Post by turtlegirl on Sept 23, 2014 16:13:42 GMT -5
Another person chiming in with long and irregular cycles. I have been charting when not on the pill or pregnant for the past 4+ years. I ovulate anywhere from day 19-day 35 or something crazy like that. Never had had a 28 day cycle.
I think I told them my LMP date with DS1 but said I was having weird cycles, so they did a dating u/s and the date matched up with my chart date - about 2.5 weeks later than my LMP date. And they went with the u/s date.
I think when DS2 came around I just lied about my LMP so it matched up with their expected 28 day cycle. They still did a quick dating u/s.
We are TTC#3 right now and I'm due to take a pregnancy test any day now. If I am pregnant then I'm going to lie again. I don't think I ovulated until day 28 or something like that this cycle.
Dating u/s have always been standard for me and they are just a quick 5 minute procedure done by the OB right in the office. I loved having them to confirm that I was right, lol. And just seeing the little heartbeat on the screen is so comforting and amazing.
I'm looking forward to that first u/s this time around.
Post by thejen626 on Sept 23, 2014 16:33:51 GMT -5
I have Kaiser and it's standard at my OB's office to do a dating ultrasound early in the pregnancy. With both of mine, they have actually been too early and we couldn't see a HB yet, so then I had another a week later.
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.
"Although there are no known risks of ultrasound imaging and heartbeat monitors, the radiation associated with them can produce effects on the body," says Robert Phillips, Ph.D., a physicist with FDA's Center for Devices and Radiological Health (CDRH). "When ultrasound enters the body, it heats the tissues slightly. In some cases, it can also produce small pockets of gas in body fluids or tissues."
Phillips says the long-term effects of tissue heating and of the formation of partial vacuums in a liquid by high-intensity sound waves (cavitation) are not known.
Using ultrasound equipment only through a prescription ensures that pregnant women will receive professional care that contributes to their health and to the health of their babies, and that ultrasound will be used when medically indicated.
I never said ultrasound did not have value. Just the opposite in fact. However I still do not think a dating ultrasound needs to be standard for every pregnancy. Based on what else was said, it sounds like that may not even be the case. If you are unsure of your dates, have irregular cycles, etc I certainly think a dating ultrasound would be valuable. However it you are charting/sure of your dates I am not convinced it is really needed.
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.
dude. If you're referring to one tangential sentence then quote it. We're not mind readers. The portion poppy quoted and you responded to had nothing to do with elective us.
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.
I never said ultrasound did not have value. Just the opposite in fact. However I still do not think a dating ultrasound needs to be standard for every pregnancy. Based on what else was said, it sounds like that may not even be the case. If you are unsure of your dates, have irregular cycles, etc I certainly think a dating ultrasound would be valuable. However it you are charting/sure of your dates I am not convinced it is really needed.
The guidelines aren't saying that ultrasounds are needed for every pregnancy. It just outlines the different ways in which to get the most accurate dates and the importance of having accurate dates.
Here are the conclusions: Accurate dating of pregnancy is important to improve outcomes and is a research and public health imperative. 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. 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 LMP alone, should be used as the measure for gestational age.
I'm mobile and can't C&P but it looks like they are pushing to make first tri dating ultrasounds standard. Thoughts?
I'm not sure if you've come back to this thread, but now I've read over the recommendations. It's not necessarily saying everyone must get an US in the 1st trimester.
Basically they're saying that physicians should figure out the EDD as early as possible and not change that date once it's decided. You can use LMP if it's definitely known, but US is the most accurate overall (because only 50% of women know their LMP) and should be used if there is a discrepancy of up to 1 week in the first trimester.
Overall, I think the point is, they don't want doctors to make clinical decisions based on 3rd trimester US because those are less accurate. So pick a date from the beginning and stick with it.
These are the recommendations: 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 confirm gestational age.
If pregnancy resulted from assisted reproductive technology (ART), the ART-derived gestational age should be used to assign the estimated due date (EDD). For instance, the EDD for a pregnancy resulting from in vitro fertilization should be established using the age of the embryo and the date of transfer.
