ACOG changes pregnancy dating recommendations

[Brie]

Link: huff.to/1riRhYc

I'm mobile and can't C&P but it looks like they are pushing to make first tri dating ultrasounds standard. Thoughts?

[Brie]

I'm also in favor of this. There are some people on my FB saying they're unnecessary but the thing is, hindsight is 20/20 and I think it's better to have as much empirical data as possible. I know people with various health issues where every day in utero mattered, and I'd hate to be taking my best guess at an EDD in that position.

Would be interested to see what @wandering thinks!

[Deleted]

Dating from the first day of a period seems crazy to me- so few people actually ovulate on the 14th day...

[jr009j]

I have mixed feelings on this. I loved having early ultrasounds but they were also expensive because we hadn't met our deductible yet. I'm not sure the benefit warranted the price.

Also, I read your title and was confused why anyone was making recommendations as to pregnant women's dating life.

[ilikedonuts]

My doctor pretty much always orders an early dating u/s anyways for all his patients.

I have a bunch anyways in first tri because of multiple losses.

[Deleted]

Never happen in Canada. Cost, access... never happen.

[speckledfrog]

I also think it's a good idea.

[curbsideprophet]

I am not a fan. I think it is overkill for every pregnancy. I think we already perform an excessive amount of ultrasounds. It seems fairly common to end up with three or four for a routine, low risk pregnancy. I am not convince outcomes are improved with increased scans, but I have not really looked to see if there is any research in it.

I do think doctors should start listening to their patients. If you are charting and know you ovulated early or late, that should be factored in instead of just using LMP. As a patient I should not have to fudge my dates.

While u/s is considered safe and a valuable tool the medical community admits we do not know all the impacts of repeated scans. We used to think X-rays were okay in pregnancy and then we realized that was not true. I certainly believe repeated u/s in early pregnancy could have more of an impact than we realize. I think it is a great tool to have if there are potential concerns or you are unsure of your dates. However I do not think every patient needs a dating u/s.

I am also not a fan of elective scans just to find out the gender. I think it is a medical tool and should be treated as such.

[stealthmom]

Thumbs up. If I hadn't had an early us to date my second pg. The IUGR may have gone completely undetected. Plus I like the accuracy to have it later in the pg. Bc as it is now a woman who is considered 40 weeks may be induced but she may only be 38 weeks. That kind of thing.

As far as cost goes my dating us was done in my ob's office and there was no cost *to me* bc all my ob appts were covered 100%. I can see how going to a proper sonographer would cost more.

[MrsAggie]

I've found early dating to be the most accurate. Anytime an OB changed a mom's date later in pregnancy, I found baby to assess out at the gestation that correlates with the first dates. I also agree with PP's comment about being able to identify IUGR. I know entirely too much about what can go wrong so I'm very pro-ultrasound.

[rbp]

Sept 22, 2014 22:17:05 GMT -5 @idaholakelady said:

Dating from the first day of a period seems crazy to me- so few people actually ovulate on the 14th day...

Yeah, but if it's within a week of the true gestational age, then no harm, no foul. If someone is induced at "39 weeks" when she's really only 38 weeks, that's not going to be terrible for the baby.

Problem is that apparently 40% of due dates based on LMP are off by a week or more.

[greycat]

My OB did ultrasounds at 12 weeks (my due date stayed the same) and 20 weeks. I had an extra one because of bleeding at 11 weeks.

The article mentions using ultrasounds before 14 weeks for dating. I'm not sure how this would have changed anything for me.

[bowies]

I thought this was a thread about something entirely different. Now I'm disappointed that there isn't a rule book on where pregnant ladies can go with their special friends.

[kershnic]

I think it makes sense. But then I had eleventy billion ultrasounds. But I also particularly like the recommendation to date ivf pregnancies based on ivf. It drove me nuts when they wanted to use lmp or a dating ultrasound. We know when conception occurred, no need to guess.

[imimahoney]

My ob used to do a 7ish week u/s for dating purposes. But last year they changed and no longer do that u/s unless health issues arise. To my surprise I found out that I was having twins at my 12 week NT scan. Unfortunately one of the twins did not survive but seriously, that would have been nicer to know earlier on.

I'm all for early u/s.

[irishbride2]

If they want one before 14 weeks, then they don't need to ADD a dating U/S. The NT scan one can count. I realize not everyone does an NT scan, but they make it sound like they are recommending a specific dating u/s....

