Pregnancy ultrasound
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anonynon
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Joined: Dec 22, 2007
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 Posted:
Sep 17, 2008 - 12:18 PM |
 
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| Post subject: Pregnancy ultrasound |
I am pregnant but really don't know how long for. I am going back home next month but that could potentially take me over 12 weeks. my understanding is that to age a foetus accurately, you need to do it within the first trimester.
Do you think it's worth doing an ultrasound here? I would expect that it is not possible to obtain the actual scan to take home as it is not permissible to reveal the baby's gender, so I would just be relying on the doctor's estimation which may actually be based on a different calculation method to back home (e.g. from estimated conception rather than first day of the period).
Do you think it is worth doing the scan, and does anyone have any hopital recommendations? I no longer have health insurance as I've just quit my job so it would have to be for a (semi-) local hospital. |
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sinned69
Veejay
Joined: Sep 01, 2004
Posts: 1854
Location: China, Middle East, Asia Pacific
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Sep 17, 2008 - 02:47 PM |
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in reply...
The estimation of pregnancy dates is somewhat complicated but uses 3 basic methods used to help estimate gestational age (GA) and these include; menstrual history, clinical examination, and ultrasonography. The first 2 are subject to considerable error and should only be used when ultrasonography facilities are not available. The date of feeling the first fetal movements (quickening) is far too unreliable to be useful. In rare cases, the date of coitus is known, and this may be useful in calculating the length of pregnancy.
-GA refers to the length of pregnancy after the first day of the last menstrual period (LMP) and is usually expressed in weeks and days. This is also known as menstrual age.
-CA Conceptional age is the true fetal age and refers to the length of pregnancy from the time of conception. This terminology does vary geographically and over time, and it may need clarification.
Gestational age (GA) has traditionally been estimated from the date of the last menstrual period (LMP). That conception occurs on day 14 of the cycle is assumed. The fallacy in this assumption is that the time of ovulation in relation to the menstrual cycle varies greatly, both from cycle to cycle and individual to individual. Basing GA on the LMP tends to result in an overestimation. The 95% confidence interval of menstrual dates is -27 to +9 days. To further complicate matters, 10-45% of pregnant women cannot provide useful information about their LMP, and 18% of women with certain menstrual dates have significant differences between menstrual and ultrasonographic dating. The accuracy of menstrual history in women with a history of oligo-ovulation, such as those with polycystic ovarian syndrome, should be questioned. If pregnancy occurred while oral contraceptives were being taken, the LMP cannot be used because such measures have no bearing on ovulation.
Date of pregnancy test
Knowing the date of the first positive pregnancy test result allows the calculation of a minimum GA. This depends on the sensitivity of the test. For example, if the test was performed 4 weeks ago and the test is known to return positive results as early as 1 week after conception, then the minimum CA would be 5 weeks (GA, 5 + 2 = 7 wk of amenorrhea). This information can be useful in clinical practice if the test finding has been documented by a health care professional.
Pregnancy following assisted reproduction techniques
The GA of pregnancies resulting from in vitro fertilization can be precisely calculated from the time of embryo replacement; however, conception may be delayed for a few days in pregnancies resulting from intrauterine insemination. In patients who have had ovulation induction, calculate GA from the day of human chorionic gonadotropin administration.
Clinical examination
The size of the uterus can be assessed by pelvic examination or by abdominal palpation. Size can be misleading in the presence of multiple pregnancy, uterine fibroids, or a full bladder. Tape measurement of the symphysis-fundus height may be useful up to 28-30 weeks' gestation, beyond which it becomes too inaccurate for dating.
Perception of fetal movement
The perception of fetal movement by the patient, often referred to as quickening, is a relatively late sign of pregnancy, usually occurring at 19-21 weeks' gestation in nulliparous women and 17-19 weeks' in multiparous women. Before the advent of pregnancy tests and ultrasonography, quickening was often the method by which a suspected pregnancy was confirmed; however, at present, it has little diagnostic value.
The expected date of delivery (EDD) is one of the earliest pieces of information a pregnant woman requests once pregnancy is confirmed. In order to calculate this, the practitioner must know the median length of normal pregnancy and the last menstrual period (LMP) or ultrasonographic estimation of gestational age (GA). Pregnant women should be counseled that only 4% of all babies are born precisely on the estimated date of confinement. Failure to appreciate this may lead to unnecessary maternal anxiety if a pregnancy progresses beyond the EDD. Therefore, giving a range for the likely date of birth (eg, estimated date of confinement ± 2 wk) is more useful.
