“From the day we found out about these MCMA twins, we knew we had a story to tell.”
Rose found out she was having Monochorionic monoamniotic (MCMA) twins at her dating scan with QUFW. MCMA is a rare twin condition, where both babies are in one gestational sac and share the one placenta.
This short documentary, exclusive to QUFW, explores Rose and her family and their experience with MCMA twins and the challenges they had to overcome to have these two healthy happy little girls in their arms today 💕!
From a young age, Kate knew she wanted a family. But what she didn’t know then, was the journey to motherhood would be more complicated than expected. After experiencing miscarriages previously, Kate and her husband Aaron were nervous when they got pregnant again, but were relieved when they found out that baby Ruby had a heartbeat! With the finish line in sight, at their 36 weeks scan, the pair faced a new hurdle when they were told that their baby girl may not live a full and healthy life. However, thanks to new and improved ultrasound technology Dr. Robert Cincotta, Maternal Fetal Medicine Specialist, and the team at Queensland Ultrasound For Women were able to detect her intracerebral bleed and make an early diagnosis.
This video was produced by BBC StoryWorks Commercial Productions on behalf of GE HealthCare.
We sat down with QUFW’s Clinical Educator, Simone Karandrews, to learn more about her inspiring journey as a women’s health sonographer, her role as a clinical and career mentor, and the changes she’s making in the community
Simone Karandrews is the Clinical Educator at QUFW. She has more than 28 years’ experience in the diagnostic imaging sector.
Simone’s story as an experienced sonographer and community change-maker is as unique as it is inspiring.
As she delivers her answer to the classic ‘tell me how your career started’ question, it quickly becomes obvious why Simone holds so much respect across her clinic, industry, and community.
Simone is a skilled clinician, with more than 28 years’ experience in diagnostic imaging. She tells fascinating stories, both happy and sad, about her journey as a sonographer.
But what sets Simone apart is her passion—for helping others, for creating positive change, and for the lifechanging outcomes sonography provides far beyond the scanning room.
This is where her story takes a different path. Unlike some, Simone’s interest in sonography didn’t ignite during a university lecture or career workshop. Instead, it captivated her for the first time in a more unusual setting: piano lessons, during her late school years.
“When I was in school, I took piano lessons with a wonderful old piano teacher,” Simone recalls.
“There was another student whose mother was a sonographer, which was quite rare at the time. My piano teacher used to talk to me about her and her role.”
“And so I met up with her when I was on work experience in medical imaging in year ten, and obviously I was able to watch her scan.”
Simone explains what she felt as she saw an ultrasound scan for the first time.
“I remember how in awe I was, that this woman could know what she was looking at, what she needed to look at, what other things she may need to look at, and why,” she explains.
“With ultrasound, you’re like a detective using great technology to make a difference to people’s lives.”
“It was a combination of technology and medicine all in one”, she says.
An official introduction to sonography
Simone was officially introduced to clinical ultrasound during placement at a local hospital.
“My first work experience placement was in nuclear medicine at one of the local hospitals in Canberra,” she explains.
“And, as I mentioned, as part of my rotation there, I was able to see an ultrasound being performed.”
“And for me, that was it, I was hooked.”
“That’s where I wanted to end up,” she says with a sense of nostalgia.
Deciding to pursue this career path, Simone studied a Bachelor of Applied Science in Medical Radiation, specialising in nuclear medicine at the University of Sydney.
As her graduation approached, a radiology company in Queensland reached out, flying her interstate for an interview.
By the end of the day, Simone had a new job and a new city to call home.
“I remember ringing my dad from the Brisbane Queen Street Mall saying, I’m taking the job.”
”But, I’d never been to Brisbane. I didn’t have any family here, didn’t have any friends here.”
“So it was a leap into the great unknown,” she reflects.
“There was a lot of personal growth for me and change at the same time, but it was all a big adventure.”
Simone gathered experience in some of Queensland’s busiest medical hubs. She was quickly recognised as a rising star in nuclear medicine, and was offered a spot in a rigorous training program and post-graduate Diploma in Medical Ultrasound at QUT.
During this time, Simone was introduced to various facets of ultrasound, including training in women’s imaging clinics. Here, she found her niche—breast ultrasounds, gynaecology, and obstetrics.
“I felt much more comfortable with obstetrics and gynaecology, and I think that that’s really what laid the foundation for me and my passion.”
Simone’s current role
Fast forward two passionate decades, and Simone is now the Clinical Educator at QUFW.
In this role, she trains and mentors QUFW’s junior sonographers and helps ensure high clinical standards and continuing education across all four practice locations. Simone also enjoys scanning patients in QUFW’s Brisbane and Ipswich practices.
