Post by hilwithonelary on Sept 23, 2014 10:12:52 GMT -5
I can see how dating u/s are useful when people are unsure of their dates, but I don't see the need to make it standard.
@wandering, I did not find my OB to be willing to listen to me when I was charting. This is a little long, but I'd like to share.
I ovulated on day 42 the cycle I conceived DS. I normally have long cycles, but not THAT long. On day 40, I thought “I must have missed something. Maybe I am already pregnant somehow.” I took a test, which was negative. I then had a clear temperature shift and CM dry up which showed ovulation occurred on day 42. I tested positive 10 days after ovulation.
At my first appointment, I was 7 weeks by my dates and 11 by LMP. I tried to show my OB my chart. She wouldn’t even look at it and responded with "Charting is especially inaccurate in women with irregular cycles." (I was so taken aback that when I got out of the appointment, I wrote it down. So yes, after 5 years, I know this is exactly what she said) I tried to tell her that I had a negative test on day 40 so I couldn’t possibly be 11 weeks along, and then she told me, “You were already pregnant when you took that test.”
Next, she did an exam, got a very concerned look on her face and said, “Hmm. Your uterus only feels about 7-9 weeks. I’ll schedule you for an ultrasound to see what’s going on.” Um, hello? I just told you what was going on.
I wasn't able to get a dating u/s until about 10 weeks. We tried when I was 8 weeks, but I was carrying twins and their positions made it so she couldn't get an accurate measurement. I lost one twin between 8 and 10 weeks, and she took measurements then.
The measurements from the ultrasound gave me a due date that was 6 days earlier than my calculation. I didn’t press the issue further and just hoped that I wouldn’t go past my due date. I feared that I would be pushed for induction because my OB thought I was further along that I really was. In the end, I had DS early. I was 37 weeks 3 days by ultrasound, 36 weeks 4 days by ovulation. Guess what? The newborn evaluation they did at the hospital estimated him to be 36.5 weeks gestation. I know these evaluations aren't 100% accurate, but I thought it was interesting that it lined up with my date, not the u/s date.
I switched to a CNM in a different practice when I had DD, but I lied about my LMP because I didn't want to risk dealing with that again.
Post by hilwithonelary on Sept 23, 2014 10:16:09 GMT -5
I didn't want this to get lost in my long post. I have a couple questions.
Is there any data regarding the accuracy of dating ultrasounds on an in office machine performed/read by an OB vs a machine at a radiology center performed by a radiology technician/read by a radiologist?
What about the decreasing accuracy of dating as pregnancy progresses? I'd imagine that dating done at 6 weeks is more accurate than 12 weeks which is more accurate than 20 weeks. Is there data on the margin of error for various points in pregnancy?
Dating ultrasounds were already standard at my OB's practice when I had M over two years ago. Here's what I don't get...if full term is now supposedly 38 weeks instead of 37, doesn't that tell us that each week is incredibly important in pregnancy? Shouldn't doctors actually use the date and no say "well, it's within a week...so we'll just go with LMP." I've seen SO many people make that comment here.
There is also a margin of error of a few days in dating u/s, so there's no way pinpoint the due date *to the day* unless you know when you ovulated and only had sex once near your ovulation.
I think it makes sense to have a dating ultrasound. Every week matters in pregnancy. My practice only does a 20 week ultrasound, but I was measuring ahead at 16 weeks with ODS and 11 weeks with YDS and had an ultrasound to check for possible twins and to confirm the date.
It's news to you that not everyone gets the exact same medical care as you do?
Well, that's kind of a generalization. Given that I don't know much about obstetrics and this is my first, I made an assumption that having an ultrasound first thing was typical. I think I would have been surprised if they hadn't done one at my first appointment.
Lol, no. I don't think acog made these recommendations so that radiologists can make more money. Although the job prospects for radiologists aren't that great these days, I don't think this is a move to try and help that!
In what way are radiologists involved in obstetric u/s? Mine were always performed by the OB.
Post by shellbear09 on Sept 23, 2014 10:23:57 GMT -5
More and more has come out about how important those last weeks of pregnancy are so yeah I think it is a good thing. It is normal at my practice to get one about 8w.
Lol, no. I don't think acog made these recommendations so that radiologists can make more money. Although the job prospects for radiologists aren't that great these days, I don't think this is a move to try and help that!
In what way are radiologists involved in obstetric u/s? Mine were always performed by the OB.
In the 3 hospitals I've been in, we send to radiology department for dating and measurements and then we get the report with all the measurements. I'm sure everywhere might be different though!
