Hey Brittany,

I am right there with you when it comes to embryology! I find when things are color coded it helps my brain process new concepts better compared to when they're just labeled. Something that I am thinking about doing is sculpting the fetal heart in clay or using pipe cleaners to show the looping and twisting process that the heart must go through before it's in its final structure. I have so much clay left over from 1st quarters project, so it could be a fun way to learn this material!

I also tried to find some images of the heart development week by week but I didn't find much information on the web! Here's another cool picture that is similar to the one in my original post that does include a timeline! Hope this helps!

Hi Brittany,

I hear ya on the embryology! I wrote in another comment, I'm going to have to watch animations on repeat until I get it. , starting at 2:08, was nice and slowly went through each step. While it is difficult now, I know it will help me understand all the pathology as we progress in our studies. 

I feel like I have a basic understanding of 4 main heart views (4chamber, LVOT, RVOT, and 3VV), and how one angles superiorly to cycle through them. I think one of my concerns is finding and keeping a good view while scanning. It is something I hope to practice in clinicals this week. Everything gets more challenging when baby won't stay still. 

Also remembering all the things to check when scanning the fetal heart... maybe we can write a song or something? Some way to easily run through the long list in my head when scanning. I'm so nervous I'm going to miss something, especially anomalies or pathology. 

I'll probably think of more as the week goes on, but these would be the initial 3 that come to mind. Can't wait to see what resources people share!

Hi Brit! Embryology is definitely a foreign beast. I found this short video (start at 2:07) that has great animations. I found it particularly helpful for the development of the septum primum and second secundum, and what structures form the septa (endocardial cushion and such). I'll likely draw these steps later since I find that helps me make concepts stick a little better. It also dives a little into what defects can arise, which is a great reminder of why we need know these processes. 

https://www.youtube.com/watch?v=-d2UfOePgZw

Edit: Whoopsie, it's the same video that Leah just posted >.< I guess that means it is definitely a good one! 

Hi Alexis!

I love the idea of writing out everything that you need to see in each view. I think it's a great organization tool.

How does your CI keep track of all the images that need to be taken?

I am in the same boat Alexis! But I compiled a small pop quiz for you to differentiate views. I will grade easy don't worry. What view is this?

There is another lecture that is up, I'm not sure if you guys looked at it, but when I was a student it helped me A TON! Everything is broken down into nice little sections and the images are incredibly helpful! It's at the bottom of the week 5 class shell and it's called Normal Fetal Circulation. I rewrote this ppt in my notes and drew the pictures that I found especially helpful!

Other than that, this is a heavy topic. EVERYONE struggles when learning it. Even Michelle did when she was a student. Just keep on keepin on :)

Alexis,

 This is amazing!! I love how this organized. I also appreciate the simplicity of it. I This is so important because it is not just about getting the image it is also about understanding what we should see in the image and why. 

Great job!

I love love love this image!! The colors are incredibly helpful and I like how it shows the changes over the different developmental days.

Great job!

Hi Chrishawna,

Thank you for sharing that you record yourself going over lecture material! That's definitely one way of studying I've never thought of.

I, and the rest of the girls, I'm sure, would love to see your drawings!! Your notes and drawings are always so organized, clean, and helpful.

Love the diagram you shared, too!

Thanks,

Karen

I love this image! This is what I was talking about! Follow a section until you understand how everything comes together. Awesome.

Chrishawna,

Drawing it can really help! Remember to use different colors to help the structures pop out.

I found this video extremely helpful. Fun fact: it's super old but still useful.   https://www.youtube.com/watch?v=5DIUk9IXUaI

Sarah

Chrishawna,  This graphic is amazing. I love to draw things out too, it really prints in my brain. I have been struggling to findthe time to do though this quarter unfortunately. This image is really going to help me out though. What does the AS and CT stand for?

Hi Hailey,

I'm totally with you on having a hard time understanding embryology!

What do you think is the most daunting part about embryology for you? Do you struggle with the vocabulary or visualizing the developmental steps?

Well unfortunately my image won't post :( I have no idea why. Sorry ladies! But Brittany has so graciously volunteered to post it for me! Thanks Brit!

Here is the image that goes along with Lania's post! Her computer was having some technical difficulties :)

Howdy Lania,

Clinical helps a lot! I'd love to have a few 20 week moms in lab. There's nothing like hands on practice.