Whilst the Clinical Educator role involves teaching traditional ‘hands-on’ skills, it also requires Simone to lead by example and personify the unwritten qualities of an impactful sonographer: clinical excellence, a warm bedside manner, a thirst for knowledge, and all of the other things that helps QUFW deliver the exemplary care it is known for.
It should come as no surprise that Simone is thriving.
“I feel fulfilled that I am in a great role,” she says.
“I have great support networks and some wonderful colleagues surrounding me.”
“And this allows me to continue my desire to learn new things and help others.”
“I think it’s important to keep learning, to keep life interesting.”
She also feels grateful to work with fellow sonographers who share her work ethic, mentioning how they feed off each other’s dedication and expertise.
“The sonographers that I work with also have a very similar work ethic.”
“And working in that way, we work really well together.”
“We all are there for each other, and collaborate and assist each other,” she says.
The joy of touching lives
Simone explains how the beauty of sonography lies in the privilege of helping people experience life’s cherished moments.
“It’s a privilege to be a part and parcel of people’s health journeys,” she says.
“Ultrasound is a fantastic way for families to bond with their new unborn baby.”
Simone recalls a patient story that left an indelible mark on her heart.
“I remember a patient, Rosanna, coming to our practice for the first time, and she was about seven weeks pregnant,” she explains.
“She is a GP, so she knew what to expect.”
“We scanned her, and discovered that she was having twins, actually MCMA twins, which are extremely rare,” she explains.
“And I remember her looking at the screen, and she’s having this quiet… well, not so quiet panic attack, knowing what she was looking at and her poor husband who’s not medical, was asking, what’s the problem?”
“And she’s trying to explain to him what’s happening, walking him through the diagnosis side of things, but also managing her anxiety and excitement at the same time.”
“We developed a closer relationship, because we got to see Rosanna so frequently.”
“And that was really lovely. Just like with our other patients that we get to see over the course of their journey.”
Both babies were delivered safely, and are now thriving. Simone was ecstatic to meet them and, of course, be part of their origin story.
“And to know that this family ended up with a great outcome with two beautiful healthy girls in such a rare pregnancy, which had so many potentials for a poorer outcome, was just wonderful,” Simone says.
Watch more here:
The challenging times
However, it’s not always about joyous occasions. Simone opens up about the challenging moments, like delivering the heartbreaking news of a miscarriage.
But even in these trying times, she focuses on providing individualised, compassionate care, ensuring patients feel supported and receive appropriate follow up with doctors.
“You might see people on the worst days of their lives,” she says.
“During the scan, for instance, we may discover a miscarriage or an abnormality and we have to impart that information to those patients.”
“The challenge is being able to try and do that the best way possible.”
Simone pauses and reflects on some of the feedback she has received after delivering bad news.
“For people who have just received awful news, they are trying to absorb information and grieve all at once. But when they make the effort to say thank you for being so kind and compassionate, I feel as though I’ve done the best I possibly can given the nature of their situation.”
Passing on her knowledge
Simone thrives on her role as a mentor, shaping the essential hard and soft skills of the sonographers of tomorrow. She relishes in their achievements, likening this to the highs of parenthood.
“Sharing knowledge and being able to tutor the sonographers of tomorrow, shaping their skills and setting them up for a good, strong career is so important.”
“I like being part of their learning journey, and I feel like a proud mum when they actually realise their goals,” she says with a smile.
“I really do get a kick out of seeing them become the developed sonographer that they are hoping that they can be.”
Simone also has sage advice for budding sonographers.
“I would say to them that it’s a really rewarding career.”
“Finding your passion within the many facets of ultrasound specialty is really important.”
“It’s such an interactive profession with so much patient interaction. It’s a skill to bring pieces of information together to assist in making a diagnosis.”
This statement isn’t just a career catchphrase for Simone—it is built around her belief that the quality of an ultrasound scan relies heavily on the skills of the sonographer.
Emphasising the sonographer
A good scan requires an attentive eye, adept hand-eye coordination, a strong connection with patients, an understanding of anatomy and physiology, and a deep knowledge of the technology at hand, Simone says.
“Ultrasound can be used widely across so many different areas of the body, but the one thing that I’d really like to highlight is the fact that its strength is definitely in the hands of the sonographer.”
“It’s as much science as it is art.”
“There is so much visual recognition, hand-eye coordination, ability to drive the machine, talk to patients, communicate, draw information from them, that can actually really help with providing an accurate diagnosis,” she says.
Simone also highlights the importance of effective communication, empathy, and active listening.
In Simone’s eyes, an effective ultrasound scan requires an intricate blend of science, art, and human connection. It’s a field where the expertise and intuition of the sonographer play a crucial role, turning a standard scan into a precise diagnostic tool through visual acumen, technical skill, effective patient communication, and a deep sense of empathy.
