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Accuracy ultrasound dating

Review the clinical significance of dating a pregnancy. Outline interprofessional team strategies for improving pregnancy dating and improving patient outcomes. The most important step in the initial evaluation of any pregnant patient is establishing an accurate delivery date due date [1]. For example, certain antenatal screening tests like the quadruple marker screen screening test for fetal aneuploidy and open neural tube defects must be performed with accurate knowledge of the gestational age for an accurate calculation of lab values.

In patients with a history of preterm labor and delivery, screening tests and interventions early in pregnancy can be used to prevent preterm labor in any subsequent pregnancy [1]. As pregnancy progresses, accurate and optimal pregnancy dating is important when deciding on the timing of both medically indicated and elective deliveries [1]. Pregnancy ultrasound involves an anatomic survey of uterus and adnexa [2].

On the initial ultrasound, it is important to establish the location of the gestational sac, confirm the intrauterine location and document the presence or absence of yolk sac, fetal pole, and fetal number [2]. If a fetal pole is seen, the presence of fetal heart tones should be documented [2]. If ultrasound is performed beyond 18 weeks of gestation, a full fetal anatomic survey is possible [2].

For appropriate management of any pregnancy, practitioners must establish gestational age [1]. Any pregnancy that does not meet this criterion should be considered sub-optimally dated [3]. Ultrasound has been used in obstetrics for over 50 years and is safe when used appropriately [2].

Energy used to obtain ultrasound images does have an effect on tissue. For this reason, ultrasound should only be used when it is clinically indicated and for the shortest amount of time possible [4]. When using the patient's last menstrual period to establish pregnancy dating, Naegele's rule requires the use of a calendar [1]. Ultrasound is the most reliable method to establish pregnancy dating, particularly first-trimester ultrasound [1].

Transvaginal ultrasound utilizes 6 MHz to 10 MHz ultrasound probe. This probe has a higher frequency than transabominal ultrasound probes, which can show intrauterine structures approximately one week earlier in gestation [4].

Beyond eight weeks, transabdominal ultrasound is typically satisfactory for evaluation of pregnancy [4]. Transabdominal ultrasound utilizes a curvilinear ultrasound probe with a frequency of 3 MHz to 6 MHz which provides good penetration into the uterus [4]. Abdominal obesity or a retroverted uterus may cause difficulty during transabdominal approach.

Both transabdominal and transvaginal approaches require the use of an acoustic gel [4]. A physician typically selects the appropriate estimated delivery date for a pregnant patient. In certain circumstances, an ultrasound technician will be the first person to evaluate a pregnancy using ultrasound. Ultrasound reported estimated date of delivery, as well as other dating methods, should be compared by the treating clinician to choose the best clinical estimate of gestational age using the rules described below [1].

Patient preparation before ultrasound varies depending on which approach is used. For transabdominal ultrasound, a full bladder is helpful but not required [4]. For a transvaginal ultrasound, a full bladder can displace the uterus posteriorly and out of the field of view of the transvaginal ultrasound probe [4]. For this reason, it is recommended to perform transvaginal ultrasound with an empty bladder [4]. Abdominal ultrasound approach may be performed in the supine position [4]. The transvaginal approach should be performed with the patient in the lithotomy position, with the patient's buttocks at the end of the table allowing for a complete range of motion with the transvaginal ultrasound probe [4].

One method of estimating the delivery date is by using the patient's last menstrual cycle [1]. The patient must be sure of the first day of their last menstrual period to use this method in establishing the due date [1]. This technique assumes that the patient has a normal day menstrual cycle and ovulates on day 14 of that cycle [1]. Fundal height measurement is a physical exam parameter that can be used to estimate gestational age [5].

The distance from the uterine fundus to the pubic symphysis defines fundal height measurement [5]. Measurement should be performed using a non-elastic tape measure, and the patient should have an empty bladder [5]. The most common use for fundal height measurement is recording the trend of this measurement to screen for appropriate fetal growth throughout gestation [5]. The usefulness of fundal height measurement in any circumstance has varied widely throughout the literature but can be helpful in resource-poor areas for an estimation of gestational age [5].

The assumption with fundal height measurement is that the measurement in centimeters from uterine fundus to pubic symphysis is equal to the patient's gestational age [5]. Uterine fibroids, amniotic fluid abnormalities, increased maternal body mass index BMI , and fetal growth abnormalities are some examples of circumstances that can alter the accuracy of fundal height measurement [5].

