Pregnancy - first ultrasound appointment

Which part of the world?

UK....

The first 12-wk scan is usually to specifically date the duration of the pregnancy, and of course check that there is still baby in the uterus. If the baby is coming up underdeveloped, then it could just purely be that the woman got her dates wrong. It's down to the experience of the sonographer on what abnormalities are picked up, but I think at that stage you're looking maybe at only major problems (limb deformities etc). Just don't quote me on that

On your pregnancy notes (uk anyway) you have both an estimated date of coneception, then a Scans due date. They go by your estimation up until 12wks, then use the scan's for the remainder of the 40wks.

In the UK, scans are done at the hospital, then the notes forwarded to the midwife or specialist. The doctor isn't present. The only time a doctor was present with mine was when I had an earlier scan at 8wks (heavy bleeding, I'd lost a twin I didn't know I was carrying).

My daughter in law got her first ultrasound at around 8 weeks - they live in a small coastal town in Hawaii! But of course the baby is very tiny at that point, I'm not even sure you could tell if there was anything wrong.

If the first appointment is early, then the doctors wouldn't have heard the heartbeat yet. You can see it on ultrasound before you can hear it. (It looks amazing!) Also, if the woman is less than six weeks pregnant, the ultrasound technician isn't going to see anything at all. In my experience, the technician sent the images to the doctor. They aren't allowed to make a diagnosis on anything. It can be infuriating if they obviously think something is wrong but can't say.

If the woman is not as far along as she thinks, odds are the doctors would've noticed before the ultrasound because her hormone levels on her blood test would've come back low. They might then do several follow-up tests and if the hormone levels rose as they should, they'd probably assume all was well and she just got her dates confused.

I have been accused of getting my dates wrong by almost three weeks. With my last pregnancy, my hormone levels were low and one doctor told me I was either miscarrying or I was actually four weeks pregnant, not six. I knew my dates were not wrong, so sadly, I knew the answer. But I was surprised they suggested I could be that mixed up.

For whatever it's worth, you can always borrow a copy of What to Expect When You're Expecting at the library. It'll give you a week-by-week outline of fetal development and what a typical exam is like at the various points. You can also look up ultrasound photos online, but honestly, a still image doesn't do much justice to a moving one. At seven weeks, you can see the heart as a throbbing vein in the middle of the body. In a still image, you can't see it at all. (At least, untrained me couldn't see it.)

It depends on how far along she is at her first u/s.

The earliest one I had was at 6 weeks with baby #3. I had to have a blood test to make sure I had enough Hcg to even see a baby. I did and they did a transvaginal u/s (fun). Her little heart was fluttering away (I was bleeding that's why I had the us).

I had an u/s at 12 weeks with my first daughter because they couldn't find a heartbeat.

Had a u/s at 10 week with my second dd because they couldn't find one either (I have a tilted uterus).

But back to your question, doctors usually tend to go with the us dates over the period dates you give them. If a baby was 2 weeks behind, they would probably schedule another us to see if the baby was growing right and didn't have any defects.

Hope this helps.

Sat Nam! (literally "Truth Name"--a Sikh greeting)

I had an ultrasound at 3 months or a little less. The midwife couldn't hear a heartbeat. The ultrasound showed a little glob of tissue. Nothing that remotely looked like a baby. The ultrasound was done in a training hospital, so a doctor rather than a tech was at the console. He said, "I'm sorry to tell you, but that baby's dead." I asked if I might have my dates wrong. He said, no, and showed me how big the fetus would be if it were viable, even if the dates were wrong.

I miscarried that night.

Blessings,

Siri Kirpal

ohthatmomagain said:

If a baby was 2 weeks behind, they would probably schedule another us to see if the baby was growing right and didn't have any defects.

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^This.

And just to second the people who said the first U/S is 12-13 weeks in the US unless you have some kind of risk factor like bleeding. You can see the heartbeat from as early as 5 weeks on a transvaginal U/S (had to have one around that time with both of my preganancies -- what fun!). A smaller than expected embryo is often an indicator of a miscarriage because it means it stopped growing, but if the heartbeat is there, then it means the baby is alive and they'd probably just want to check up on it occasionally.

Also, they do measure size in milimeters and calculate due dates down to the exact day based on size, even at 5 weeks. So I can only assume they'd tell her she must have ovulated late or something.

The answer (as it is to most pregnancy questions) is: it depends.
A first trimester ultrasound is good at predicting a due date. If the dates are off by two weeks, but everything looks good, it simply suggests the due date is two weeks off. An 8-week ultrasound is considered predictive +/- 4.48 days. So really it would indicate a dating error more than anything else.