Personal and political passions
Aside from her role as a sonographer, Simone is an active member of her community. She’s involved in the West Moreton Darling Downs Primary Health Network, where she plays a role in bridging the gap between the community and healthcare providers. She is also responsible for forming and coordinating a community led disaster support group to assist her community in times of natural disasters.
Simone has also been a part of the Australian Sonographers Association Committee for Queensland for over 20 years, showing her dedication to peer education and overall advancement of the profession.
“I’m genuinely interested in healthcare outcomes for people, which is all about how people actually access healthcare within the region, as well as assisting in skill advancement for other sonographers,” she says.
Outside the clinic, Simone seeks solace in the company of her family, including her retired racing greyhound, Alice. Her love for nature, photography, and baking serves as her personal retreat from the demanding nature of her job.
But there’s another facet to Simone that might surprise many: politics. In 2019, driven to address regional issues she felt were being ignored, she took a plunge into federal politics as a candidate in the election.
Although she didn’t achieve the resolution she sought, Simone’s political journey led her to be part of the inaugural cohort of the Pathways to Politics Course in Queensland, empowering women to change the political landscape.
“It all came about because I’ve been pushing a particular campaign to do with an issue in our region.”
“And I didn’t feel as though we were really being represented very well to seek a resolution that would make a real difference to the people and businesses within the community. But it became more than about just one issue – it was about being a genuine voice for community and future outcomes.”
Looking back and forward
Reflecting on her career, Simone is content with her choices. She wouldn’t change a thing.
Her parting wisdom is an echo of QUFW’s philosophy, ‘experience really does matter’.
“And I say that, because our team is invested in our patients.”
“We aim to be the leaders of what we do,” she says.
When asked if she’d do anything differently throughout her career, her answer is clear:
“No, nothing. I’m happy.”
For Simone, sonography is so much more than a diagnostic tool. When she picks up the transducer, she’s helping one patient. But when Simone mentors her students and pushes for change in her community, she’s using her clinical and social skills to change the lives of so many more.
Simone’s journey is one of passion, excellence, and an unyielding intention to change things for the better. If you’re a patient in Simone’s ultrasound room, a sonographer under her wing, or a member of her community, you’re luckier than you might realise.
–
November 2023
Content Disclaimer
The information provided on this website is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen.
The content on this website is not intended to be a comprehensive source of information on any particular topic and should not be relied upon as such. The authors and publishers of this website are not liable for any damages or injury resulting from the use or misuse of the information provided on this website.
Gestational diabetes (GDM) is a condition in which a woman without pre-existing diabetes develops high blood glucose levels during pregnancy.
GDM can lead to complications for both the mother and the baby. The baby might grow larger than usual, which can potentially lead to issues during the pregnancy or during delivery. After birth, babies of mothers with gestational diabetes might experience low blood glucose, jaundice, or breathing problems. Additionally, having had gestational diabetes increases a woman’s lifetime risk of developing Type 2 diabetes.
Most women with gestational diabetes can manage their condition through diet and exercise, but some may require medication such as metformin or insulin.
At QUFW, we perform third trimester growth assessments for GDM generally from 28 weeks onwards.
Gestational diabetes (GDM) is a condition that may arise during pregnancy when the body can’t produce enough insulin to meet its needs. This leads to elevated blood glucose levels which can impact both mother and baby. Possible implications of GDM include:
The baby’s growth can be affected, which can sometimes increase risk during pregnancy
If a baby is larger due to diabetes in pregnancy, this can increase the risk of some complications during delivery, and may require an alteration to delivery plan – timing, or the way that you deliver your baby
Post-birth, the baby may experience low blood glucose, jaundice, or breathing problems
Increased lifetime risk of type 2 Diabetes for women who have had gestational diabetes diagnosed in a pregnancy
It’s called “gestational” diabetes because it originates during gestation, or the pregnancy period.
How is gestational diabetes different from type 1 and type 2 diabetes?
Each of these forms of diabetes is characterised by high blood glucose levels, but they arise from different causes and manifest in different ways. Here’s a breakdown of the distinctions:
Gestational Diabetes (GDM)
Onset: Only develops during pregnancy.
Cause: Pregnancy results in the production of hormones that can make cells less sensitive to insulin. In some women, the body can’t produce enough insulin to transport the glucose into the cells, leading to elevated blood glucose levels.
Management: Often managed with dietary changes, exercise, and monitoring. Some women might need medication (either tablets, injections, or both).
Post-pregnancy: Usually resolves after giving birth, but women who had GDM are at a higher risk for developing type 2 diabetes later in life.