Sadly there really is no "correct" place to put the transducer on mom's body (in my experience). It's totally dependent on how baby is positioned.

This image only shows a cephalic presentation BUT baby can be in so many positions! So the transducer doesn't really have a home.

Sarah

Hi Allison!

That is confusing how some images label it LPA and some label it the ductus arteriosus. The only thing I can think of is perhaps they're in a certain plane where they only see one or the other? They both branch off of the main pulmonary artery close to each other.

Also, the ductus arteriosus can be seen entering the aorta in what is known as the "hockey stick sign".

Can you find any images of the "hockey stick sign" vs the "candy cane sign"? What different structures are seen?

Allison, I love that you brought this up! I have asked SO many different techs about this to try to understand better so here are my thoughts:

They're basically both correct. It's hard to explain without visually showing you, but basically, in this view there are structures we can't see because of how our probe is hitting these structures. We can see the RPA branch as it heads to the rt lobe of the lungs, but the LPA is actually shooting backwards, parallel to our sound beam (remember the heart lies slightly at an angle with the RV more anterior and the LV more posterior). I did my own labeling on this image so I hope it helps.

You can see the split between the RPA and LPA before the LPA dives and then we are see the ductus arteriosis (DA). It originates from the LPA and dumps into the descending Ao (DAo). 

Hopefully this didn't confuse you more!

Hi Monica,

I definitely agree that this is an overwhelming week, but I think it's normal to feel this way! Something that helped me with fetal circulation is first understanding normal adult heart anatomy and function. Once you have this down I think it's easier to go back and look at the different parts the fetal circulation bypasses.

What do you think would help you most with learning this material? Drawing, listening, watching videos, reading?

Hi Monica!

You are doing great, hang in there, I think we are all feeling like this is a lot of material but remember to be patient with yourself! You will get it. I found this short quiz really helpful in making sure I understood the basics of fetal heart anatomy and circulation, it might be helpful to you also! I also like viewing multiple videos of the same thing, because hearing it from different voices helps me remember it! 

https://www.registerednursern.com/fetal-circulation-quiz-maternity-nursing-nclex/

Hi Monica!

I completely agree with you! I think we're all feeling super overwhelmed right now, but the good thing about these boards is that we can bounce concepts and knowledge off of each other. Someone's weakness may be someone else's strong suit! I think the best thing we can do right now na try to scan the fetal heart as much as we can in order to lock these structures in. I know I'm personally a visual learner, textbooks do absolutely nothing for me lol so seeing it in clinicals and also I've found drawing each view out has helped me a little bit more lock it in as well. Maybe that can help you as well? :)

Hi Monica,

It seems we are all struggling, huh? I definitely feel the same. However, you are so great at creating study materials, I am not at all worried about how you will handle all this new info. Remember all the great slides you made for physics when it was overwhelming?? Not to mention all the flashcards you made, don't forget about those!

Do any of those anatomy apps you have help with teaching the structure of the heart? I haven't even had any time to check for any! 

You'll do excellent in this class.

Karen

Hi Candee!

I agree that the outflow tracts seem super tricky along with embryology! It helped me to memorize the order that we take these images in to understand where I need to be to obtain them. 

For example, we typically start our cardiac images at the four chamber heart. We know by sweeping more cephalic we should next hit the LVOT, from there sweeping more superiorly we will encounter the RVOT and finally we should see the 3 vessel view scanning up even further. So if we're scanning the heart and we suddenly go from the 4 chamber up to the RVOT we could assume that we might have swept too fast and should come down slightly inferior and see the LVOT in between those two views. Again this is assuming that the baby has a normal anatomy and that the outflow tracts do cross. 

One image that I always keep in the back of my mind for the LVOT view is a ballet slipper. I attached a picture down below so you can see exactly what I'm talking about, but if you see the ballet slipper you know you're in the correct view! Hopefully this helps!

Hi Candee,

It can definitely be hard to keep track of the blood flow path in the heart. I think it's beneficial to go back to the basics first and review the normal adult heart. I've attached an image here with arrows to show flow in an adult heart. 

I think it helps to remember that the adult heart basically works as two halves. The right side pumps blood to the lungs to get oxygen, and the left side pumps blood that returns from the lungs out to the rest of the body.  Once this becomes a bit clearer I think it's easier to then go back and add in the bypasses that the fetal heart uses. It helps me to remember that the fetus really wants that oxygenated blood fast so it doesn't want to take long routes and instead tries to get into the aorta asap!