[Deleted]

Sept 22, 2014 23:52:57 GMT -5 curbsideprophet said:

I do think doctors should start listening to their patients. If you are charting and know you ovulated early or late, that should be factored in instead of just using LMP. As a patient I should not have to fudge my dates.

In my (limited) experience, doctors do listen to their patients and take last menstrual period in to consideration and it usually matches up with the US if a patient actually knows their LMP. Most of the time we get "I think it was sometime in May" or something along those lines.  I have had exactly zero patients know when they've ovulated, honestly I'm sure that the majority of the patients I work with don't understand how the menstrual cycle works to completely understand ovulation. Medical literacy in general in this country is at about the 5th grade level. 

I'm not sure I have a major opinion about this at the moment due to the patient population that I've worked with, so it kind of colors my views. 99% of the time we order an US at 12 and 20 weeks, so this doesn't really change the way I'd practice because I'll probably always work with an urban or rural and young population . Most of the patients I've worked with are young and we can't reliably go by LMP, so the US is pretty crucial. If you are going to use an US for dating then it's more accurate earlier, so it'd defeat the purpose to only use the 20 week US. 50% of pregnancies are unplanned, and even of the ones that are planned, women aren't charting like I see is more common on this board. 

I do recognize it's not always necessary in every case, but in the vast majority of the patients I work with we will go by an US due to unknown LMP. 

[water*drop]

I like this. My practice doesn't do dating u/s and will not let you go a day over 41 weeks. They offer an NT scan, but if you don't do that, it's just the 20-week u/s. I have long cycles, and I charted and therefore knew when I ovulated, yet they still dated my pregnancy by my LMP. I didn't know enough to lie about my LMP with DD and was super stressed out about my induction date being scheduled based on my LMP and not my date of ovulation. DD came right before my induction was scheduled, so it was all fine, but still. I know my office says they don't need to do the dating u/s because due dates can be off by up to 7 days without changing the date, but I think that guideline sucks when you don't do a dating u/s to confirm the due date and then induce no later than 7 days after the due date that you didn't confirm with a dating u/s, even with patients who are documented to have 40+ day cycles.

I shouldn't have to lie to my doctor (or to the lady answering the phone and scheduling the appointments because she's the gatekeeper who tells me that I absolutely cannot schedule my first appointment even a day earlier than 10 weeks by LMP, even if I know that's not the right date). Ever.

[rbp]

Sept 23, 2014 5:24:52 GMT -5 @wandering said:

Sept 22, 2014 23:52:57 GMT -5 curbsideprophet said:

I do think doctors should start listening to their patients. If you are charting and know you ovulated early or late, that should be factored in instead of just using LMP. As a patient I should not have to fudge my dates.

In my (limited) experience, doctors do listen to their patients and take last menstrual period in to consideration and it usually matches up with the US if a patient actually knows their LMP. Most of the time we get "I think it was sometime in May" or something along those lines.  I have had exactly zero patients know when they've ovulated, honestly I'm sure that the majority of the patients I work with understand how the menstrual cycle works to completely understand ovulation. Medical literacy in general in this country is at about the 5th grade level. 

This is always so shocking to me. Apparently patients also can't tell their doctors what meds they take??

When I went to my first OB appointment after my BFP, the nurse asked me ail lion questions. One of them was "how long ago did you get a positive pregnancy test?" I said "I got it on November 25" because I remembered the date but didn't bother to count how long ago that had been. She looked at me like because apparently people usually say "like a month ago"?

[Deleted]

Sept 23, 2014 6:24:36 GMT -5 rbp said:

Sept 23, 2014 5:24:52 GMT -5 @wandering said:

In my (limited) experience, doctors do listen to their patients and take last menstrual period in to consideration and it usually matches up with the US if a patient actually knows their LMP. Most of the time we get "I think it was sometime in May" or something along those lines.  I have had exactly zero patients know when they've ovulated, honestly I'm sure that the majority of the patients I work with understand how the menstrual cycle works to completely understand ovulation. Medical literacy in general in this country is at about the 5th grade level. 

This is always so shocking to me. Apparently patients also can't tell their doctors what meds they take??

When I went to my first OB appointment after my BFP, the nurse asked me ail lion questions. One of them was "how long ago did you get a positive pregnancy test?" I said "I got it on November 25" because I remembered the date but didn't bother to count how long ago that had been. She looked at me like because apparently people usually say "like a month ago"?

Ha, yeah forget about a patient knowing their meds. Sometimes elderly will bring all their bottles to the ER, but that's rare.