Risk: Babies born to mothers with uncontrolled gestational diabetes are at a higher risk for problems like obesity and type 2 diabetes.
Type 1 Diabetes (T1DM)
Onset: Typically manifests in childhood or adolescence, but can appear in adults.
Cause: An autoimmune reaction where the body’s defence system attacks the insulin-producing cells in the pancreas, leading to little or no insulin production.
Management: People with T1DM require lifelong insulin therapy – this can be administered through injections or an insulin pump.
Chronic Condition: This is a lifelong condition and does not go away.
Risk: Without proper management, T1DM can lead to various complications in many parts of the body.
Type 2 Diabetes (T2DM)
Onset: More common in adults but can also appear in younger individuals, especially with rising childhood obesity rates.
Cause: The body either resists the effects of insulin, meaning it doesn’t use insulin efficiently, or it can’t produce enough insulin to maintain normal blood glucose levels.
Management: Can often be managed with lifestyle changes like diet and exercise, but some people also need medication.
Chronic Condition: Like T1DM, this is a lifelong condition. However, with effective management, some individuals can revert their blood glucose levels back to normal.
Risk: Uncontrolled T2DM can lead to various health complications, similar to those of T1DM.
Diabetes – MODY
This is the name given to the Maturity Onset of Diabetes in the Young (MODY). It is a rare type of Diabetes where there has been a genetic change in either the individual or by inheriting the genetic change from a parent.
Onset: it generally affects children, adolescents and young adults and often manifests before the age of 25.
Cause: The body either resists the effects of insulin, meaning it doesn’t use insulin efficiently, or it can’t produce enough insulin to maintain normal blood glucose levels.
Management: Can often be managed with lifestyle changes like diet and exercise, but some people also need medication.
Chronic Condition: Like T1DM, this is a lifelong condition. However, with effective management, some individuals can revert their blood glucose levels back to normal.
Risk: Uncontrolled T2DM can lead to various health complications, similar to those of T1DM.
What causes gestational diabetes?
Multiple factors contribute to the onset of GDM during pregnancy. Here are some of the primary causes and contributing factors:
Pregnancy Hormones: During pregnancy, the placenta supports the growing fetus by producing several necessary hormones. Some of these hormones can interfere with the mother’s insulin (which helps regulate blood glucose levels), making her body less sensitive to insulin. This is a condition called insulin resistance.
Increased Demand for Insulin: As the pregnancy progresses, especially during the second and third trimesters, the mother’s body requires two to three times more insulin than usual. If her pancreas can’t produce enough insulin to meet this demand, blood glucose levels rise, resulting in gestational diabetes.
Excess Weight: Being overweight or obese prior to pregnancy, or gaining excessive weight during pregnancy, can increase a woman’s risk of developing gestational diabetes. Excess weight can cause increased insulin resistance.
Genetic Factors: Women with a family history of diabetes may have a higher risk of developing GDM. Specific genes have also been linked to the susceptibility of developing gestational diabetes.
Age: Women older than 25 years are at a greater risk of developing gestational diabetes compared to their younger counterparts.
Ethnicity: Women from certain ethnic backgrounds, including African, Hispanic, Native American, South or East Asian, and Pacific Islander, are at a heightened risk.
Multiple pregnancy: carrying twins, triplets or higher order multiples increases the chance of developing GDM
Previous GDM: Having gestational diabetes in a previous pregnancy significantly increases the risk of experiencing it in subsequent pregnancies.
Previous delivery of a large baby: If a woman has previously delivered a baby weighing more than 9 pounds (4.1 kilograms), she might be more likely to develop gestational diabetes.
Polycystic Ovary Syndrome (PCOS): Women with PCOS, a common condition characterised by irregular menstrual periods, excess hair growth, and obesity, are at increased risk of GDM.
Other health conditions: Conditions like hypertension or having a slightly elevated blood glucose level before pregnancy (known as prediabetes) can also increase the risk.
It’s worth noting that while these factors can increase the risk, gestational diabetes can develop in women without any of these risk factors. Early screening and management are crucial to ensure the health of both the mother and the baby.
What symptoms might suggest a woman has developed gestational diabetes?
Gestational diabetes often doesn’t present with noticeable symptoms, which is why routine screening during pregnancy is so important. However, when symptoms do occur, they may include:
Increased Thirst: A noticeable increase in thirst compared to what’s typical for the individual’s pregnancy.
Increased Urination: Needing to urinate more often than usual or in larger quantities.
Fatigue: While fatigue is common in pregnancy, sudden or excessive tiredness might signal a change in blood glucose levels.
Glucose in the Urine: This is usually detected during a routine prenatal visit rather than being a symptom the pregnant person notices.
