When LMP and Ultrasound Dates Don’t Match: When to Redate?

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30. Obstetric estimate of gestation at delivery

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Current ACOG guidelines recommend changing the EDD when a first-trimester ultrasound differs more than 7 days from the LMP date or more than 10 days.

Read terms. Pettker, MD; James D. Goldberg, MD; and Yasser Y. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. As soon as data from the last menstrual period, the first accurate ultrasound examination, or both are obtained, the gestational age and the estimated due date EDD should be determined, discussed with the patient, and documented clearly in the medical record.

Subsequent changes to the EDD should be reserved for rare circumstances, discussed with the patient, and documented clearly in the medical record. When determined from the methods outlined in this document for estimating the due date, gestational age at delivery represents the best obstetric estimate for the purpose of clinical care and should be recorded on the birth certificate.

For the purposes of research and surveillance, the best obstetric estimate, rather than estimates based on the last menstrual period alone, should be used as the measure for gestational age. For instance, the EDD for a pregnancy that resulted from in vitro fertilization should be assigned using the age of the embryo and the date of transfer. 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.

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. An accurately assigned EDD early in prenatal care is among the most important results of evaluation and history taking.

ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries.

Name the time in gestation when ultrasound is most accurate 2. Discuss the ACOG recommendations for redating a pregnancy based on trimester. Postgraduate Institute for Medicine PIM requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest COI they may have as related to the content of this activity.

Discuss ACOG’s and SMFM’s Safe Prevention of the Primary Gynecologists (​ACOG) i) Note whether dating criteria is optimal (confirmed or set by

Preeclampsia Pre-E is a hypertensive disease of pregnancy with multi-system involvement that usually occurs in the second half of pregnancy. Improvements to the current diagnostic paradigm have been evaluated. However, no stand-alone diagnostic method has emerged that more accurately identifies women at risk for preeclampsia, warranting improvements in diagnosing Pre-E. This sample collection study will obtain serum and urine samples from pregnant women who present with clinical signs, symptoms, or conditions contributing to the suspicion of Pre-E.

Samples will be used to evaluate and validate the performance of an assay intended to aid in assessing the risk of Pre-E. Eligible subjects will provide written informed consent after which demographic and baseline clinical data will be recorded. Collection of whole blood and urine samples will be performed at one or more clinic visits from pregnant women carrying a single fetus with no known fetal abnormalities.

In addition, a group of pregnant women diagnosed with Pre-E will be enrolled as positive control cases. Latest version submitted January 22, on ClinicalTrials. A study version is represented by a row in the table. Select two study versions to compare. One each from columns A and B.

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Redating a pregnancy may occur when there is a discrepancy between the estimated due date EDD calculated by the last menstrual period LMP and that by ultrasound. Care should be taken when redating a pregnancy, especially in the third trimester, as there may be other reasons for a fetus to be small for gestational age e. According to the ACOG redating is more reliable using the earliest available and reliable ultrasound examination surrogates.

For instance, CRL in the first trimester would be more accurate than a debatable uncertain LMP or 2nd-trimester biometrics. The estimated timelines listed below mandates the redating of pregnancy when these differences happen on obstetric US exams. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.

○Estimated date of delivery (EDD) – The EDD is days from the onset of the ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Obstet Gynecol ;

Join NursingCenter to get uninterrupted access to this Article. Accurate determination of the estimated due date EDD during pregnancy has personal and social significance for the woman and her family, guides obstetric evaluation and intervention, and has research and public health consequences. Ultrasound measurement of the crown-rump length CRL in the first trimester is considered the most accurate estimator of the EDD.

Once the EDD is determined it should be documented in the medical record and discussed with the patient. Although determination of the EDD is a responsibility of the obstetric provider, nurses should be aware of the process of standards-based determination of EDD to give the most accurate and current information to women and their families and to enhance the nurse’s advocacy role surrounding gestational age-based assessments and interventions.

Obstetrics and Gynecology , 4 , Baskett T. Naegele’s rule: A reappraisal. Standards-Based Determinati Share This. Article Content Accurate determination of the estimated due date EDD during pregnancy has personal and social significance for the woman and her family, guides obstetric evaluation and intervention, and has research and public health consequences. More Featured Jobs.

Twin Pregnancy Obstetric Care Guidelines

NCBI Bookshelf. Kenia I. Edwards ; Petr Itzhak. Authors Kenia I. Edwards 1 ; Petr Itzhak 2.

Pregnancy dating was confirmed by ultrasound before 20 weeks of and post-​ACOG guidelines was conducted in the following subgroups: (1).

Read terms. Miller, MD, and R. Phillips Heine, MD. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. This document provides guidance for managing pregnancies in which the best clinical estimate of gestational age is suboptimal. There is no role for elective delivery in a woman with a suboptimally dated pregnancy.

Although guidelines for indicated late-preterm and early-term deliveries depend on accurate determination of gestational age, women with suboptimally dated pregnancies should be managed according to these same guidelines because of the lack of a superior alternative. The best clinical estimate of gestational age should serve as the basis for decisions regarding antenatal corticosteroid exposure in women with suboptimally dated pregnancies who are at perceived risk of preterm delivery.

Amniocentesis for fetal lung maturity is not recommended as a routine component of decision making when considering delivery in a woman with a suboptimally dated pregnancy. Late-term delivery is indicated at 41 weeks of gestation when gestational age is uncertain, using the best clinical estimate of gestational age.

Standards-Based Determination of the Estimated Due Date

The guidelines appeared in the September issue of Obstetrics and Gynecology. Post-term pregnancy is defined as a pregnancy that has extended to or beyond 42 weeks of gestation days, or estimated date of delivery [EDD] plus 14 days. The reported frequency of post-term pregnancy is approximately 7 percent. Most cases of post-term pregnancy result from a prolongation of gestation.

Dating criteria: optimal estimation of gestational age. Hospital and physician practice policies that facilitate ACOG criteria. Awareness of risks & expected benefit.

Due to ongoing road work, please plan for extra travel time to the hospital. Many aspects of the obstetric management of a twin pregnancy are different than for a singleton pregnancy. Printable Diagram of the Classification of Identical Twins. Click here for an illustrated and printable diagram of the classification of identical twins that you can share with your patient. Am J Obstet Gynecol ; 5 : A woman carrying twins has unique nutritional needs, especially for additional calories.

Because the patient most often experiences early satiety and loss of appetite, we recommend a consult with a nutritionist to address this and other issues. All women carrying twins — regardless of age — are candidates for routine aneuploidy screening. For dizygotic twins, there is a higher probability that one or more of the fetuses will have a trisomy, resulting in a higher overall risk to the pregnancy. The incidence of congenital anomalies is fold higher in monozygotic twins than in singletons or dizygotic twins; thus, we stress the importance of an early anatomy ultrasound.

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Clinical Guidelines

Replacing abdominal palpation with symphysis-fundal height SFH measurement for the assessment of fetal growth is not recommended to improve perinatal outcomes. A change from what is usually practiced abdominal palpation or SFH measurement in a particular setting is not recommended. SFH measurement is a commonly-practiced method of fetal growth assessment that uses a tape measure to measure the SFH, in order to detect intrauterine growth restriction IUGR. It also has the potential to detect multiple pregnancy, macrosomia, polyhydramnios and oligohydramnios.

For fetuses growing normally, from 24 weeks of gestation, the SFH measurement in centimetres should correspond to the number of weeks of gestation, with an allowance of a 2-cm difference either way

* Adopted from: ACOG reVITALize “Obstetric Data Definitionsexternal icon” and “​Method for Estimating Due Dateexternal icon” (Committee Opinion No.

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