Your Doctor Saw Something on Your Ultrasound and What They’re Not Telling You.

The Evidence Room: When ACOG rejected important research, they sent a clear message: Maintaining the mystique of medical knowledge is more important than ensuring patients understand their care.

Several years ago, I performed a routine 20-week anatomy scan. Everything looked perfect—four chambers of the heart pumping beautifully, kidneys filtering, brain structures developing right on schedule. But there was one finding: an echogenic intracardiac focus. A tiny bright spot in the baby’s heart.

I know exactly what this means. It’s a normal variant, seen in about 5% of pregnancies, almost always meaningless. The baby is fine. But here’s what happened next: I handed my patient a two-page “patient education sheet” from ACOG—the American College of Obstetricians and Gynecologists, the most prestigious organization in my field—that was supposed to explain this finding.

She took it home. She Googled at 2am. She called my office in tears the next morning.

Why? Because the pamphlet might as well have been written in ancient Greek. Packed with terms like “aneuploidy screening,” “soft markers,” and “chromosomal abnormalities,” it was designed to inform but succeeded only in terrifying. And I knew this would happen because I literally published research proving it.

The Research ACOG Didn’t Want You to See

A few years ago, my team analyzed ACOG’s patient education materials—the pamphlets doctors hand out in millions of exam rooms across America. We ran them through standard readability assessments. The results were damning: the average reading level required to understand these materials was 11th to 12th grade.

The problem? The average American reads at a 7th to 8th grade level. Half the U.S. adult population cannot read at an 8th grade level. We were handing patients documents they literally could not comprehend, then wondering why they seemed “non-compliant” or “anxious.”

We submitted our findings to Obstetrics & Gynecology—ACOG’s own journal, known as “The Green Journal,” the most influential publication in our field. Their response?

Rejected. “Low importance.”

Let me be clear about the irony here: We proved that ACOG’s own patient education materials were failing patients, and ACOG’s journal rejected the research as unimportant. The organization whose mission is “ensuring the highest standards of clinical practice and continuing education of its members” decided that evidence of their educational failure wasn’t worth publishing.

We eventually got it published elsewhere in the Journal of Perinatal Medicine. But the message was sent: Health literacy isn’t a priority. Despite all the talking.

The Ultrasound That Shows Everything—And Explains Nothing

This matters more than you might think. We live in an age of miraculous medical imaging. Modern ultrasound technology can detect a 2mm abnormality at 18 weeks. We can see blood flow through a fetus’s brain, count fingers and toes, measure the angle of the nasal bone. We’ve spent billions perfecting these machines.

But we can’t be bothered to explain what they show in language people can understand.

The result? Patients stare at their ultrasound images—those grainy, abstract pictures that look like weather radar—while I point and explain using words like “nuchal translucency” and “choroid plexus cysts.” Then I hand them a pamphlet written at a college reading level and expect them to make informed decisions about their pregnancy.

Is it any wonder that patients leave my office, immediately open Google, and descend into a panic spiral of misinformation? We’ve created a perfect storm: complex technology, incomprehensible explanations, and an internet full of worst-case scenarios.

What Your Ultrasound Actually Shows (And What It Doesn’t)

Here’s what that echogenic intracardiac focus actually means: It’s a tiny calcium deposit in the heart muscle. It appears as a bright white spot on ultrasound. It’s seen in about 1 in 20 babies. In the vast majority of cases—we’re talking 95%+—it means absolutely nothing. The baby is born healthy, the spot disappears, life goes on.

But here’s what the ACOG pamphlet leads patients to believe: It’s a “soft marker” for chromosomal abnormalities. It increases risk for Down syndrome. Further testing may be recommended.

All technically true. But without context, without plain language, without percentages a normal person can understand, this information is worse than useless—it’s harmful.

And this isn’t unique to echogenic foci. It happens with every finding we see: “Two-vessel cord.” “Marginal cord insertion.” “Low-lying placenta.” Each one sends patients to Google. Each one generates anxiety that could be prevented with clear communication.

The Gatekeeping Has to Stop

The medical establishment’s refusal to prioritize health literacy isn’t just bad practice—it’s arrogant gatekeeping. We’ve convinced ourselves that complexity equals expertise, that dumbing things down would somehow diminish our authority. We’re wrong.

The real expertise is explaining a complex finding so clearly that a patient with a high school education can understand their options and make informed decisions. The real authority comes from being trusted, not feared.

When ACOG rejected our research, they sent a clear message: Maintaining the mystique of medical knowledge is more important than ensuring patients understand their care. Publishing the 47th paper on a rare complication that affects 0.001% of pregnancies is “high importance.” Publishing evidence that millions of patients can’t read our pamphlets is not.

This is why I started Obstetric Intelligence. If academic medicine won’t prioritize making obstetric care accessible and understandable, I’ll do it directly. No medical jargon. No 12th-grade reading level. Just straight talk about pregnancy and women’s health. What findings mean, and what you actually need to worry about (hint: it’s a much shorter list than you think).

Your ultrasound shows a story about your pregnancy. You deserve to understand every chapter.