Blurred Vision: High blood glucose levels can cause fluid levels in the body to shift, impacting the lenses of the eyes and leading to blurry vision.
Increased Hunger: An increased appetite, particularly after eating.
Nausea and Vomiting: Although this can be a symptom of a typical pregnancy, particularly in the first trimester, sudden onset later in pregnancy might be indicative.
Recurrent Infections: Such as bladder infections or yeast infections.
Unexplained Weight Loss: Despite having a good appetite, some women may experience unexplained weight loss.
It’s essential to understand that many of these symptoms can also be typical experiences during pregnancy or be related to other conditions. Therefore, any woman experiencing these symptoms during pregnancy should promptly consult her healthcare provider. Again, because many women with gestational diabetes may not exhibit symptoms, routine screening during the second trimester is standard practice in many countries.
At what point during pregnancy is gestational diabetes most commonly diagnosed?
GDM is most commonly diagnosed during the second trimester of pregnancy. In most pregnancies, screening will be recommended with a GTT between 26 and 28 weeks of pregnancy. However, if a woman has risk factors for the development of GDM, she will often also be recommended to undertake additional screening in early pregnancy. .
How is gestational diabetes diagnosed? What tests are involved?
GDM is diagnosed through specific tests that assess how a pregnant woman’s body manages glucose. Here’s a streamlined explanation of the process:
HbA1c:
This is a single non-fasting blood test which tests for glycosylated haemoglobin
This gives an indication of blood glucose levels over the prior 3 months
It is only helpful in pregnancies when performed <14 weeks gestation, but if done at this stage, can avoid the need for a full early GTT in women with risk factors
HbA1C is utilised to monitor glycaemic control during pregnancy in women with pre-existing diabetes – and to inform fetal risk
Oral Glucose Tolerance Test (OGTT):
The woman fasts overnight, and her blood glucose level is initially measured.
She then consumes a glucose-rich solution.
Blood glucose levels are tested several times over the next 2 to 3 hours.
If two or more of these readings exceed a certain threshold, a diagnosis of gestational diabetes is confirmed.
Are there specific ultrasound findings that may indicate or be associated with gestational diabetes?
There are specific ultrasound findings that may suggest the presence of GDM or indicate that a fetus has been affected by the mother’s elevated blood glucose levels. It’s important to note that while these findings can be associated with GDM, they are not diagnostic on their own and can be seen in pregnancies without GDM. Here are some of the ultrasound findings:
Macrosomia: This is when the fetus is significantly larger than average for its gestational age. GDM increases the risk of a fetus developing large body size due to the increased glucose supply.
Estimated fetal weight
Increased Abdominal Circumference: The fetus might have a disproportionately large abdominal circumference compared to its head circumference.
Increased abdominal circumference
Increased Amniotic Fluid (Polyhydramnios): Mothers with GDM may produce more amniotic fluid. This happens because the fetus might produce more urine in response to the mother’s higher blood glucose levels.
Amniotic Fluid Index
Cardiac Abnormalities: Some studies suggest that babies of mothers with GDM might have slight alterations in cardiac function or structure.
Mature Placenta: An earlier maturation of the placenta can sometimes be seen on ultrasound in women with GDM.
Subcutaneous Fat Thickness: Some studies have used the measurement of subcutaneous fat thickness in the fetus as an indicator of its overall size and potential exposure to high glucose levels.
Remember, while these findings can be associated with GDM, they don’t confirm the diagnosis. If such findings are detected on ultrasound, further investigations, including glucose testing, are essential to determine the presence of gestational diabetes.
What lifestyle changes can help manage or reduce the risk of gestational diabetes?
Managing or reducing the risk of gestational diabetes (GDM) often involves lifestyle changes, particularly in the areas of diet and exercise. Some of these changes include:
Dietary Modifications:
Balanced Meals: Eating balanced meals with a mix of carbohydrates, protein, and healthy fats can help stabilise blood glucose levels.
Complex Carbohydrates: Opt for whole grains, legumes, and vegetables. These take longer to digest, leading to a more gradual rise in blood glucose.
Limit Sugary Foods and Drinks: Reduce the intake of sweets, sugary soft drinks, and other foods and drinks with added sugars.
Fibre: High-fibre foods, like whole grains, fruits, and vegetables, can help manage blood glucose.
Limit Saturated and Trans Fats: Opt for healthier fats like those found in olive oil, nuts, and avocados.
Exercise:
Regular Activity: Aim for at least 30 minutes of moderate activity most days of the week. This can include walking, swimming, or prenatal yoga.
Strength Training: Light resistance training can help improve insulin sensitivity. Always consult a healthcare provider before starting any new exercise regimen during pregnancy.
Consistency: Regular, consistent physical activity helps the body use insulin more efficiently.