As soon as data from the last menstrual period (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. 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 LMP alone, should be used as the measure for gestational age.
by catbus. I am surprised that they use this language "the possibility exists that such biological effects may be identified in the future" because I maintain that such a statement could be made about nearly anything. I would hope that if they were to issue the same statement today (that was 10 years ago) that they would consider how phraseology like that has used by anti-science groups to confuse and scare people. I personally find their other reasons in that statement to be more compelling, but I guess I don't get to pick and choose. And catbus you were explicit about disliking ultrasounds for fun, so sorry for quoting you - my irritation was really at the previous post. FWIW ACOG also says "Ultrasonography involves the use of sound waves and is not a form of ionizing radiation. There have been no reports of documented adverse fetal effects for diagnostic ultrasound procedures, including duplex Doppler imaging. Energy exposure from ultrasonography has been arbitrarily limited to 94 mW/cm2 by the U.S. Food and Drug Administration. There are no contraindications to ultrasound procedures during pregnancy".
I really take issue with curbsideprophet's comparison to X-Rays because to the lay person the two technologies may seem similar but it's really apples and oranges. And FWIW curbsideprophet, I also never said dating ultrasounds should be routine - my point is that it's dangerous to scare people off from ultrasounds because their use has provided great medical value and there is no reason to believe that medical ultrasounds are in any way harmful.
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.
Usually when medical care is cheaper in other countries it is subsidized by the gov. I do not think this will cause the price of a us to go up, but will increase overall healthcare costs
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.
It made me crazy that people would not listen to me about my IVF dates! I actually had a nurse argue with me about it. I finally looked at a calendar and figured out two weeks before my ER date so I could just say that was my LMP. My due date was based on a dating ultrasound, but DD was born exactly 38 weeks after she was conceived. She knew when she was really due!
I have been thinking about this because this pregnancy is not as a result of fertility treatments. This means I will have a lot fewer ultrasounds. I think I only get 12 weeks and 20 weeks. Last time I had 5, 7, 14, 21, 28, 34, 37. Lol. High risk FTW
The thing is, I didn't have regular cycles before, and I don't know if they are suddenly regular now. So if they use the last day calc, I am like 6 weeks pregnant, I could be more like 5 if I ovulated late.
I go to the doc today, will find out when my first u/s is, hoping I will get 8 weeks!
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.
Usually when medical care is cheaper in other countries it is subsidized by the gov. I do not think this will cause the price of a us to go up, but will increase overall healthcare costs
Usually when medical care is cheaper in other countries it is subsidized by the gov. I do not think this will cause the price of a us to go up, but will increase overall healthcare costs
Private healthcare is not subsidized in Malaysia.
Well i would be really interested in knowing the reasons behind the price differences. That is an amazing price
I never said ultrasound did not have value. Just the opposite in fact. However I still do not think a dating ultrasound needs to be standard for every pregnancy. Based on what else was said, it sounds like that may not even be the case. If you are unsure of your dates, have irregular cycles, etc I certainly think a dating ultrasound would be valuable. However it you are charting/sure of your dates I am not convinced it is really needed.
The guidelines aren't saying that ultrasounds are needed for every pregnancy. It just outlines the different ways in which to get the most accurate dates and the importance of having accurate dates.
Here are the conclusions: Accurate dating of pregnancy is important to improve outcomes and is a research and public health imperative. 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. 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 LMP alone, should be used as the measure for gestational age.
I realize the guidelines are not saying that now. However the way this thread was started implied that they were and that is what people seemed to be discussing. I absolutely agree that having an accurate date is important. Which is why I don't understand why some doctors are so adamant about using LMP when they have a patient who is charting and knows they ovulated late.
Post by curbsideprophet on Sept 23, 2014 21:34:27 GMT -5
Poppy I am not trying to scare anyone off from having ultrasounds. I have had three myself between two pregnancies. Since we do not know all the long term effects I would prefer to avoid unnecessary scans. I realize I might be in the minority on this. Many people here seem to want as many scans as they can get. I was not trying to compare the actual technology of x-rays and ultrasounds. Simply the fact that there was a medical tool that we thought was okay but later realized was not.
What American Pregnancy Association has to say about ultrasound (more info at the link, I just copied the part about risk)
What are the risks and side effects to the mother or baby?
The ultrasound is a noninvasive procedure that, when used properly, has not demonstrated fetal harm. The long term effects of repeated ultrasound exposures on the fetus are not fully known. It is recommended that ultrasound only be used if medically indicated.