I have noticed that some obgyn residency programs have a month of Ultrasoind as a required rotation, while many don't.
Post by mrsGreeko on Sept 23, 2014 12:10:03 GMT -5
Anecdote alert: my first DD I had an early u/s at 8 weeks that showed I was exactly right in my dates. She was born 11 days past her due date spontaneously, but they were offering an induction well before that.
My second and third I only had one u/s at 20 weeks, but was charting (temping with second, just watching signs with third) with both of them so I knew when they were conceived. Second was born on her due date according to LMP and 2 days late according to chart. Third was born 5 days early.
There are so many factors, I don't think even early u/s can predict much of anything. I do think it can end in more inductions though because the baby "should" be here and isn't. I think it can create a psychological issue for the mother when her baby is "late" and I do think that's a problem.
I didnt read the article, but I think it's a good idea. I know that I knew exactly when I ovulated but many people do not and dating in the beginning is much, much more accurate. This may help avoid unnecessary inductions later.
And, of course, I was very thankful to find out I was having twins at 8 weeks and change rather than 12 weeks at my nt scan!
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.
And this is why I lied about my lmp with both pregnancies!
Lol, no. I don't think acog made these recommendations so that radiologists can make more money. Although the job prospects for radiologists aren't that great these days, I don't think this is a move to try and help that!
In what way are radiologists involved in obstetric u/s? Mine were always performed by the OB.
Mine were always performed by radiologists. The OB came in during one to look at a spot that was concerning, but during the other ones, the OB just gave me follow-up information.
It DOES state that first tri ultrasounds are considered the most accurate way to determine EDD. However, the opinion really seems to be giving specific guidelines for when a due date should be changed (and really, saying that ultrasound estimates of gestational age become less reliable as the pregnancy progresses). So specifically, the ultrasound should show that the baby's size is X days off in order to change the date, where X gets larger as the pregnancy gets later. It also discourages changing dates late in pregnancy if there was a first trimester ultrasound performed.
FWIW, my provider only does the 20w scan as standard procedure. NT scan at 12w is optional. Other scans are ordered when there are reasons for them. My provider was also not interested in my OPK dates, only considered LMP (mine were only "off" by a few days though so not a huge cause for concern).
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.
This is pretty alarmist.
It's now quite well understood how radiation impacts molecular structure. It did not take that long (in an historical sense) to come to that understanding, once we were able to produce radiation for study. Sound waves have been studied for centuries and there is no reason to think that they have hand wavy INVISIBLE IMPACTS. Not to mention that there is an enormous amount of clinical data showing that ultrasounds do not affect babies, whereas once the data on Xrays was actually rigorously studied, there were clear negative consequences. Ultrasounds have, however, demonstrated immense clinical value in diagnosis and monitoring of medical conditions.
Oh, well that is very surprising. They are a lot more when I get ultrasounds.
Not the US. So the American College of Gynecologist is not talking about that situation.
As I said earlier, I put that out there in response to the more ultrasounds will cause the price of all ultrasounds to go up comment. I never even saw a Doppler until we moved back to the US mid-3rd tri because they always just used the u/a machine instead.
Post by carolinagirl831 on Sept 23, 2014 14:17:15 GMT -5
My office does dating u/s standard. I'm so glad because my first pregnancy i was averaging 40 day cycles, when I went to the first ultrasound I thought I was only about 7 weeks, come to find out I had ovulated early and was 9 weeks! I ended up being almost 2 weeks late as well so who knows what would have happened without it.
It's great for peace of mind too, I love confirmation of size and heartbeat early on.
Our office does the dating u/s and anatomy scan standard and then the NT scan is optional. I do them all. I want as much info as possible.
It DOES state that first tri ultrasounds are considered the most accurate way to determine EDD. However, the opinion really seems to be giving specific guidelines for when a due date should be changed (and really, saying that ultrasound estimates of gestational age become less reliable as the pregnancy progresses). So specifically, the ultrasound should show that the baby's size is X days off in order to change the date, where X gets larger as the pregnancy gets later. It also discourages changing dates late in pregnancy if there was a first trimester ultrasound performed.
FWIW, my provider only does the 20w scan as standard procedure. NT scan at 12w is optional. Other scans are ordered when there are reasons for them. My provider was also not interested in my OPK dates, only considered LMP (mine were only "off" by a few days though so not a huge cause for concern).
