As soon as data from the last menstrual period, the first accurate ultrasound examination, or both are obtained, the gestational age and the estimated due date EDD should be determined, discussed with the patient, and documented clearly in the medical record. Subsequent changes to the EDD should be reserved for rare circumstances, discussed with the patient, and documented clearly in the medical record. When determined from the methods outlined in this document for estimating the due date, gestational age at delivery represents the best obstetric estimate for the purpose of clinical care and should be recorded on the birth certificate.
For the purposes of research and surveillance, the best obstetric estimate, rather than estimates based on the last menstrual period alone, should be used as the measure for gestational age.
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The American College of Obstetricians and Gynecologists, the American Institute of Ultrasound in Medicine, and the Society for Maternal—Fetal Medicine make the following recommendations regarding the method for estimating gestational age and due date:. An accurately assigned EDD early in prenatal care is among the most important results of evaluation and history taking. This information is vital for timing of appropriate obstetric care; scheduling and interpretation of certain antepartum tests; determining the appropriateness of fetal growth; and designing interventions to prevent preterm births, postterm births, and related morbidities.
Appropriately performed obstetric ultrasonography has been shown to accurately determine fetal gestational age 1. A consistent and exacting approach to accurate dating is also a research and public health imperative because of the influence of dating on investigational protocols and vital statistics.
Can your pregnancy scan give the wrong due date?
This Committee Opinion outlines a standardized approach to estimate gestational age and the anticipated due date. However, there is great usefulness in having a single, uniform standard within and between institutions that have access to high-quality ultrasonography as most, if not all, U. Accordingly, in creating recommendations and the associated summary table, single-point cutoffs were chosen based on expert review.
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.
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. 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. American College of Obstetricians and Gynecologists.
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Women's Health Care Physicians. They resumed when DS 2 was 16 months I had no reason to think i was pregnant until I started feeling sick Anybody ever had an ultrasound for dating? I did not do ultrasounds with my last baby and don't want to with this one AFter a few more weeks he was right on with measurements.
Now at 31 weeks he's ahead a little. Good luck with your decision mama! My MW had me have an early ultrasound with my last baby even if I knew when my missed period was.
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That ultrasound was 5 days off. With my first at both my early ultrasounds the dates were within a day. This time around I had an early ultrasound at 8 weeks because I didn't even get my period back since my last baby. I seem to remember reading that 8 week ultrasound are most accurate, to within a day or two even if you know when your last period was, that doesn't guarantee an accurate due date since dates of ovulation can vary quite a bit.
The longer you wait the less accurate an ultrasound is for dates. At 20 weeks they can be off by at least a week. I had one at 7. I think I read that the earlier ultrasounds are more accurate for predicting due dates then the third thrimester ones based on size. But, the baby will come out either way - whether its December or January - if you aren't a planner it might be fun to wait and see.
Wrong due date from ultrasound scan - why it happens | MadeForMums
I have heard between weeks is the most accurate. Because I'm high risk history of 8 miscarriages and severe pelvic inflammatory disease I've had 6 ultrasounds. My first one, turns out I was 4w3d, we couldn't see anything. My second one was 5w4d, I had a sac but no fetal pole, it dated me earlier than I could have been. Number 3 through 6 have all dated the baby consistantly 7w through 12w5d. I'm done with ultrasounds now, I've just hit my second trimester!!!
It looks like by the last period date you gave, you are about 9 weeks. A dating ultrasound now should be fine, you should be far enough along to see a fetal pole, and maybe even a heartbeat even if you ovulated a week or 2 late. Thanks for responses - it sounds like ultrasounds are somewhat accurate within a week or so I am not the type to worry about what day