Ultrasound dating early pregnancy
Accordingly, in creating recommendations and the associated summary table, single-point cutoffs were chosen based on expert review.
Women's Health Care Physicians
Because this practice assumes a regular menstrual cycle of 28 days, with ovulation occurring on the 14th day after the beginning of the menstrual cycle, this practice does not account for inaccurate recall of the LMP, irregularities in cycle length, or variability in the timing of ovulation. It has been reported that approximately one half of women accurately recall their LMP 2—4.
Accurate determination of gestational age can positively affect pregnancy outcomes. For instance, one study found a reduction in the need for postterm inductions in a group of women randomized to receive routine first-trimester ultrasonography compared with women who received only second-trimester ultrasonography 5.
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A Cochrane review concluded that ultrasonography can reduce the need for postterm induction and lead to earlier detection of multiple gestations 6. Because decisions to change the EDD significantly affect pregnancy management, their implications should be discussed with patients and recorded in the medical record. Measurements of the CRL are more accurate the earlier in the first trimester that ultrasonography is performed 11, 15— The measurement used for dating should be the mean of three discrete CRL measurements when possible and should be obtained in a true midsagittal plane, with the genital tubercle and fetal spine longitudinally in view and the maximum length from cranium to caudal rump measured as a straight line 8, Mean sac diameter measurements are not recommended for estimating the due date.
Dating changes for smaller discrepancies are appropriate based on how early in the first trimester the ultrasound examination was performed and clinical assessment of the reliability of the LMP date Table 1. For instance, the EDD for a pregnancy that resulted from in vitro fertilization should be assigned using the age of the embryo and the date of transfer.
First Trimester / Dating Ultrasound | Advanced Women's Imaging
For example, for a day-5 embryo, the EDD would be days from the embryo replacement date. Likewise, the EDD for a day-3 embryo would be days from the embryo replacement date. Using a single ultrasound examination in the second trimester to assist in determining the gestational age enables simultaneous fetal anatomic evaluation.
With rare exception, if a first-trimester ultrasound examination was performed, especially one consistent with LMP dating, gestational age should not be adjusted based on a second-trimester ultrasound examination. Ultrasonography dating in the second trimester typically is based on regression formulas that incorporate variables such as. Other biometric variables, such as additional long bones and the transverse cerebellar diameter, also can play a role. Date changes for smaller discrepancies 10—14 days are appropriate based on how early in this second-trimester range the ultrasound examination was performed and on clinician assessment of LMP reliability.
Because of the risk of redating a small fetus that may be growth restricted, management decisions based on third-trimester ultrasonography alone are especially problematic; therefore, decisions need to be guided by careful consideration of the entire clinical picture and may require close surveillance, including repeat ultrasonography, to ensure appropriate interval growth.
The best available data support adjusting the EDD of a pregnancy if the first ultrasonography in the pregnancy is performed in the third trimester and suggests a discrepancy in gestational dating of more than 21 days. As soon as data from the LMP, the first accurate ultrasound examination, or both are obtained, the gestational age and the EDD should be determined, discussed with the patient, and documented clearly in the medical record.
For the purposes of research and surveillance, the best obstetric estimate, rather than estimates based on the LMP alone, should be used as the measure for gestational age. The American College of Obstetricians and Gynecologists, the American Institute of Ultrasound in Medicine, and the Society for Maternal—Fetal Medicine recognize the advantages of a single dating paradigm being used within and between institutions that provide obstetric care.
Table 1 provides guidelines for estimating the due date based on ultrasonography and the LMP in pregnancy, and provides single-point cutoffs and ranges based on available evidence and expert opinion.
No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Methods for estimating the due date.
If the scan is after 10 weeks, ultrasound recordings are usually made through your abdomen. The sonographer will put gel on your abdomen and move a hand-held device called a transducer, back and forward over your skin. In some situations, such as when the scan is completed before 10 weeks of gestation or you are overweight, you may also need a vaginal scan. Your sonographer will let you know if this is needed. For an abdominal dating ultrasound, you will need to have a full bladder.
You may be asked to drink some water and not go to the toilet beforehand because a full bladder helps to push your womb up to give a better picture. For a vaginal scan, you can have an empty bladder. This will provide a fairly accurate estimate of how many weeks pregnant you are.
But it is important to remember that only a few women go into labour on their due date, so it can be more helpful to think about the month in which you are expecting your baby, rather than the exact day.
When is a dating scan necessary?
Information on pregnancy ultrasound scans including when they are taken, what it can be used for, dating scans, anomaly scans, plus links to trusted resources. This Dads Guide to Pregnancy article covers early pregnancy scans and screening, plus normal fetal development and early miscarriage for men, by men.
In the second trimester of pregnancy, you may be offered to have an morphology scan anomaly scan. Learn about what it looks for and when it is performed. A nuchal translucency scan is part of the ultrasound scan that may give an indication of chromosomal abnormality. Learn more about how and when it is performed. During your pregnancy, you will be offered a number of tests and scans. The aim is always to check on the health of you and your baby, but it can sometimes be overwhelming and confusing.
Handy infographic that shows what you can expect at each antenatal appointment during your pregnancy. Measurements at such an early stage aren't accurate which is why they wait for 12 weeks to date you. Expert Jan Steward, who is director of Ultrasound Direct and Babybond, agrees that early scans carry a much greater risk of inaccuracy. We always recommend mums get a definitive dating scan closer to 12 weeks as this will be much more accurate. Just half a millimetre at such an early stage can change your date by a week. Your week scan will be far more accurate. The sonographer then said that I was only about 4.
Then at the week scan I got an EDD of 15 march, so that early scan was completely out.
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Well, you'd think so, wouldn't you. At around 12 weeks you can get more accurate measurements. By talking to the health care professionals you should get a clearer picture as to what is happening. Thanks so much for your post — we always welcome feedback, positive or negative, as we always aim to make our articles as accurate and as helpful as possible.
We spent a lot of time talking to sonographers before writing this article, so we're surprised that you think what they're saying is not in line with what you have studied.
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We'd be really keen to know more about your studies — and what you have learned. You're right that we did include 'anecdotal stories' in our article. We used them to illustrate the key points we were making in the articles but the quotes we used were all centred on the real experiences of pregnant women posting in our forum. We are confident that we are not using these quotes to 'misinform women', as the key points in our article were all sourced from expert monographers.
It's interesting that you say that ultrasounds between 8 and 10 weeks are the most accurate. In the UK, most pregnant women don't have an ultrasound until they are at least 12 weeks pregnant.