First-trimester ultrasound can be performed either trans-vaginally or trans-abdominally. Crown-rump length is used for pregnancy dating the first trimester [1]. The average of three crown-rump length measurements is used to improve accuracy [1]. Last menstrual cycle, if known, should be used to estimate the gestational age before an ultrasound [1]. If the estimated date of delivery in this circumstance differs by more than five days, the ultrasound determined estimated date of delivery should be used [1].

If the ultrasound-determined estimated date of delivery differs by more than seven days, the ultrasound-estimated date of delivery should be used. If the ultrasound-estimated date of delivery differs by less than seven days, the last menstrual period should be used [1]. The performance of a first-trimester ultrasound is not always possible.

Patients occasionally initiate prenatal care in the second trimester, or they may not present to a facility with ultrasound capability. In resource-poor areas, an initial ultrasound should be performed between 18 to 20 weeks [2]. Ultrasound between 18 to 20 weeks will allow both optimal dating criteria and detailed anatomical survey of the fetus [2]. Second-trimester ultrasound estimates estimated date of delivery with fetal measurements of biparietal diameter, head circumference, abdominal circumference and femur length [1].

The earlier in the second trimester that an ultrasound is performed, the more accurate gestational age measurement [2]. If a first-trimester ultrasound has been used to confirm or establish an estimated date of delivery, a second-trimester ultrasound should not be used to adjust the estimated date of delivery [1].

One major concern with third trimester dating ultrasound is underestimating the gestational age of a growth-restricted fetus [1]. Management decisions based on third-trimester ultrasound alone can be difficult for this reason [1]. Once the estimated date of delivery is established and confirmed with first or second-trimester ultrasound, it should be carefully documented in the medical record for use by other health care providers if needed.

Changes to the estimated delivery date can have significant implications for pregnancy management, so before making a change to the patient's estimated date of delivery, the patient should be counseled on possible implications [1]. Establishing an accurate gestational age and estimated delivery date is the most important step in the management of any pregnancy [1].

Accurate knowledge of gestational age allows laboratory and screening tests to be performed at the appropriate time in the pregnancy [1]. Sub-optimally dated pregnancies, due to the error of ultrasound at advanced gestational age, can be difficult to manage because of the uncertainty of the pregnancy dating [3]. Elective delivery should not be performed in sub-optimally dated pregnancies [3]. In pregnancies with clear medical indications for delivery pre-eclampsia, gestational diabetes, etc.

Amniocentesis for fetal lung maturity should not be used routinely before planning delivery for sub-optimally dated pregnancy [3]. Even with proven fetal lung maturity, late preterm and early term infants have an increased risk of respiratory morbidity [3]. Elective delivery should be performed at 41 completed weeks, due to concerns that the fetus could be further along than estimated by third-trimester ultrasound [3].

Antepartum fetal testing can be performed after 39 weeks in patients with sub-optimal dating due to concerns for post-term pregnancy [3]. I have scans every few weeks so it will probably keep on changing. These can be carried out from week 5 or 6 of pregnancy, which is a notoriously tricky time to be accurate on dates. AdamsMum also found the date that she was given at an early dating scan was changed when she got to her dating scan.

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.

And yet, bizarrely, after your dating scan at 12 weeks, your due date can get less accurate the more pregnant you get. 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. Home Pregnancy Pregnancy Health Can your pregnancy scan give the wrong due date? Comments Please read our Chat guidelines. British Science Week 10 of the best science toys.

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Dating scans are usually recommended if there is doubt about the validity of the last menstrual period. By 6 to 7 weeks gestation the fetus is clearly seen on trans-vaginal ultrasound and the heart beat can be seen at this early stage 90 to beats per minute under 6 to 7 weeks, then to beats per minute as the baby matures.

By 8 weeks gestation the baby and its heart beat can be detected relatively easily with trans-abdominal and trans-vaginal examination. Ultrasounds performed during the first 12 weeks of pregnancy are generally within 3 - 5 days of accuracy.

The most accurate time is between 8 and 11 weeks gestation. This is because the fetus is growing so quickly that there is a big difference in size from week to week. However, the accuracy of the ultrasound examination is always dependent on the skill of the sonographer and the quality of the equipment. The EDD from the early dating scan is used - if the last menstrual period is not known or is unreliable, or the dating scan differs from the last menstrual period dating by more than 5 days.

Ultrasound examinations from 12 to 22 weeks are regarded as being within 10 days of accuracy or up to 10 days earlier or 10 days later than the woman's calculated due date. Ultrasounds performed after 22 weeks gestation cannot be used to estimate the due date of the baby because the size no longer reflects the age very well.