Monitor Blood Glucose: For those already diagnosed with GDM, it’s important to monitor blood glucose levels after exercise, as physical activity can lower blood glucose.
Additional Lifestyle Measures:
Maintain a Healthy Weight: Gaining the recommended amount of weight during pregnancy, based on a healthcare provider’s advice, can help manage or reduce the risk of GDM.
Avoid Smoking: Smoking can increase the risk of various pregnancy complications, including GDM.
Manage Stress: Chronic stress can affect insulin sensitivity. Techniques like meditation, deep breathing exercises, and prenatal yoga can help manage stress during pregnancy.
Regular Monitoring: For those at risk or diagnosed with GDM, regular monitoring of blood glucose levels is crucial.
It’s essential for pregnant women, especially those at risk for GDM, to work closely with their healthcare providers. This ensures they are making the best lifestyle choices for themselves and their babies. A registered dietitian or a diabetes educator can also offer personalised strategies and support.
Are medications such as insulin ever required to treat gestational diabetes?
While many women with GDM can manage their blood glucose levels with lifestyle changes alone, some do require medications to maintain their blood glucose within the target range.
It is important to remember that fetal risk – both during pregnancy and after birth – relates to the quality of the diabetic control, and not to the diagnosis of GDM.
What are the potential complications if gestational diabetes is not managed effectively?
If GDM is not managed effectively, it can lead to various complications for both the mother and the baby. Here are some of the potential complications:
For the Baby:
Macrosomia: Babies of mothers with uncontrolled GDM might grow too large due to excess glucose crossing the placenta. This can make vaginal delivery difficult and increase the risk of birth injuries.
Early (preterm) Birth: High blood glucose might increase the risk of early labour or require early delivery for the health of the baby.
Respiratory Distress Syndrome: Babies born early might face respiratory issues because their lungs aren’t fully matured.
Low Blood Glucose (Hypoglycemia): Shortly after birth, babies might have low blood glucose levels, which can lead to seizures if not treated promptly.
Jaundice: Babies of mothers with GDM have a higher risk of developing jaundice due to the breakdown of red blood cells, leading to a buildup of bilirubin.
Type 2 Diabetes Risk: It is unlikely that your baby will be born with diabetes. However, babies exposed to high blood glucose in the womb are at a higher risk of obesity and type 2 diabetes in their later life.
Stillbirth: In severe cases, uncontrolled GDM can increase the risk of stillbirth.
For the Mother:
High Blood Pressure and Preeclampsia: GDM increases the risk of high blood pressure and its severe form, preeclampsia, which can be life-threatening for both the mother and the baby.
Delivery Complications: Due to the baby’s larger size, there’s an increased risk of needing a C-section or encountering complications during vaginal delivery.
Future Diabetes: Women with GDM have a higher risk of developing type 2 diabetes later in life.
GDM in Subsequent Pregnancies: Having GDM in one pregnancy increases the risk of its recurrence in subsequent pregnancies.
What is the likelihood of a woman developing type 2 diabetes after experiencing gestational diabetes?
Women who have had GDM are at an increased risk of developing type 2 diabetes later in life. The exact risk can vary based on multiple factors, including but not limited to body weight, age, and lifestyle.
The information provided on this website is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your obstetric doctor or other qualified provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen.
The content on this website is not intended to be a comprehensive source of information on any particular topic and should not be relied upon as such. The authors and publishers of this website are not liable for any damages or injury resulting from the use or misuse of the information provided on this website.
Determining the due date of a pregnancy is an important part of prenatal care. With the help of ultrasound technology, it is possible to pinpoint a baby’s gestational age, due date, and other important clinical information with a high degree of accuracy. Using this diagnostic information, doctors and obstetric specialists can provide the most appropriate level of care.
If you’ve been booked in for a dating scan at QUFW, or you are interested in learning more about prenatal diagnostics and the process and technology behind pregnancy dating, this fact sheet may address some of your questions and concerns.
What does it mean to “date” a pregnancy, and why is a “dating scan” important?
To “date” a pregnancy means to determine how far along the pregnancy is and, subsequently, estimate the date the baby will be born (the due date).
This is typically calculated based on the baby’s gestational age, which starts from the first day of the mother’s last menstrual period (LMP) and includes the two weeks prior to conception. The due date, often referred to as the estimated date of delivery (EDD), is approximately 40 weeks from the LMP.
The EDD from the LMP is calculated under the assumption of a regular 28 day menstrual cycle. In the event of irregular menstrual cycles or a shorter/longer cycle, EDD may differ from what is calculated by general dating apps or calculators.