Poppy I am not trying to scare anyone off from having ultrasounds. I have had three myself between two pregnancies. Since we do not know all the long term effects I would prefer to avoid unnecessary scans. I realize I might be in the minority on this. Many people here seem to want as many scans as they can get. I was not trying to compare the actual technology of x-rays and ultrasounds. Simply the fact that there was a medical tool that we thought was okay but later realized was not.
What American Pregnancy Association has to say about ultrasound (more info at the link, I just copied the part about risk)
What are the risks and side effects to the mother or baby?
The ultrasound is a noninvasive procedure that, when used properly, has not demonstrated fetal harm. The long term effects of repeated ultrasound exposures on the fetus are not fully known. It is recommended that ultrasound only be used if medically indicated.
this is a red herring. the acog are not recommending us that are not medically indicated. No one in this thread has argued for elective us.
Many people here seem to want as many scans as they can get.
I don't think anyone posted about getting scans every week for no reason. We were only talking about the necessity of a first trimester US. That's vastly different than getting as many ultrasounds as possible. Who said that?
Post by stealthmom on Sept 23, 2014 22:37:22 GMT -5
The thing is we're talking about one more us. Not dozens. So if one additional us means fetal harm, I'll say it again, high risk babies are fucked. Not to mention that it sounds like this is sop for many obs already.
Poppy I am not trying to scare anyone off from having ultrasounds. I have had three myself between two pregnancies. Since we do not know all the long term effects I would prefer to avoid unnecessary scans. I realize I might be in the minority on this. Many people here seem to want as many scans as they can get. I was not trying to compare the actual technology of x-rays and ultrasounds. Simply the fact that there was a medical tool that we thought was okay but later realized was not.
What American Pregnancy Association has to say about ultrasound (more info at the link, I just copied the part about risk)
What are the risks and side effects to the mother or baby?
The ultrasound is a noninvasive procedure that, when used properly, has not demonstrated fetal harm. The long term effects of repeated ultrasound exposures on the fetus are not fully known. It is recommended that ultrasound only be used if medically indicated.
Of course a medical body believes that a medical procedure should only be used when medically indicated. I can't think of any medical procedures that medical bodies suggest using on a whim. That doesn't mean there's anything wrong with them.
If I am confident in my dates (due to IVF, charting, etc) a dating ultrasound does not seem necessary. What would the medical need be?
Medical indication is determined by the physician, not the patient. I wouldn't want a physician prescribing antibiotics every time someone shows up with a sore throat demanding them. *Most* patients cannot reliably date their pregnancies. If you feel your physician is ignoring your wishes, that's a communication issue that has no bearing on the general utility of u/s.
If I am confident in my dates (due to IVF, charting, etc) a dating ultrasound does not seem necessary. What would the medical need be?
Then you wouldn't need one. If you read the recommendations, it is saying use IVF dates, LMP OR an US. Then, once you have a date, don't change it if a patient has to have an US later in pregnancy because those are less accurate.
It then goes on to explain in a little more detail about the accuracy of an US.
The reason most doctors probably don't "listen" as well in regards to ovulation because there are no guidelines in regards to ovulation because 99% of the general population doesn't know when they ovulated. So the standard is to use lmp because that's typically more clear, but again slightly less than 50% of women even know their lmp.
So like I said above these recommendations aren't really earth shattering as I have learned them since I've been in school and older docs seem to typically follow these rules too. It has just been made official, which I think is a good thing.
The bottom line is 1st tri US is the most accurate, but you can use LMP. Once you have a date determined in the first tri, stick with it (assuming the woman comes in in her first tri which doesn't always happen). That 2nd part is the most important so that clinical decisions aren't made on a less accurate 3rd tri US.
No one is saying to give a million extra US, only if needed.
catbus and curbsideprophet I have gotten an elective ultrasound before, but I have no problem with your opinions on them. Do you feel the same way about the at home dopplers?
Not a fan of home dopplers either. I feel like they can freak you out unnecessarily if you don't find the heartbeat. They can also give you a false sense of security later on. If you are doing kick counts and not feeling the baby move, you should call you provider, not use your home doppler and assume everything is okay just because you found the heartbeat.
I never said ultrasound did not have value. Just the opposite in fact. However I still do not think a dating ultrasound needs to be standard for every pregnancy. Based on what else was said, it sounds like that may not even be the case. If you are unsure of your dates, have irregular cycles, etc I certainly think a dating ultrasound would be valuable. However it you are charting/sure of your dates I am not convinced it is really needed.