The median length of human pregnancy is 280 days of amenorrhea (from the first day of the LMP) or a CA of 266 days (280 - 14). Infants born before 37 completed weeks' gestation are deemed preterm, whereas those born after 42 weeks' are considered post-term. In normal pregnancies, the length of gestation is not affected by maternal characteristics.
The Nägele rule and the obstetric wheel
In women with regular cycles and a certain LMP, the EDD is calculated by adding 7 days to the first day of the LMP and adding 9 months. For example, with an LMP beginning on June 15, the EDD will be March 22 of the following year. Most antenatal clinics have obstetric wheels. These consist of an outer wheel that has markings for the calendar and an inner, sliding wheel with weeks and days of gestation. They facilitate the estimation of GA and the calculation of the EDD. The quality of these wheels varies, but in general, the larger wheels yield better results.
Dates calculated on the basis of the LMP are often inaccurate because the time of ovulation can be extremely variable in relation to the occurrence of menses. Furthermore, cycle lengths among women vary greatly, as they do for individual women, changing from cycle to cycle, with a standard deviation of plus or minus 2.5 days. The tendency is toward longer anovulatory cycles, and in such women, the error in GA estimation can be much greater.
Ultrasonography in the first trimester
GA in the first trimester is usually calculated from the fetal crown-rump length (CRL). This is the longest demonstrable length of the embryo or fetus, excluding the limbs and the yolk sac. The correlation between CRL and GA is excellent until approximately 12 weeks' amenorrhea. No sex or race differences are appreciable. The GA estimate has a 95% confidence interval of plus or minus 6 days. The following formula allows the estimation of GA (weeks) from the CRL (mm):
GA = –0.0007 (CRL)2 + 0.1584 (CRL) + 5.2876
Ultrasonography in the second trimester
Fetal biometry in the second trimester can yield acceptably accurate estimates of GA from 12 to approximately 22 weeks of amenorrhea. Recent work has shown that the accuracy of ultrasonographic biometry at 12-14 weeks' gestation is at least as good as biometry performed after 14 weeks, 2004). The best parameters are the biparietal diameter (BPD) and the head circumference (HC), which are virtually linearly related to GA. The femur length (FL) can also be used and is nearly as accurate as head measurements. Racial differences in FL are significant, but differences in HC are not. GA estimates by the BPD or HC have a 95% confidence interval of plus or minus 8 days. The following formula allows estimation of GA (days) from the BPD (mm):
GA = 39.1 + 2.1 (BPD)
Ultrasonography in the third trimester
Fetal biometry in the third trimester is subject to much greater individual size variations than in the second trimester. Its accuracy for GA assignment is reduced considerably, and estimates may have confidence intervals of plus or minus 3 weeks. More recent work with pregnancies resulting from in vitro fertilization suggests that third trimester scans are considerably more accurate, with random errors (1 SD) of 8-9 days. This is equivalent to confidence intervals of about plus or minus 2 weeks.
In many ultrasound departments, a common practice is to combine the last menstrual period (LMP) with ultrasonographic dates in what is known as the 10-day rule or 7-day rule. For example, with the 10-day rule, if LMP dates and ultrasonographic dates are in agreement within 10 days, LMP dates are accepted. On the other hand, if the discrepancy exceeds 10 days, ultrasonographic dates are used. The rationale for using these rules is to exclude large errors from incorrect menstrual dates. The implicit assumption of this method is that menstrual dating is preferable to ultrasonographic dating. Detailed analysis from large databases has not shown any advantage in using these rules. Unless the fetus is thought to be anatomically abnormal, ultrasonographic dates may be used for all pregnancies if a scan is available in the first half of pregnancy. However, combining menstrual dates with ultrasonographic dates is still widely practiced in the United States and in Australia.
Gestational age calculators
Computer software is now available for accurate determination of GA from either ultrasonographic biometry or menstrual dates, and results are more accurate than those obtained with obstetric wheels.
you ask about facilities in China, well simply put, most facilities will provide ultrasonography scans, without too much identifying features, which to the lay person would be near on impossible to interpret anyway. The "scan" will also detail useful information aside from the intrauterine "picture".
There are a number of facilities in Shanghai that offer services to foreigners aside from the wholly/fully foreign run facilities that may suit your budget.
heres a list of facilities...
Shanghai Hospitals
American-Sino Ob/Gyn Service
6249-3246 (8am-8pm) / 2288-2373 (24hr)
Website: www.americanobgyn.com
Shanghai East International Medical Center
551 South Pudong Road Pudong, Shanghai 200120
5879-9999
Website: www.seimc.com.cn
United Family Hospitals Updated!
