Twins When a twin pregnancy is the result of in vitro fertilization determination of gestational age should be made from the date of embryo transfer. Clinical management guidelines for obstetricians-gynecologists. Number 55, September 2004 (replaces practice pattern number 6, October 1997).
Otherwise "..avoid missing a situation of early intrauterine growth restriction in one twin, most experts agree that the clinician may consider dating pregnancy using the larger fetus." [22,23].
"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" .
The Society of Obstetricians and Gynaecologists of Canada recommends the earliest ultrasound with a crown rump length equivalent to at least 7 weeks (or 10 mm) should be used to determine the gestational age .
Doppler Ultrasonography The fetal heart can be heard using Doppler ultrasound by 10 to 12 weeks in most patients . Savitz DA, Terry JW Jr, Dole N, Thorp JM Jr, Siega-Riz AM, Herring AH.
The gestational age should ,therefore, be at least 10 to 12 weeks if fetal heart tone are heard. Kramer MS, Mc Lean FH, Boyd ME, Usher RH: The validity of gestational age estimation by menstrual dating in term, preterm and postterm gestations. Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination.
However, ultrasound determination of the date of ovulation has the same imprecision as does the ultrasound estimate of the gestational age and, therefore, a precise date of conception cannot usually be determined as with in vitro fertilization.
Determining the Date of Conception Because the human egg is capable of fertilization for only 12 to 24 hours after ovulation the date of ovulation may be taken as being the date of conception. The American College of Obstetricians and Gynecologists recommends that ultrasound-established dates should take preference over menstrual dates when the discrepancy between ultrasound dating and LMP is "Because of the risk of redating a small fetus that may be growth restricted, management decisions based on third-trimester ultrasonography alone are especially problematic; they need to be guided by careful consideration of the entire clinical picture and may require closer surveillance, including repeat ultrasonography to ensure appropriate interval growth." . Birth weight from pregnancies dated by ultrasonography in a multicultural British population. Other Methods For Estimating the Gestational Age Clinical Examination A pelvic examination supported by good menstrual records in the first trimester has been reported to be a reliable method for dating of pregnancy . If you have agreed to have screening for Down's syndrome, the dating scan and the screening will usually happen at the same time.Find out more about the combined screening test for Down's syndrome.