It was the worse as a 3rd year when I wasn't familiar with brand names trying to decipher what med a patient was on because they wouldn't pronounce it correctly and I had no experience to figure out what the hell they were trying to describe.

Just like most things, this board seems to represent about .1% of the general population

[AmyRI]

I totally see why it's not necessary for the majority of people. However, I do think it has some uses - by doing a dating ultrasound, you can get the most accurate estimate of due date. To me, this means I won't have to consent to any 3rd tri ultrasounds until I'm at the very least past my due date (ideally past 41w). I can comfortably decline bullshit size and due date estimates that are horribly inaccurate that late in pregnancy. I can better discuss the pros and cons of early induction. Basically, knowing a due date better would help me make better care decisions at the end of my pregnancy.

Also, it's the one ultrasound I'd totally elect to do again (and did have them during both of my pregnancies). It gave me peace of mind to see a heartbeat and know that things progressed normally.

Standard for my care providers was dating (7-8w), NT (11-12w), and anatomy (18-20w), although I had a partial previa the first time and went for 1 follow up to the anatomy scan, and they screwed up scheduling of the NT scan and I did it twice since the first scan was too early during my second pregnancy, so I had 4 each time.

[karinothing]

Sept 23, 2014 5:24:52 GMT -5 @wandering said:

Sept 22, 2014 23:52:57 GMT -5 curbsideprophet said:

I do think doctors should start listening to their patients. If you are charting and know you ovulated early or late, that should be factored in instead of just using LMP. As a patient I should not have to fudge my dates.

In my (limited) experience, doctors do listen to their patients and take last menstrual period in to consideration and it usually matches up with the US if a patient actually knows their LMP. Most of the time we get "I think it was sometime in May" or something along those lines.  I have had exactly zero patients know when they've ovulated, honestly I'm sure that the majority of the patients I work with understand how the menstrual cycle works to completely understand ovulation. Medical literacy in general in this country is at about the 5th grade level. 

I'm not sure I have a major opinion about this at the moment due to the patient population that I've worked with, so it kind of colors my views. 99% of the time we order an US at 12 and 20 weeks, so this doesn't really change the way I'd practice because I'll probably always work with an urban or rural and young population . Most of the patients I've worked with are young and we can't reliably go by LMP, so the US is pretty crucial. If you are going to use an US for dating then it's more accurate earlier, so it'd defeat the purpose to only use the 20 week US. 50% of pregnancies are unplanned, and even of the ones that are planned, women aren't charting like I see is more common on this board. 

I do recognize it's not always necessary in every case, but in the vast majority of the patients I work with we will go by an US due to unknown LMP. 

In my experience, doctors don't really listen when it comes to a woman that has been charting. Even my midwives (who are like super pro women and super pro taking charge of your fertility and your healthcare) had to go by LMP. I am not sure that not listening is the right word, I think the standard of care was/is just to go by LMP so they go by that even if you have a chart.

I am not sure how I feel about early ultrasounds being mandated. I am not really sure the financial cost is worth the health benefit for the majority of women. I feel like this could be beneficial for some women, like perhaps doctors could ask "when was your LMP, who long are your cycles, etc." If the woman is unsure or answers something like "my cycles are 60 days" a dating ultrasound would certainly be necessary. If she answers my cycles are always 28 days and my last period was on this specific date, it seems less necessary.

[undecidedowl]

Sept 23, 2014 6:44:32 GMT -5 minniemouse said:

I think this is a fantastic idea. With dd1, I had bleeding that I thought was my period (it was implantation bleeding). I tested the next month and got a super dark bfp (should have been a clue lol). I ended up having more bleeding at what I thought was 7 weeks, so my OB sent me for an u/s. Imagine my surprise finding out I was 10.5 weeks!! If I had waited for my 12 week scan, I would have actually been 15 weeks. It would have been too late for the NT.
And I am educated about my cycle, had read TCOYF.

I had the same thing happen, only I didn't have an US until 20 weeks at which point they estimated I was actually 24 weeks. It was pretty shocking. Everything I read said that implantation bleeding was light and not common, but that wasn't the case for me. Luckily, I had been recording my periods and was able to determine what my 'one month back' LMP would have been, otherwise my new due date would have been pretty rough of a guess based on the US.

I am torn on how I feel about the new rec because on one hand, it would have been really nice to know in my first pregnancy. But, at the same time, it wouldn't have affected the outcome at all. With my current pregnancy I had the same heavy implantation bleeding but was familiar with it so even though I was sent for a dating US I already had the right ovulation date. 