Thank you for posting the link so I don't have to go hunting for it
I still haven't read it yet, but based on what you said this announcement doesn't seem to change a thing except now it's an official statement. Everything I've learned in the books and generally what I've seen in practice is exactly what seems to be stated in this official statement. Physicians don't always follow the book rules of what we learn as students and obviously use their clinical judgement a lot of the time, but this doesn't seem to be new ground breaking info.
It DOES state that first tri ultrasounds are considered the most accurate way to determine EDD. However, the opinion really seems to be giving specific guidelines for when a due date should be changed (and really, saying that ultrasound estimates of gestational age become less reliable as the pregnancy progresses). So specifically, the ultrasound should show that the baby's size is X days off in order to change the date, where X gets larger as the pregnancy gets later. It also discourages changing dates late in pregnancy if there was a first trimester ultrasound performed.
FWIW, my provider only does the 20w scan as standard procedure. NT scan at 12w is optional. Other scans are ordered when there are reasons for them. My provider was also not interested in my OPK dates, only considered LMP (mine were only "off" by a few days though so not a huge cause for concern).
Thank you for posting the link so I don't have to go hunting for it
I still haven't read it yet, but based on what you said this announcement doesn't seem to change a thing except now it's an official statement. Everything I've learned in the books and generally what I've seen in practice is exactly what seems to be stated in this official statement. Physicians don't always follow the book rules of what we learn as students and obviously use their clinical judgement a lot of the time, but this doesn't seem to be new ground breaking info.
So basically this whole thread is pointless lol.
I think it's significant that the leading body of OB/gyns took a public stance on the matter. For example, my provider quit doing Pap smears every year (unless requested) based on updated ACOG guidelines, since I've never had an abnormal Pap.
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.
This is pretty alarmist.
It's now quite well understood how radiation impacts molecular structure. It did not take that long (in an historical sense) to come to that understanding, once we were able to produce radiation for study. Sound waves have been studied for centuries and there is no reason to think that they have hand wavy INVISIBLE IMPACTS. Not to mention that there is an enormous amount of clinical data showing that ultrasounds do not affect babies, whereas once the data on Xrays was actually rigorously studied, there were clear negative consequences. Ultrasounds have, however, demonstrated immense clinical value in diagnosis and monitoring of medical conditions.
Eh, I'm with curbsideprophet. Of course ultrasound technology can be very helpful, but it is still a medical tool that shouldn't be used just for fun. When we talk about potential impacts, it's not necessarily cancer or defects that should be considered. Maybe those sound waves stress the fetus. Maybe they subtly affect a developing organ. Maybe they are totally benign. Point is, we don't know, so having them performed for no real reason should be discouraged.
That said, I can certainly see the value of dating ultrasounds. I don't have a strong opinion on the matter otherwise.
Never happen in Canada. Cost, access... never happen.
I wouldn't be so sure. It's routine to do them in the UK.
Of course, they don't routinely test for GBS here and seem to offer/advise gestational diabetes testing less frequently. Guess you have to keep costs down somewhere
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.
This is pretty alarmist.
It's now quite well understood how radiation impacts molecular structure. It did not take that long (in an historical sense) to come to that understanding, once we were able to produce radiation for study. Sound waves have been studied for centuries and there is no reason to think that they have hand wavy INVISIBLE IMPACTS. Not to mention that there is an enormous amount of clinical data showing that ultrasounds do not affect babies, whereas once the data on Xrays was actually rigorously studied, there were clear negative consequences. Ultrasounds have, however, demonstrated immense clinical value in diagnosis and monitoring of medical conditions.
if us are dangerous to babies mine should be dead. I lost count of how many he had. I think 35 ish?
It's now quite well understood how radiation impacts molecular structure. It did not take that long (in an historical sense) to come to that understanding, once we were able to produce radiation for study. Sound waves have been studied for centuries and there is no reason to think that they have hand wavy INVISIBLE IMPACTS. Not to mention that there is an enormous amount of clinical data showing that ultrasounds do not affect babies, whereas once the data on Xrays was actually rigorously studied, there were clear negative consequences. Ultrasounds have, however, demonstrated immense clinical value in diagnosis and monitoring of medical conditions.
Eh, I'm with curbsideprophet. Of course ultrasound technology can be very helpful, but it is still a medical tool that shouldn't be used just for fun. When we talk about potential impacts, it's not necessarily cancer or defects that should be considered. Maybe those sound waves stress the fetus. Maybe they subtly affect a developing organ. Maybe they are totally benign. Point is, we don't know, so having them performed for no real reason should be discouraged.
That said, I can certainly see the value of dating ultrasounds. I don't have a strong opinion on the matter otherwise.
I mean, we don't know the effects of a damned thing in our environment by this logic. However, we do know that ultrasounds have clinical value.