1139, Xian Xia Road, Changning District, Shanghai
6291-0917
Website: www.unitedfamilyhospitals.com
World Link
Portman Clinic 1376 Nan Jing Road
The Shanghai Center, Suite 203
6279 7688
Hong Qiao Clinic (Medical and Dental)
788 Hong Xu Road, Mandarin City, Unit # 30
6405 5788
New Pioneer Medical Center
2F Ge Ru Building, 910 Heng Shan Road, Xu Hui
6469 3898 Fax: 6469 3897
Huashan Hospital (19th floor)
2 Wulumuqi Zhong Road, Jing An
6248 3986 Fax: 6248 8476
Sino-Canadian Shanghai Dental Center
639 Zhi Zoo Ju Road, Nan Shi
63133174
Int'l Peace Maternity Hospital
910 Heng Shan Road, Xu Hui
6438 2452
Shanghai Medical University Children's Hospital
183 Feng Lin Road, Pudong
64047129
Dr Anderson & Partners General Medical Clinic
Room 1001, Block D New Century Plaza, 48 Xing Yi Road, Hong Qiao
6270 3263
Sheng Da Dental Hospital
No.1, Lane 83, Tai Yuan Road, Xu Hui
64377987
Rui Jin Hospital
197 Rui Jin Er Road, Lu Wan
6437 0045
IMCC First People’s Hospital
85 Wu Jin Road, Hong Kou
6306 9480
Huadong Hospital
221 Yan An Xi Road, Pu Dong
6248 4867
Ren Ji Hospital (Pucongi
1630 Dong Fang Road, Pudong
5875 2345
Global Healthcare
Level 3, Room 301
Shanghai Kerry Centre
1515 Nanjing Road West
5298-6339
Parkway Health Clinics
-389, Level 4 Nanjing Xi Lu, Tomorrow Square
-203-4 West Retail Plaza, 1376 Nanjing Xi Rd
-170 Danshui Lu, 2/3 Floor (Near the corner of Danshui Lu and Xinye Lu, near Xintiandi) |
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anonynon
Lurker
Joined: Dec 22, 2007
Posts: 21
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| Posted:
Sep 17, 2008 - 04:23 PM |
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Many thanks for so much interesting information and also for answering my question. What I want is a copy of an early (and therefore more accurate) 'scan' that I can take home to doctors responsible for me throughout my pregnancy and I'm happy to learn that I may be able to achieve this. I'll skip the dental hospital  and have a look at some of the useful hospital links you've provided. Thank you once again for such a comprehensive answer. |
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rebeccalund123
Talker
Joined: Feb 27, 2006
Posts: 92
Location: Huangpu
Status: Offline
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Sep 19, 2008 - 06:41 PM |
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Just for the record:
American Sino (Huashan)
Consultation 500
Ultrasound 500
Shanghai East International Medical Centre
Ultrasound 1,200 (didn't clarify whether this included consultation)
Shanghai United
Consultation 1,000 - 1,200
Ultrasound 370
Ruijin
Consultation 300
Ultrasound 300
(pushy receptionist)
Ren'ai
Consultation 90
Ultrasound 180
I went to Ren'ai as I am familiar with it from dental treatment. It has what I presume to be a new foreigner's department which obviously ups the price a bit but you get the nice surroundings and translation.
The consultant I saw was very nice and talked to me for a few minutes. After ascertaining I wanted the baby she was very happy to send me for the scan. I was then ushered to the ultrasound in the ordinary part of the hospital. As this is a private hospital it is quite nice anyway and it was clean and the equipment modern. Everyone in the room was female but the attitudes were pretty typical, patient as a lump of meat, seen-it-all-before-and-you-come-out-lacking, Chinese doctor. The ultrasound was internal, inserted by lubricated condom and there were cries of "too big" (God knows what, I don't want to think about it). Afterwards a paper towel was thrown onto me and I was dismissed.