[shortstax]

As someone with extremely long and uneven cycles (think 60-120 days) I never realized that everyone didn't get these. Now I feel special

[undecidedowl]

Sept 23, 2014 7:41:06 GMT -5 karinothing said:

Sept 23, 2014 5:24:52 GMT -5 @wandering said:

In my (limited) experience, doctors do listen to their patients and take last menstrual period in to consideration and it usually matches up with the US if a patient actually knows their LMP. Most of the time we get "I think it was sometime in May" or something along those lines.  I have had exactly zero patients know when they've ovulated, honestly I'm sure that the majority of the patients I work with understand how the menstrual cycle works to completely understand ovulation. Medical literacy in general in this country is at about the 5th grade level. 

I'm not sure I have a major opinion about this at the moment due to the patient population that I've worked with, so it kind of colors my views. 99% of the time we order an US at 12 and 20 weeks, so this doesn't really change the way I'd practice because I'll probably always work with an urban or rural and young population . Most of the patients I've worked with are young and we can't reliably go by LMP, so the US is pretty crucial. If you are going to use an US for dating then it's more accurate earlier, so it'd defeat the purpose to only use the 20 week US. 50% of pregnancies are unplanned, and even of the ones that are planned, women aren't charting like I see is more common on this board. 

I do recognize it's not always necessary in every case, but in the vast majority of the patients I work with we will go by an US due to unknown LMP. 

In my experience, doctors don't really listen when it comes to a woman that has been charting. Even my midwives (who are like super pro women and super pro taking charge of your fertility and your healthcare) had to go by LMP. I am not sure that not listening is the right word, I think the standard of care was/is just to go by LMP so they go by that even if you have a chart.

I am not sure how I feel about early ultrasounds being mandated. I am not really sure the financial cost is worth the health benefit for the majority of women. I feel like this could be beneficial for some women, like perhaps doctors could ask "when was your LMP, who long are your cycles, etc." If the woman is unsure or answers something like "my cycles are 60 days" a dating ultrasound would certainly be necessary. If she answers my cycles are always 28 days and my last period was on this specific date, it seems less necessary.

I definitely see this. I knew my LMP and ovulation date this time. They only wanted to know the LMP. I was sent for a dating US that lined up exactly with my ovulation date but they weren't interested since it was within a week of LMP. I kind of get it, but at the same time, if I go overdue I would rather use the more accurate date to determine when/if intervention is necessary.

[water*drop]

Sept 23, 2014 7:41:06 GMT -5 karinothing said:

Sept 23, 2014 5:24:52 GMT -5 @wandering said:

In my (limited) experience, doctors do listen to their patients and take last menstrual period in to consideration and it usually matches up with the US if a patient actually knows their LMP. Most of the time we get "I think it was sometime in May" or something along those lines.  I have had exactly zero patients know when they've ovulated, honestly I'm sure that the majority of the patients I work with understand how the menstrual cycle works to completely understand ovulation. Medical literacy in general in this country is at about the 5th grade level. 

I'm not sure I have a major opinion about this at the moment due to the patient population that I've worked with, so it kind of colors my views. 99% of the time we order an US at 12 and 20 weeks, so this doesn't really change the way I'd practice because I'll probably always work with an urban or rural and young population . Most of the patients I've worked with are young and we can't reliably go by LMP, so the US is pretty crucial. If you are going to use an US for dating then it's more accurate earlier, so it'd defeat the purpose to only use the 20 week US. 50% of pregnancies are unplanned, and even of the ones that are planned, women aren't charting like I see is more common on this board. 

I do recognize it's not always necessary in every case, but in the vast majority of the patients I work with we will go by an US due to unknown LMP. 

In my experience, doctors don't really listen when it comes to a woman that has been charting. Even my midwives (who are like super pro women and super pro taking charge of your fertility and your healthcare) had to go by LMP. I am not sure that not listening is the right word, I think the standard of care was/is just to go by LMP so they go by that even if you have a chart.

I am not sure how I feel about early ultrasounds being mandated. I am not really sure the financial cost is worth the health benefit for the majority of women. I feel like this could be beneficial for some women, like perhaps doctors could ask "when was your LMP, who long are your cycles, etc." If the woman is unsure or answers something like "my cycles are 60 days" a dating ultrasound would certainly be necessary. If she answers my cycles are always 28 days and my last period was on this specific date, it seems less necessary.

This has been my experience as well, and I DO have long cycles. It's very frustrating because if you're scheduling my induction for 40w6d because you won't let me go past 41 weeks, I want to actually BE 40w6d, not 39w6d.