The "we just don't know" attitude is very anti-science. It makes me angry in the way that anti-vax propaganda makes me angry. It is dangerous to go around scaring people about medical procedures for which there is immense evidence of benefit and no evidence of harm.
It's now quite well understood how radiation impacts molecular structure. It did not take that long (in an historical sense) to come to that understanding, once we were able to produce radiation for study. Sound waves have been studied for centuries and there is no reason to think that they have hand wavy INVISIBLE IMPACTS. Not to mention that there is an enormous amount of clinical data showing that ultrasounds do not affect babies, whereas once the data on Xrays was actually rigorously studied, there were clear negative consequences. Ultrasounds have, however, demonstrated immense clinical value in diagnosis and monitoring of medical conditions.
Eh, I'm with curbsideprophet. Of course ultrasound technology can be very helpful, but it is still a medical tool that shouldn't be used just for fun. When we talk about potential impacts, it's not necessarily cancer or defects that should be considered. Maybe those sound waves stress the fetus. Maybe they subtly affect a developing organ. Maybe they are totally benign. Point is, we don't know, so having them performed for no real reason should be discouraged.
That said, I can certainly see the value of dating ultrasounds. I don't have a strong opinion on the matter otherwise.
w.t.f.
You seriously think the american college of gynecologists is making this recommendation for no real reason either than being for funsies?
Eh, I'm with curbsideprophet. Of course ultrasound technology can be very helpful, but it is still a medical tool that shouldn't be used just for fun. When we talk about potential impacts, it's not necessarily cancer or defects that should be considered. Maybe those sound waves stress the fetus. Maybe they subtly affect a developing organ. Maybe they are totally benign. Point is, we don't know, so having them performed for no real reason should be discouraged.
That said, I can certainly see the value of dating ultrasounds. I don't have a strong opinion on the matter otherwise.
I mean, we don't know the effects of a damned thing in our environment by this logic. However, we do know that ultrasounds have clinical value.
The "we just don't know" attitude is very anti-science. It makes me angry in the way that anti-vax propaganda makes me angry. It is dangerous to go around scaring people about medical procedures for which there is immense evidence of benefit and no evidence of harm.
I was just thinking the same thing. catbus stole a page out of megan heimer's playbook here.
Eh, I'm with curbsideprophet. Of course ultrasound technology can be very helpful, but it is still a medical tool that shouldn't be used just for fun. When we talk about potential impacts, it's not necessarily cancer or defects that should be considered. Maybe those sound waves stress the fetus. Maybe they subtly affect a developing organ. Maybe they are totally benign. Point is, we don't know, so having them performed for no real reason should be discouraged.
That said, I can certainly see the value of dating ultrasounds. I don't have a strong opinion on the matter otherwise.
w.t.f.
You seriously think the american college of gynecologists is making this recommendation for no real reason either than being for funsies?
I'm genuinely dumbfounded.
That's not at all what I was saying. I was talking about ultrasounds done for no medical purpose; the elective ultrasounds done at third-party facilities. Like the ones for determining sex early, or having "keepsake" images. I clearly said I see the value of dating ultrasounds.
Eh, I'm with curbsideprophet. Of course ultrasound technology can be very helpful, but it is still a medical tool that shouldn't be used just for fun. When we talk about potential impacts, it's not necessarily cancer or defects that should be considered. Maybe those sound waves stress the fetus. Maybe they subtly affect a developing organ. Maybe they are totally benign. Point is, we don't know, so having them performed for no real reason should be discouraged.
That said, I can certainly see the value of dating ultrasounds. I don't have a strong opinion on the matter otherwise.
I mean, we don't know the effects of a damned thing in our environment by this logic. However, we do know that ultrasounds have clinical value.
The "we just don't know" attitude is very anti-science. It makes me angry in the way that anti-vax propaganda makes me angry. It is dangerous to go around scaring people about medical procedures for which there is immense evidence of benefit and no evidence of harm.
I was not fucking talking about ultrasounds ordered by a medical professional. Jesus.
I mean, we don't know the effects of a damned thing in our environment by this logic. However, we do know that ultrasounds have clinical value.
The "we just don't know" attitude is very anti-science. It makes me angry in the way that anti-vax propaganda makes me angry. It is dangerous to go around scaring people about medical procedures for which there is immense evidence of benefit and no evidence of harm.
I was not fucking talking about ultrasounds ordered by a medical professional. Jesus.
I think you confused every one bc no one in this thread, including curbsidepriphet, was talking about elective us.