According to the Australasian Society of Ultrasound in Medicine (ASUM) Guideline for the performance of First Trimester Ultrasound, the EDD by LMP (adjusted for cycle length) should be used unless the LMP is unknown or if the gestational age by the CRL differs significantly or by more than 5 days. EDD by assisted reproduction dates (for example, IVF) should only be adjusted with extreme caution.
Dating a pregnancy is important for several reasons:
Prenatal care planning: Accurately dating a pregnancy allows doctors and obstetric specialists to schedule necessary prenatal tests, screenings, and ultrasounds at appropriate times. Different tests are conducted at specific times throughout the pregnancy, so knowing the gestational age ensures timely and appropriate care.
Monitoring fetal growth: An accurate gestational age provides a benchmark for evaluating the fetus’ growth and development. If the fetus is larger or smaller than expected for its gestational age, it may indicate potential health issues or complications.
Anticipating birth: Knowing the EDD helps parents-to-be prepare for the baby’s arrival, both emotionally and logistically. It aids in planning maternity leave, organising baby-related purchases, and mentally preparing for labour and childbirth.
Medical interventions: If complications arise, or if the baby doesn’t arrive by the expected due date, medical decisions such as inducing labour or scheduling a C-section can be informed by the accurate dating of the pregnancy.
Assessing potential complications: In cases where pregnancies go beyond 42 weeks (post-term), there might be increased risks to both the mother and baby. Conversely, preterm births (before 37 weeks) can also present challenges. Knowing the accurate gestational age helps doctors and obstetric specialists make informed decisions regarding the management of these situations.
What is a dating scan?
A dating scan, often known as a first trimester ultrasound, is an ultrasound examination best carried out between 7 and 12 weeks of pregnancy. Its primary purpose is to determine the gestational age of the pregnancy and, consequently, estimate a due date. Here are some of the key objectives of a dating scan:
Determination of gestational age: By measuring the baby from the top of its head (crown) to the bottom of its spine (rump), known as the crown-rump length (CRL), doctors and obstetric specialists can determine the age of the pregnancy. This measurement is particularly reliable during the early stages of pregnancy when developmental differences between individual fetuses are minimal. It is most reliable between 7-10 weeks.
Estimation of due date: Once the gestational age has been determined, a due date can be estimated. Knowing the expected due date helps in planning subsequent prenatal care, preparing for childbirth, and identifying if there are any deviations from the expected fetal growth or development in later stages.
Additional observations: While the primary objective of a dating scan is to determine gestational age, the scan can also provide other important information. For example, it can confirm whether the pregnancy is intrauterine (developing within the uterus), ascertain if there are multiple pregnancies (e.g., twins or triplets), and detect the fetal heartbeat.
How accurate is an ultrasound scan in determining gestational age?
Ultrasound is a reliable tool for determining gestational age, especially when conducted in the first trimester of pregnancy. However, its accuracy can vary based on the timing of the ultrasound and certain other factors. Like any measurement, there may be measurement error that needs to be considered. A vaginal ultrasound may be necessary to have more accuracy in visualising and measuring the length of your baby.
First Trimester Ultrasounds (7-13 weeks):
These are considered the most accurate timing for dating a pregnancy. During this period, the fetus undergoes rapid developmental changes, and variations in growth among different fetuses are minimal. The crown-rump length (CRL), which is the measurement from the top of the baby’s head (crown) to the bottom of its spine (rump), is used to determine gestational age. The most accurate timing is ideally between 7-11 weeks gestation.
Second Trimester Ultrasounds (14-24 weeks):
While still relatively accurate, the margin of error increases as the pregnancy progresses. In the second trimester, gestational age is often estimated by measuring various fetal body parts like the head circumference, abdominal circumference, and femur length.
Third Trimester Ultrasounds (after 24 weeks):
By this stage, individual differences in fetal growth become more pronounced, making ultrasounds less precise for dating purposes.
What are the various ultrasound markers and parameters used for age determination?
A ultrasound scan uses the following markers and parameters to determine the age, and other factors, of a pregnancy:
Crown-Rump Length (CRL): Used primarily in the first trimester, CRL measures the length of the fetus from the top of its head (crown) to the bottom of its spine (rump). This measurement is the most accurate in the early stages, specifically between 7 and 11 weeks of gestation.
Biparietal Diameter (BPD): Measured during the second and third trimesters, BPD is the diameter of the fetus’s head, taken from one parietal bone to the other.
Head Circumference (HC): Also taken during the second and third trimesters, this measurement encompasses the entire circumference of the fetal head. Along with the BPD, the HC is taken in the second and third trimesters.
Abdominal Circumference (AC): This measurement, which represents the circumference of the fetal abdomen, gives insights into the baby’s liver size and overall growth. It’s usually taken in the second and third trimesters.