[mpc]

Sept 23, 2014 7:41:06 GMT -5 karinothing said:

In my experience, doctors don't really listen when it comes to a woman that has been charting. Even my midwives (who are like super pro women and super pro taking charge of your fertility and your healthcare) had to go by LMP. I am not sure that not listening is the right word, I think the standard of care was/is just to go by LMP so they go by that even if you have a chart.

I am not sure how I feel about early ultrasounds being mandated. I am not really sure the financial cost is worth the health benefit for the majority of women. I feel like this could be beneficial for some women, like perhaps doctors could ask "when was your LMP, who long are your cycles, etc." If the woman is unsure or answers something like "my cycles are 60 days" a dating ultrasound would certainly be necessary. If she answers my cycles are always 28 days and my last period was on this specific date, it seems less necessary.

My doctor basically laughed and said "you're such an engineer" when I tried to explain that I charted and knew I ovulated a week later than my LMP would suggest. They wouldn't change my date even though an early ultrasound agreed with my dates. No big deal, until she decided to induce me at "39 weeks", which according to my real dates was only 38 weeks.

I like the idea of doing the dating ultrasound if the woman says she normally has irregular periods. If she's always every 28 days, then chances are LMP would be good enough.

[Cicero]

My dating U/S cost $19 total. It was performed by my OB in KL.

[Deleted]

Sept 23, 2014 7:41:06 GMT -5 karinothing said:

Sept 23, 2014 5:24:52 GMT -5 @wandering said:

In my (limited) experience, doctors do listen to their patients and take last menstrual period in to consideration and it usually matches up with the US if a patient actually knows their LMP. Most of the time we get "I think it was sometime in May" or something along those lines.  I have had exactly zero patients know when they've ovulated, honestly I'm sure that the majority of the patients I work with understand how the menstrual cycle works to completely understand ovulation. Medical literacy in general in this country is at about the 5th grade level. 

I'm not sure I have a major opinion about this at the moment due to the patient population that I've worked with, so it kind of colors my views. 99% of the time we order an US at 12 and 20 weeks, so this doesn't really change the way I'd practice because I'll probably always work with an urban or rural and young population . Most of the patients I've worked with are young and we can't reliably go by LMP, so the US is pretty crucial. If you are going to use an US for dating then it's more accurate earlier, so it'd defeat the purpose to only use the 20 week US. 50% of pregnancies are unplanned, and even of the ones that are planned, women aren't charting like I see is more common on this board. 

I do recognize it's not always necessary in every case, but in the vast majority of the patients I work with we will go by an US due to unknown LMP. 

In my experience, doctors don't really listen when it comes to a woman that has been charting. Even my midwives (who are like super pro women and super pro taking charge of your fertility and your healthcare) had to go by LMP. I am not sure that not listening is the right word, I think the standard of care was/is just to go by LMP so they go by that even if you have a chart.

I am not sure how I feel about early ultrasounds being mandated. I am not really sure the financial cost is worth the health benefit for the majority of women. I feel like this could be beneficial for some women, like perhaps doctors could ask "when was your LMP, who long are your cycles, etc." If the woman is unsure or answers something like "my cycles are 60 days" a dating ultrasound would certainly be necessary. If she answers my cycles are always 28 days and my last period was on this specific date, it seems less necessary.

I need to read the exact guidelines but it doesn't sound like US are being mandated. It seems these days insurance companies are the only organization that can mandate anything!

It seems as though acog is just making this a formal statement on something that has already been occurring. They're saying a first tri US is the most accurate way to get EGA for the vast majority of the population. But when I'm on my computer tonight I'll read the exact statement from acog to get the full picture of the statement.

Guidelines are just that, guidelines. Doctors can then use their critical thinking skills to decide if a US is the best thing to go by. But like I said, most women in the general public don't seem to know their lmp or how cycles work.

[isabel]

This is news to me that it's not standard. We had an ultrasound at 7 weeks due to spotting. My first actual appointment at almost 9 weeks included a dating ultrasound. I won't have another until 20 weeks for the anatomy scan, but I find it interesting that most people don't see the baby until that time. I love that we've gotten to see pictures! For me, it's a bonding thing. I was and still am struggling with realizing this thing is inside me. Having the pictures makes it more real.

Eta: both of those US made me feel better that the baby was growing the way it should be as well. I'm less nervous waiting for the next one because I've seen it and have a visual in my mind. I'm low risk and everything has been fine so far, so I easily could have done without the early US, but I appreciated having them nonetheless.