Day 1: Obstetrics

   To the untrained eye, the black and white image that appears in an ultrasound is simply an outline of a little baby’s head, hands, body, and feet. However, after flipping through a book of obstetrics ultrasounds, the other seemingly amorphous spots on the screen became more identifiable—a stomach, kidney, heart, and gallbladder were all visible. The doctors I shadowed today, my first day at Tufts Medical, are specialists in identifying problems in fetuses. After I followed the doctor into the patient’s room, I quickly saw the outline of the baby, a heartbeat, and then a circle, within a circle, within a circle. Although most of it was black and gray, some white was visible. Not too soon after did I hear the words echogenic and cysts being thrown around. What did these things mean?


   The definition of echogenicity is the ability for something to generate or reflect sound waves, which in this case, are captured in an ultrasound. I found out that if something, like a fetus’ little kidney, is echogenic, then the image appears whiter on the ultrasound. This warns the doctor that the kidney is damaged or not functioning properly.  Other signs of a fetus having abnormalities can be determined by sampling the mother’s blood to check for a balance in hormones. I learned that the doctor can tell whether a baby is at high risk of being born with Down syndrome depending on the balance of the hormones. The baby can then be tested for Down syndrome by amniocentesis. What is amniocentesis?


   The baby develops in a sac called the placenta, which is inside a woman’s uterus. Inside the placenta is a fluid which contains an amniotic fluid rich with nutrients to help the baby grow.  As the baby develops, it actually swallows the fluid and urinates it back into the placenta, so that the amniotic fluid becomes the baby’s urine (and not water as I thought it was). The fluid actually contains fetal tissue, which is why, if extracted, can help more accurately determine if a baby has any genetic abnormalities. When a doctor performs amniocentesis, he penetrates the mother’s belly and the baby’s sac in order to obtain some of the fluid which will yield the baby’s karyotype (a “chart” of the baby’s chromosomes), and therefore uncover any genetic abnormalities. 


   These are two of the things I learned today shadowing at Tufts. The doctors were very patient with me, answering all my questions ranging from “Why would a pregnant woman bleed, and where does the blood come from?” to “If the baby’s kidney is failing and the amniotic fluid is low, why can’t some artificial fluid be injected into the sac?” to “What happens if a woman has complications but no insurance?” I definitely enjoyed walking around and seeing patients in different stages of pregnancy because the image of the baby was different every time. I am very excited to come back and see the babies outside of the womb. Overall, I had a great first day.