Is there a specific part about fetal circulation that is challenging for you? Is it just difficult because the fetal heart has several different routes?

For LVOT, RVOT, and the 3 vessel view I would recommend looking at images to first learn the anatomy. Then use the heart model that is at school. It will really help!

Hi Karen!

fetal circulation is another beast we have to get down on top of embryology. It’s going to be rough but I think the stories we create are really going to help us remember. I found this video on fetal circulation, I always love watching this guys videos. He’s really good at explaining and drawing everything out. 

Hi Karen!

I love this image you shared. Embryology is a challenge for me too and I think it helps to see images of what we are starting with and where we want to end up.

What do you think is the most challenging part of embryology of the fetal heart for you?

Hi Hailey,

Thanks for the video! I will take any extra help I can, haha!

Hi Brittany,

To be honest I think it's really the extra terminology and remembering what becomes what... I feel what is partially overwhelming is all the information we have to digest and memorize this quarter. My brain can't keep up with the constant waves of new information!

All in all the "repetitiveness" that Dr Wilson is going for should help us start to fully absorb everything.. or at least recognize, which is a great start. Still, it is hard not to feel like we're almost drowning in this quarter's classes.

I'm glad we're such a great and supportive group.

Thanks ladies,

Karen

Karen, your image helped me A LOT. I was also having a hard time wrapping my head around embryology, but these definitely helped since they show the change and are simple! thank you!

Another great diagram for formation of the fetal heart: 

This time nice labelled!

Hi Molly!

Great videos, I actually watched these before class on Monday! They definitely help me visualize where I'm scanning on mom as well as what image I'm getting of the baby.

I struggle with determining the baby's lie as well. I did notice last week though that our biometry simulator lets you alter the fetal position! It may be helpful to practice getting all the measurements on one setting and then changing the position and ensuring you can still do it!

What do you think would help you with visualizing the position? Maybe using a doll? Drawing out the views for each position? 

It also may help to start with looking at a specific landmark each time. I know for me I first look at the spine and then try to orient myself!

Hi Molly,

I love these videos! It made a huge difference for my understanding of the fetal heart views. I'm also grappling with the concept of fetal lie. I was just talking to one of the CIs at my site about how there is my Rt/Lt, the screen's Rt/Lt, mom's Rt/Lt, and baby's Rt/Lt. And when you consider baby can be upside down and facing any which direction, it is definitely an art that I'm trying to master. I've been trying to watch the beginning of the scan when my CI does it and then determine fetal lie. Today I got one right! 

Keep up the good work!

Hey Molly,

I am with ya girl!! The heart is hard!!!! I think my first priority is trying to really nail down fetal lie and where the heart should be. I found this really interesting image that shows if you assess the fetal lie properly this is where the heart should be. If you close your fingers and extend your thumb the babies head signifies your knuckles, your palm side is the belly, back of your hand is the babies back. If you extend your thumb it should signify where the heart is. It looks interesting, not sure if it actually will help but its a start!

Great videos! 

Try to see if you can find one for RVOT in an axial view of the heart. For LVOT we like to see it in a long view, but for RVOT, we like to see the split of the pulmonary arteries in addition to where it leaves the RV. In order to see both, we have to be in an axial plane. 

Hi Molly! I definitely had some false confidence going into this week about fetal lie. It all makes sense in my head, but you're totally right that the baby moves around and makes it so much more difficult! I have gotten one thing drilled into my head these first two weeks in clinical though, and its to do a sweep before imaging anything! My CI tells me often "no, sweep through first" when she sees I'm jumping into that first image. I think doing that initial sweep is super helpful for determining fetal lie since we will go from possibly abdomen/chest area (wherever you put your probe down) and sweep around to find possible head or feet and then be able to sweep through the whole length of the body again to see which way baby is lying. I hope this little tip helps!

Hi Sarah!

A lot of us see embryology as a daunting task. What about embryology confuses you most? Is it just such a large topic that it's overwhelming?

Ello Sarah!