Having said that, my conception date was either going to be very specific or several weeks earlier. The predicted date was only one day away from my calculation and there is a nice colour printout including details of the health of my womb ovaries and of course the baby. The nice consultant gave me basic nutrition, lifting, resting type advice and the whole thing was over within 20 minutes. If you can steel yourself to the indignity I think it's very good value. |
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anmile
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Joined: Mar 28, 2005
Posts: 39
Location: Xuhui
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Sep 21, 2008 - 09:02 AM |
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sorry to bring that up: but i would be very cautious flighing in the first trimester. that is when all the organs are formed and the radiation from security check and up in the sky can add up to quite an amount ... |
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tnmom
PopStar
Joined: Mar 04, 2004
Posts: 1169
Location: No longer in Shanghai
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Sep 21, 2008 - 09:14 AM |
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I would think that getting an ultrasound here would not give you too much useful information. Babies don't arrive exactly when they are supposed to anyway. I suggest calling your home country doctor and asking them if an early scan will be of value - you may find that it isn't even part of their standard procedure. |
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Cure
Newbie
Joined: June 25, 2005
Posts: 7
Location: Shanghai
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Sep 21, 2008 - 09:04 PM |
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The early ultrasound exam is not required for all pregnant women, however, there are several reasons for an early ultrasound for some women, I am listing a few here: 1. Not sure about your date. Some genetic testings are done based on your date/gestational age. If you are not sure about your date/conception time, and you would like to do some genetic testings, the first trimester ultrasound is a more accurate way for dating. 2. History of GYN problems. Certain medical history can cause high risk of ectopic pregnancy, pregnancy loss etc, it is better for them to know the viability/location of the pregnancy early. 3. Advanced maternal age increases chance of chromosomal abnormalities, which needs early screening if one wishes. Now one type of genetic testing can be done as early as 11-14weeks with ultrasound scan of the baby's neck thickness and blood test to analyze the risk of Down symdrome etc. There is a window time for this more accurate test.
It really depends on your history and condition whether you need the early ultrasound or not.
Michelle Lu-Ferguson, MD
Fellow of American College of OB/GYN
http://www.parkwayhealth.cn/specialty.php?id=6 |
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FTM
Raver
Joined: Apr 15, 2007
Posts: 478
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Sep 23, 2008 - 03:41 PM |
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Can anyone recommend a clinic that can perform a very good and clear 20-week anomaly scan? CD a plus. |
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iara
Fire-eater
Joined: June 09, 2006
Posts: 2676
Location: brazil-shanghai
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Sep 23, 2008 - 06:03 PM |
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One friend had some consultations at United Family Hospital till her 3rd month, made some exams, i't was very good. But as she didn't have any health insurance, and the cost for having a cesarian at United was around 120.000¥, she went to Peace Maternity, where the cost was 23.000¥.
The worst part: the doctor at Peace told her that looking at one exam made by United, she could tell that her baby had Down Syndrome, for sure, and that she needed to do another kind of exam, that could hurt the baby a lot, even kill him.
My friend called her doctor in Brazil, that already had looked all her exams also, and he told her that the Peace doctor was wrong, cause he couldn't see anything wrong, and has no reason to do the dangerous exam.
My friend went back to Peace, ask again, doctor confirm 100% that it was sure, and she needed to sign a paper agreing with the exam.
But as the doctor went on a trip, my friend tried to forget about the Down and exam, and was just praying and crying, but finally decided not to do any exam or even not to think about abortion, as the doctor also mentioned.
One week before her baby was born, she went to see the doctor, that was angry because of the non-exam. She went back sunday, with contractions, but the doctor told her it was too soon (my friend is 40, and for chinese they don't like deliveries when the 36 weeks arent complete yet,)gave her medicine and sendt her back.
She came back monday, in pain, assistant doctor wouldn't touch her  they were afraid. So, finally, doctor arrived, she had the cesarian, everything was fine - plus, the baby was quite healthy, no Down Syndrome 
Sorry, to post this, but this is just to warn: Do the scan in a good clinic/hospital, and have a good doctor to analyse it. I'm sure in this website you will find doctors names and also clinics names where you can go.
Because if someone not so good analyse it wrong, you can imagine what can happen.
And I know this is not because TIC, we know that this could happen anywhere, we have bad doctors at any country.
So, I can tell don't go to Peace. I have friends that had babies with good doctors at United and Ruijin. |
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lilstar
Reacher
Joined: June 20, 2005
Posts: 306
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Sep 23, 2008 - 06:28 PM |
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I have a friend who went to reputable hospital 9 years ago. From the ultrasound the doctor diagnosed that the baby's brain was not developed. My friend was around early 30 and was in 6months pregnancy. She tried to get more informations from the doctor but didn't get much. The doctor adviced her to have the baby aborted. She didn't take the advice, they went back to Australia and had second opinion. Aussie's doctor and ultrasound didn't find any problem with the baby's condition. She had delivered a beautiful and smart daughter, now the girl is around 8 y/o
I can't imagine if they never did second ultrasound with another doctor and the doctor just adviced them to get abortion because if they continued, either the baby won't survive or has disabilities. They even said that since my friend and husband still young, they still can get another baby. It's such a horrific story and a lesson for expecting mommy not to trust first opinion when there's problem. |
Last edited by lilstar on Sep 24, 2008 - 11:06 PM; edited 1 time in total |
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anonynon
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Joined: Dec 22, 2007
Posts: 21
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Sep 24, 2008 - 07:53 AM |
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Thank you for some very useful answers, but I'd like to take issue with some of the ridiculous scaremongering in this thread.