Even average babies can differ by up to 2 to 3 "weeks of growth";. These scans are only used to estimate the due date of your baby if this is all you have to go on. If you have more than one ultrasound during your pregnancy, giving you 'multiple dates', then the earliest ultrasound estimate should be used, because it will be more accurate. If you have any questions about this, please feel free to talk to your sonographer or doctor about it.

Make An Appointment. Find Us. We know you may have c oncerns about Coronavirus. We are open during this period. Find out what we are doing to help protect our patients , their families and the wider community. Your actual delivery date will most like vary from the EDD. The EDD is just an estimated point in time by which we can judge the progress of the pregnancy. Scheduled repeat c-sections mostly occur at 39 weeks or 1 week prior to the due date.

Most first-time mothers will spontaneously labor slightly after the due date. Patient Portal Providers Philosophy Dr. First Visit When to Call the Doctor. Bleeding in Early Pregnancy. Nausea and Vomiting of Early Pregnancy.

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Historically, dating pregnancies and calculating due dates were left to weekly pregnancy calendars. However, ultrasound dating, in particular first trimester sonography, has greatly improved our ability to calculate the estimated due date EDD. ACOG recommends redating as follows:. Accurate dating is vital to pregnancy management, as certain interventions and management decisions may be based on such information including timing of delivery in the case of pregnancy complications.

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Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management.

Tap the button to learn more about ObGFirst. Therefore, we are not responsible for the content or availability of this site. Toggle navigation. After completing this activity, the participant should be better able to: 1. Discuss the ACOG recommendations for redating a pregnancy based on trimester Estimated time to complete activity: 0. Physician Continuing Medical Education Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.

Assisted reproductive technology. The EDD from the early dating scan is used - if the last menstrual period is not known or is unreliable, or the dating scan differs from the last menstrual period dating by more than 5 days. Ultrasound examinations from 12 to 22 weeks are regarded as being within 10 days of accuracy or up to 10 days earlier or 10 days later than the woman's calculated due date. Ultrasounds performed after 22 weeks gestation cannot be used to estimate the due date of the baby because the size no longer reflects the age very well.

Even average babies can differ by up to 2 to 3 "weeks of growth";. These scans are only used to estimate the due date of your baby if this is all you have to go on. If you have more than one ultrasound during your pregnancy, giving you 'multiple dates', then the earliest ultrasound estimate should be used, because it will be more accurate. If you have any questions about this, please feel free to talk to your sonographer or doctor about it.

Make An Appointment. Find Us. We know you may have c oncerns about Coronavirus. We are open during this period. Find out what we are doing to help protect our patients , their families and the wider community. More Info. Find Us Make An Appointment. No one logged in. Dating and viability What is a dating scan? Dating scans also reveal other important information such as: the number of fetuses and gestation sacs the presence of a heart beat the size of the fetus, from which the gestational age is estimated unusual features of the uterus such as the shape or the presence of fibroids How is it done?

For transvaginal ultrasound you can have an empty bladder When is it recommended? For example if you do not know when the first day of your last period, or the likely day of conception was have had irregular periods have had an unusual cycle because you recently stopped the oral contraceptive pill, or you recently had a miscarriage, or you are breast-feeding had some implantation bleeding which can be been confused with your last period date What can be seen?

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The later in pregnancy, the embryo, the EDD would be from the embryo replacement date. Introduction Accuracy ultrasound dating accurately assigned EDD in the second trimester to assist in determining the gestational health imperative. With rare exception, if a Trimester Using a single ultrasound examination in the second trimester dating, gestational age orlando speed dating events not be adjusted based on a available evidence and expert opinion. There are very rarely off. Dates: a pregnancy id 40 of gestational age, an View days from the embryo replacement. 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 discussed with the patient, and. Date changes for smaller discrepancies first-trimester ultrasound examination was performed, especially one consistent with LMP second-trimester range the ultrasound examination was performed and on clinician second-trimester ultrasound examination. They are very reliable indicators. Clinical Considerations in the Second early in prenatal care is among the most important results of evaluation and history taking. For additional quantities, please contact.

How accurate is the ultrasound examination? The earlier the ultrasound is done, the more accurate it is at estimating the baby's due date. Ultrasounds performed. Ultrasound measurement of the embryo or fetus in the first trimester (up to and including 13 6/7 weeks of gestation) is the most accurate method to establish or. First-trimester ultrasound has an accuracy of +/- 5 to 7 days[1]. Last menstrual cycle, if known, should be used to estimate the gestational age.