Femur Length (FL): Representing the length of the fetal thigh bone, FL is a standard measurement for assessing the length of the bones and overall skeletal development.
Humerus Length (HL): The length of the fetus’s upper arm bone can also be an indicator of skeletal development.
Can multiple pregnancies (like twins or triplets) affect the accuracy of gestational age determination via ultrasound?
Yes, multiple pregnancies, such as twins or triplets, can present challenges when determining gestational age via ultrasound, but it’s not necessarily that the measurements themselves are less accurate. Rather, the complications and variables introduced by the presence of more than one fetus can affect the interpretation and the application of these measurements. Here’s how:
Individual growth rates: Especially as the pregnancy progresses, twins or triplets might grow at different rates. This is especially common in monochorionic pregnancies (where the fetuses share a placenta). One fetus may receive more nutrients than the other, leading to size discrepancies. If there’s a significant size difference, determining an average gestational age might be more challenging.
Positioning: With multiple fetuses in the uterus, getting clear ultrasound images can be more challenging due to the positions of the fetuses. Accurate measurements require clear images, and if one or more fetuses are not in an ideal position, it can be difficult to obtain precise measurements.
Type of twin pregnancy: The type of twin pregnancy can also influence growth. Monochorionic twins (those sharing a placenta) can sometimes face conditions like Twin-to-Twin Transfusion Syndrome (TTTS), where blood supply is unevenly distributed between the twins. This can affect the growth of one or both babies and might complicate gestational age determination based on size.
General increased variability: Multiple pregnancies naturally have a broader range of what’s considered “normal” in terms of growth and development. This increased variability can make it harder to pinpoint gestational age based solely on measurements, especially in the second and third trimesters.
What should expectant mothers know before going in for an ultrasound meant for dating purposes?
When expectant mothers are preparing for an ultrasound meant for dating purposes, there are several key pieces of information and tips they should be aware of to ensure a smooth and informative experience:
Purpose of the ultrasound: It’s essential to understand that the primary goal of a dating ultrasound is to determine the gestational age of the pregnancy and estimate the due date. This can be especially helpful if there’s uncertainty about the date of the last menstrual period.
Full bladder may be needed: For early pregnancy ultrasounds, a full bladder can help push the uterus up out of the pelvis, but can also act as a ‘window’ to see the uterus behind the bladder, offering clearer images of the fetus.
Transvaginal ultrasound: Depending on how early the pregnancy is, an abdominal ultrasound might not provide clear images. In such cases, a transvaginal ultrasound, where an ultrasound transducer is gently inserted into the vagina, might be recommended. It provides more detailed images, especially during the very early stages of pregnancy. A transvaginal ultrasound is performed with an empty bladder.
It’s diagnostic, not just pictorial: While many expectant parents eagerly await that first “picture” of their baby, it’s crucial to remember that the primary purpose is diagnostic. The images might not always look like the clear baby profiles seen in later-term ultrasounds.
Multiple pregnancies: The ultrasound can also detect if there are multiple pregnancies, like twins or triplets. If this is the case, subsequent monitoring and care might be adjusted accordingly.
Limitations: Ultrasound, especially when done early in the pregnancy, is quite accurate for dating purposes, but it does have a margin of error.
Safety: Ultrasound uses sound waves and not radiation, making it safe for both the mother and the baby. There are no known harmful effects when used appropriately.
Results and interpretation: Occasionally, during an ultrasound if there is a discrepancy with dating it may require you to be rescanned in 7-10 days to confirm the growth of the fetus and presence of a heart beat. At QUFW, one of our specialist obstetrician and gynaecologists will review and interpret the results and share with yourself and your referring doctor. Your referring doctor will decide the EDD for you to use.
Emotional Preparedness: While many ultrasounds go smoothly, there’s always a possibility of unexpected findings, such as detecting potential complications or issues. It’s essential to be emotionally prepared and remember that the healthcare team is there to provide support and guidance.
A dating ultrasound is a significant step in the prenatal journey. It offers important insights into a pregnancy’s progress, and sets the stage for subsequent care.
If you have any other questions about your dating scan, or ultrasound, please speak to your doctor or obstetric specialist.
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The content on this website is not intended to be a comprehensive source of information on any particular topic and should not be relied upon as such. The authors and publishers of this website are not liable for any damages or injury resulting from the use or misuse of the information provided on this website.
Fast forward two passionate decades, and Simone is now the Clinical Educator at QUFW. 
A good scan requires an attentive eye, adept hand-eye coordination, a strong connection with patients, an understanding of anatomy and physiology, and a deep knowledge of the technology at hand, Simone says.
Reflecting on her career, Simone is content with her choices. She wouldn’t change a thing. 