Firstly, the original question is about an early pregnancy ultrasound for dating purposes. I am not sure why people feel I have not thought this through. I personally feel I need it as I live more that three hours away from a hospital and in these circumstances, would like to be as accurate as possible with the due date so that all is prepared. My question was whether this accuracy could be achieved when the results could be interpreted differently for cultural reasons.
Secondly, anmile, I appreciate that your advice is very well meant but frankly it is extremely vague and in no way corresponds with prevailing medical opinion internationally. I see that you have absolutely no figures or evidence to back it up and therefore can see it serving no good purpose but to spread fear.
Thirdly, the last two posts are unbelievably off track. We are not talking about ultrasound for genetic testing purposes and all you are saying is that medical interpretation diverged in two cases you've heard about. It's hardly unusual and frankly your posts are based on hearsay and hysteria. The posts are not only irrelevant and damaging to the rather fragile state of mind of expectant mothers, but also smack of pure racism. Let's have some perspective. |
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freedelia
LoopKicker
Joined: Nov 27, 2006
Posts: 949
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Sep 24, 2008 - 06:27 PM |
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Well, if hearsay is not what you are looking for, THIS HAPPENED TO ME!!! Six months pregnant, went to the hospital because i had lost some water in the middle of the night and they told my husband the baby was dead!!!!! Of course he did not tell me anything he did not want to tell me until it was confirmed -- he spent an hour crying until they tried again with another machine and said "Sorry, everything is ok"
I think the people above wanted to help you with some good solid advice. When you open a thread, you do not own it and people can take it in different directions than where you wanted it to go. |
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iara
Fire-eater
Joined: June 09, 2006
Posts: 2676
Location: brazil-shanghai
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Sep 24, 2008 - 09:05 PM |
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Totally agree with you Freedelia.
It's easy when everything it's fine, but we know when the worst comes sometimes we need to know how to handle it. And many times here the worst isn't real.Or can be on the contrary (like with all the milk we drunk all those years, and just now someone checked it and tell us that it can kill, as it had kill babies!)
So, to the OP, I wish all the best, don't want to scare you with some scare story, but I just want to share what happened to a friend here, because, if it happens with you in the future, you can remember this thread and ask the doctor to be more accurate with any diagnosis.
But if you like it better, I can erase what I post and pretend that we live in heaven and every doctor and hospital are good here and that I believe in the Easter Bunny and Santa Claus!
good luck! |
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lilstar
Reacher
Joined: June 20, 2005
Posts: 306
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Sep 24, 2008 - 11:21 PM |
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I apologize if my reply was interpreted that way. I had no intention to spread the fear or being racist. It was pure the fact and I'm also pregnant so i am interested in any pregnancy topic. Sorry if it sounded like off the track or highjacking your thread. My reply might not related to your original question, however I'd just want to give some info for what was really happened so we have to take extra precautions during pregnancy. My story was not based on rumour because that was purely fact as told directly from my own friend ( not friend's friend or story i heard from somewhere ).
I've edited my first reply which might be interpreted as racist comments but I will not delete the post as I feel it's additional info for pregnant mothers who are pregnant. My best wishes that you'll get more usefull informations from others and have smooth and peaceful pregnancy. |
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anonynon
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Joined: Dec 22, 2007
Posts: 21
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Sep 25, 2008 - 07:37 AM |
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Okay. I've never met a woman who does not take every precaution she can during pregnancy and would seriously doubt that anyone would not request a second opinion in the event a medical professional said that there was a problem with a foetus. Everyone has horror stories about misdiagnosis and insensitivity by doctors during pregnancy. I could tell you, truthfully, about my being pronounced dead in the womb at eight months and my mother being told to go home as it was Christmas and there was nothing they could do until afterwards, or a (potential) sibling been killed in an amniocenticis. What good would it do? Almost any woman would have the same reactions as my mother, to know that doctors are not gods, whatever their nationality, and to protect the child at all costs.
Yes, talk about whatever you want in the threads, but please put your comments into context or you will not give any useful argument.
Lilstar, I am very sorry I upset you, and thank you for editing your post. |
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