The guidelines aren't saying that ultrasounds are needed for every pregnancy. It just outlines the different ways in which to get the most accurate dates and the importance of having accurate dates.
Here are the conclusions: Accurate dating of pregnancy is important to improve outcomes and is a research and public health imperative. 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. 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 LMP alone, should be used as the measure for gestational age.
May I ask a strange question and maybe I am misinterpreting what is being referenced. Why would a doctor note the gestational age on a birth certificate? I understand the medical record but didn't think it had anything to do with the certificate. Again, I may be assuming they are referring to the state-issued document when that wasn't the intention.
catbus and curbsideprophet I have gotten an elective ultrasound before, but I have no problem with your opinions on them. Do you feel the same way about the at home dopplers?
Not a fan of home dopplers either. I feel like they can freak you out unnecessarily if you don't find the heartbeat. They can also give you a false sense of security later on. If you are doing kick counts and not feeling the baby move, you should call you provider, not use your home doppler and assume everything is okay just because you found the heartbeat.
I don't like them because I think the baby doesn't like the sound of the doppler. I know that DS always ran away whenever the nurse used it. It seems like it annoys them lol.
Not a fan of home dopplers either. I feel like they can freak you out unnecessarily if you don't find the heartbeat. They can also give you a false sense of security later on. If you are doing kick counts and not feeling the baby move, you should call you provider, not use your home doppler and assume everything is okay just because you found the heartbeat.
I don't like them because I think the baby doesn't like the sound of the doppler. I know that DS always ran away whenever the nurse used it. It seems like it annoys them lol.
gravytrain225, I am also not a fan of home dopplers, for the reasons given by curbsideprophet. I understand why some want them, and I don't judge that.
Huh. I wasn't aware that this was controversial. What do you guys think about this? When I was pg with DS2, I had a partial placenta abruption. The doctor proscribed bed rest but said it was highly likely that I'd end up having a miscarriage so be prepared. But they still ordered weekly ultrasounds for me despite the fact that there was nothing they could do. I'd either miscarry or not. Time would tell. I ended up having a lot of ultrasounds with him, like at least five extra. I didn't care because my insurance at the time covered it and it gave me peace of mind. If I had to pay OOP for them, I might have felt differently though. Do you think that is overkill?
I don't know if it is overkill. I guess I just want to know what the medical benefit was to them. I assume they were monitoring you re: your safety more so than the babies at that point. I am just basing this on the notion that you said there was nothing they could do for the baby. Like perhaps, the ultrasound would have shown something that would have caused them to send you to the hospital right away for your safety? I don't honestly know.
I think a lot of the stuff in the OB world is not based more on "this is just the way we do things" vs "doing this will actually improve outcomes." I was just reading an article the other day how bed rest hasn't been shown to improve outcomes for mother or baby in many cases. But I think it is prescribed because it has always been done and I think that Docs and patients like to feel like something is being done. But perhaps @wandering has a different perspective.
Huh. I wasn't aware that this was controversial. What do you guys think about this? When I was pg with DS2, I had a partial placenta abruption. The doctor proscribed bed rest but said it was highly likely that I'd end up having a miscarriage so be prepared. But they still ordered weekly ultrasounds for me despite the fact that there was nothing they could do. I'd either miscarry or not. Time would tell. I ended up having a lot of ultrasounds with him, like at least five extra. I didn't care because my insurance at the time covered it and it gave me peace of mind. If I had to pay OOP for them, I might have felt differently though. Do you think that is overkill?
I don't know if it is overkill. I guess I just want to know what the medical benefit was to them. I assume they were monitoring you re: your safety more so than the babies at that point. I am just basing this on the notion that you said there was nothing they could do for the baby. Like perhaps, the ultrasound would have shown something that would have caused them to send you to the hospital right away for your safety? I don't honestly know.
I think a lot of the stuff in the OB world is not based more on "this is just the way we do things" vs "doing this will actually improve outcomes." I was just reading an article the other day how bed rest hasn't been shown to improve outcomes for mother or baby in many cases. But I think it is prescribed because it has always been done and I think that Docs and patients like to feel like something is being done. But perhaps @wandering has a different perspective.
My OB actually mentioned the change in bedrest theory to me this most recent time. He's part of a very large HMO, which is changing its policy on the issue as a whole. I think adaptability and willingness to change are very practice-dependent.