I'm totally sitting in the same boat as you!! I'm excited to go to class on Friday and practice with the Mommy phantom! Dr. Wilson mentioned that it's a great resource to use and help us lock in the technique. However, nothing is ever like real life... on a baby that moves around every other second! Lol 

All I know is that it's a huge struggle right now, but my saying is Just Youtube It 

With embryology, we should all draw it out together or do another clay project. It's a lot to digest, but we will push through!!!

Hi Sarah!

I also struggle with embryology, I found this animation done with play doh I believe, that I'm finding helpful, it might help you too!

Hey Zuly, 

 I am really struggling with the embryology too. I typically use videos to lock everything in and I have to find a good one. I am going to check out the series you posted to see if it helps. I also can empathize with obtaining the four chamber view struggle. It is not easy because the angle of insonation can pick up extra anatomy. Only tip I have so far is keep moving around. 

 Nailah 

Hi Zuly!

I can only imagine how hard it is to get these fetal views in real life. Have you been able to ask your CI what helps them? Or observe what transducer movements they do in order to get around shadows? It also may just be something that takes practice and eventually becomes muscle memory.

I remember when we all started scanning the liver and we were struggling to find landmarks like the left portal vein, and now look at us! We will get there with the fetal heart too it just takes time.

Hi Lauren!

Great visual. From my understanding, the RVOT and LVOT are basically just the pathways of the pulmonary artery leaving the right ventricle (RVOT) and the aorta leaving the left ventricle (LVOT).

It really helped me to remember the basic functions of the adult heart and to recall that the right side works as its own system pumping to the lungs, and the left side works as its own system pumping to the rest of the body! From there I think it's easier to then think about the different bypass routes that the fetal heart takes.

When scanning, are we able to see the 3 fetal shunts? If so what should they look like? (ductus venosus, ductus arteriosus, and foramen ovale)

Hi Lauren!

I love this visual! It definitely helps show the flow in an organized way. I was also having a hard time figuring out how the shunts played a role in the circulatory system. Along with this image, the diagram Paris made has also been super helpful with showing exactly how everything flows and what the different paths back to the placenta are. 

I liked this explanation from Stanford children's health too. It is super straight forward and goes through each step of circulation. 

 Blood Circulation in the Fetus and Newborn (stanfordchildrens.org)

-Molly

Hi Nailah!

Wow look at you already being able to list out embryological steps!! That's awesome and it definitely helps to list out what you know and what areas you need clarification on.

I also love this graphic. What resources are you finding most helpful for you? The textbook, our class lectures, Youtube?

These are really amazing images, great job.

Hey Nailah!

Great images and explanation! I'm going to need you to help me with the embryological cardiac development it looks like lol. But as I was studying today, I realized how important it is to understand the embryology aspect first in order to understand what could possibly have went wrong if we happen to sonographically find a heart defect in the fetus.

Wow Nailah thank you so much for sharing this outline and the images!

It's really helpful to have an outline of how the embryologic process goes, since it's so many steps and it seems so complicated! 

Hey Nailah! 

I’m definitely going to save this chart in my notes to draw it out this weekend!!!

thanks for sharing! It really helps break down the stages and development 

Hi Raman!

You and I both girly! I'm completely the same way so don't feel alone on that! I think we have to be kind to ourselves and realize that we are still in SCHOOL for a reason lol. We will get there but we have to be patient with our learning process. It can be hard when we're in such an accelerated program, but as long as we do our part and study as much as we can, IT WILL eventually make sense. I've been watching YouTube videos like crazy to help me lock everything in!

Hi Raman!

I'm sure it's quite an adjustment to go from reading about these heart views to actually scanning them. The biometric simulator at school is actually pretty helpful for getting used to scanning though! It shows the outflow tracts and you can change the fetal position to get used to looking at the heart in different views. I've attached some images that are labeled and will hopefully help too!

Does your CI have any tips or tricks that help them to recognize the outflow tracts? Maybe associating the views with other objects would be helpful, I think it was Chrishawna who found an image of a ballerina slipper that looks like the LVOT! 

Hey Raman!

I'm 100% with you. It's a lot to learn in such little time. We should continue to draw out the images of a fetal complete protocol and then list out what we should see. I find the the other discussion post this week, really helped me retain so much info about the 4 chambers. I hope that advice helps you out too.

I'm also finding it hard to image RVOT and LVOT as well. When I asked my CI for advice, he was telling me that it will all come with time and experience. Practice, practice, practice and it shall come to us in second nature. 

