the same settings.

Ultrasound Session

Knowing how parameters of sound waves correlate to each other is a key to the optimal settings during an ultrasound session. Period and frequency are reciprocal to each other. In other words, the smaller a period is, the higher a frequency and vice versa. Amplitude, power, and intensity are grouped together because they determine a magnitude of the sound wave. The technician could adjust those parameters.Speed, on the other hand, is determined by the medium through which a sound wave is passing through. A wavelength is to be determined by the source and the medium. 

Medium is an essential factor that relates to the speed of the waves.

Its two characteristics are stiffness and density. Stiffness is defined by the object’s ability to resist the compression. An example could be a material that is resilient to squeezing. The stiffer the tissue, the more speed the sound waves have during the session. Density would have the opposite effect on speed. The higher density of the matter would cause a sound wave to travel at a slower speed.  

Ultrasound Probe

That knowledge about the physics of sound waves tied with the practical experience would help a sonographer to obtain the best images of the baby during the session.

Have or Not to Have 3D 4D Ultrasound?

When 3d 4d ultrasound imaging centers first opened for business about 15-20 years ago, there were little questions for moms and dads-to-be about having those keepsakes. The difference between the traditional black and white 2d ultrasound images and color three-dimensional 3d images benefited a new technology. The pictures of the unborn babies looked so real that parents wanted to have a photo op right away. As time progressed, more and more parents became involved in the process of getting 3d keepsakes. People also wanted to know if 3d ultrasound is safe. Few critics, mostly from medical doctors, argued that new technology could do some harm to the fetus during the development state of women’s pregnancies.

Why some obstetricians discourage parents from having recreational ultrasound?

2d, 3d, and 4d ultrasounds use sound waves technology. Compare to x-rays, sound waves are completely harmless to human bodies. Some medical researches revealed harmful heating effects on the rats’ brain tissues when used extensively. However, because the matters of brains affected were so tiny that the data was not reliable and insufficient to apply to humans. As a result, American Institute of Ultrasound in Medicine’s issued the statement: “No confirmed biological effects on patients or instrument operators caused by exposure at intensities typical of present diagnostic ultrasound equipment have ever been reported.”

What is a government position on the safety of 3d 4d sonograms?

Some publications state that FDA discourages using ultrasound for recreational purposes. However, it is not exactly right. FDA site stated an opinion of one of the engineers. If quoted: “Although there is a lack of evidence of any harm due to ultrasound imaging and heartbeat monitors, prudent use of these devices by trained health care providers is important,” says Shahram Vaezy, Ph.D., an FDA biomedical engineer.” The key phrases are: “lack of evidence of any harm” and “ a prudent use” by trained professionals. The part of “lack of evidence of any harm” is self-explanatory. The “prudent use” is more speculative and needs more explanation. FDA expressed concerns that some “enterprises in the U.S commercializing ultrasonic imaging by making fetal keepsake videos,” and the videos were too long. That is not the case with regular 3d 4d ultrasound imaging centers. Most of those facilities provide ultrasound sessions that range from several minutes, such as gender determination packages, to up to 20-30 minutes of their most deluxe and expensive packages. 

Why non-diagnostic imaging centers use only professional sonographers?

GE Ultrasound System Voluson 730

“Prudent use” concern is even less practical and applicable in real life. There are none of the imaging centers where non-professionals personnel are allowed to use those ultrasound machines. First, there is a possibility to physically harm patients by non-certified technicians that, by itself, would provide a substantial financial liability for the owners. The other aspect is the high cost of the ultrasound equipment. Ultrasound systems from GE, Samsung, Phillips, and other companies could run up to several hundreds of dollars. The owners would be the first line of defense to protect their investments. As a result, all ultrasound technicians or sonographers are appropriately licensed before they can provide service. 

How to become a licensed ultrasound technician.

Ultrasound Technician performing a session

The usual way to become an ultrasound technician is to get enrolled in accredited Sonography programs, Commission on Accreditation of Allied Health Education Programs (CAAHEP ) has the accredited Diagnostic Medical Sonography Program. The advantage of this program is that students can sit for the ARDMS exam right after graduation.  Ultrasound technicians have extensive and rigorous training while they are in college. The time of getting a license is about two years. Highly experienced and trained instructors provide students with theoretical and practical aspects of the profession. The critical part of the program curriculum is the practical skills that students obtained working with volunteers. As a result, the graduates are fully prepared after passing the ARDMS exam to work as sonographers. Below are some examples of the most affordable colleges in Southern California for the accredited Sonography programs.

Cypress College; Merced College; Santa Barbara City College; Orange Coast College.

Let’s talk about the cost of ultrasound sessions and the quality of images and videos in the next blog.      

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