Let's keep pushing through this week! 

WE GOT THIS!

Hi Raman,

The fetal heart is so humbling! I've seen so many videos of OB scans and the sonographers make it look effortless. One thing I always say to myself when I feel that I am struggling is "look how far I've come". Six months ago we knew nothing and now we have tackled abdomen, are working through GYN, and doing everything we can to grasp OB. I think our mentality plays a huge role in our abilities, if we believe we can, then we can! It sounds like your doing great in clinicals, and the more you see it the easier it will get!

I totally understand that feeling, Raman. It's so frustrating too when you're scanning a patient and you can tell you're so close to the good image, and your CI comes behind and BARELY moves the transducer and its a beautiful image. I hope once we get the textbook of this down, the bits we get to scan in clinicals will lock it in for us instead of discourage us!

Hey Brit!

I actually and still trying to learn what works best for me when I need to study but I'm feeling stressed and overwhelmed, especially since it seems like I'm always feeling that way lol. But so far, like you taking small consistent breaks while I'm studying I've found helps me stay focused a bit more, however I've found it 10x harder to find the energy after clinicals to come home and study. So I'm trying to figure out the best routine for that as well.

Oooooo I see you moderator! 

When I start feeling overwhelmed I take a step back and list out my game plan. I typically take an outline or the objectives of the textbook and answer all of them out. 

What helps my frustration and relaxing my mind, so I could study the best is working out. But it's so hard to fit that into this schedule right now )-:

Great question Brittany!

It's definitely very difficult finding time and energy  to study now that we have clinic. I sometimes just try to remind myself to take things one week at a time, and honestly lately, just one day or even hour at a time! It's all so much but I try to just focus on one thing at a time, watch a YouTube video explaining what we're learning, drawing things out, making small outlines, and taking very short practice quizzes. Just one task at a time!

For me, I find it easiest if I plan out my week's studying ahead of time and pace myself so I know exactly what I need to do and what day I plan to work on it! I have also found that making super simple outlines of the chapters (basically just organizing the headers and subcategories) really helps me keep everything straight since it can get confusing where you're at in such dense chapters! I really appreciate our group always giving each other our study methods and sending links we find helpful, since if it helped one of us, it is bound to help someone else with similar learning styles.

Hi Brittany,

Mental health is so important and as students it is often put on the back burner. If I'm feeling stressed or overwhelmed there are a few things I always do:

1. Confide in my peers (who knows the struggle more than those experiencing it with you)

2. Walk it off- Literally and figuratively (might take Bentley on a walk or move onto another subject for a while)

3. Take some time for myself (This has been hard with everything going on but I might take 10 minutes to give myself a facial, paint my toes, or take a bubble bath)

Stress is unavoidable in life, its more about how we manage it!

You all have such good responses! I know it's easy to feel like you're drowning but it's important to take things one day at a time and break studying up into small sessions.

Chrishawna, I love what you said about self care!! It is incredibly important to take care of ourselves during this time. A lot of you mentioned just taking a small break or looking away from the topic for a while and that's a great method. We also need to remember to give ourselves the basics of care such as eating good food and trying to get a good amount of sleep. How can we expect our brains to absorb everything if we don't nourish it and allow it to rest!

Also, I had a chemistry professor tell me once that sleep is so so important when you're learning new things because it allows your neurons to make connections so you can process the new information and remember it! 

I know there aren't enough hours in the day but try to take a little time to care for yourselves!

Hello Brittany,

I always try my best to not get overwhelmed and to combat it I work on my inner dialogue. So for example, let's say I had a rough day at clinics, instead of beating myself up for it I reassure myself that it happens to all of us, even our CIs. Plus, comparing ourselves who are barely a month into training is very silly if you think about the fact that some of the techs have over 21 years experience. One tech that I know has been doing ultrasound for longer than I have been alive haha. I am  very lucky to have a nice support system and one thing that I have been doing is if something bad happens like I get a bad grade on the quiz (like this past Monday's) than I only talk about it once like to my boyfriend maybe and then move on. Also, breaking down everything per week, starting with the most important assignments first and knowing that realistically to actually learn you should not need to be studying all the time but rather need sleep and taking breaks is key. This may sound cheesy but you drown not by falling into a river but by staying submerged in it. So stay positive ladies. :)