Some reasons for a first trimester ultrasound:
uncertain or unknown LMP
first trimester bleeding
worries about ectopic
first trimester genetic screening
uterine size greater than or less than dates would indicate

What do you need for your story?

lac582 said:

I'm a woman but I've never been pregnant, so I'm in the dark here

If a pregnant woman went in for her first ultrasound, and the heartbeat sounded fine and the development of the embryo looked normal (i.e. no visible defects) except that it looked about 2-weeks behind based on the date the woman gave as the first day of her last period, what would that indicate? How would the doctor react?

Could it be something innocuous, like assuming the woman is mistaken about the date or just ovulated super late, or would it inherently suggest something medically serious? What other tests might the doctor perform?

Thanks all!

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Pretty sure they'd just assume the woman either got her dates wrong or didn't have a regular cycle. I was told I was 4 days out. I had a completely regular cycle and I know my dates were correct. It wasn't an issue at all. If my cycle had been a bit irregular and I'd misremembered my period dates by a couple of days, it could have pushed up towards 2 weeks, easy.

In the UK at least, dating scans are done fairly early (about 12 weeks) and anomaly ("is anything wrong?") scans are much later, around 20 weeks. There's not a huge amount of overlap. The sonographer made a big point at my dating scan of explaining that this wasn't an anomaly scan and at this stage they couldn't see a great deal in terms of possible problems. Except for really massive ones, of course.

lac582 said:

If a pregnant woman went in for her first ultrasound, and the heartbeat sounded fine and the development of the embryo looked normal (i.e. no visible defects) except that it looked about 2-weeks behind based on the date the woman gave as the first day of her last period, what would that indicate? How would the doctor react?

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It depends.

Here the first scan is usually the 12 week scan - although, depening on circumstance, it can be earlier or later.

If it's a lot earlier, for instance with a history of problems etc, then that will be taken into consideration. However, the baby needs to be a decent size to enable accurate reading of size etc.

Dates change all the time, more so in later pregnancy, but it's not uncommon in the first scan. In fact, the 'due' date won't really be determined until the 20 week scan.

If the scan shows that the baby is very small for it's age, then that will be mentioned, although bear in mind that it's not a doctor scanning you. I was told, a couple of days before I gave birth, during an emergency scan, that my baby was very small and that I should be prepared if it needs to be taken to the special baby unit for more care, as they weren't sure, at 39 weeks, if my baby would make 6lbs. Two days later I gave birth to a little girl who weight 8lb10.

Unfortuantely that's the way of things.

Dates are tricky, especially as some women will have a bleed in the first month of pregnancy which is similar, but not the same as a period, and often gets mistaken for one. In this case it would perfectly explain the pregnancy being two weeks further along than it was thought.

Could it be something innocuous, like assuming the woman is mistaken about the date or just ovulated super late, or would it inherently suggest something medically serious? What other tests might the doctor perform?

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At that stage, if the baby is forming correctly - heart, liver, kidneys and limbs, then nothing would be done. It would be noted that he dates seemed to be earlier and it would be mentioned that some women have bleeding or spotting early on and that could be a reason for the earlier dates.

Niiicola said:

^This.

And just to second the people who said the first U/S is 12-13 weeks in the US unless you have some kind of risk factor like bleeding. You can see the heartbeat from as early as 5 weeks on a transvaginal U/S (had to have one around that time with both of my preganancies -- what fun!). A smaller than expected embryo is often an indicator of a miscarriage because it means it stopped growing, but if the heartbeat is there, then it means the baby is alive and they'd probably just want to check up on it occasionally.

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These aren't common in the UK, mostly, I feel, because we aren't as clued up when it comes to general ob-gyn health as other countries and they freak people out. That said, it's uncomfortable and very invasive, and I feel for anyone who has to have one.

lac582 said:

Actually, one more question if anyone's still reading: the hormone level tests. Do they perform those at the ultrasound appointment and have the results instantaneously? Do they do them before the visit? At the visit then get the results later?

Is it a blood test or urine test?

Thanks!

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Hormone levels are done with a blood test, as far as I know. They tend to do that at your first appointment, not at the U/S.

It really depends on whether your character was having a normal pregnancy up to this point. If so, then the first appointment (in the US) is usually at around 8 weeks (starting from the first day of your last period). They give you a general checkup, and most likely do a blood test to check your levels. You wouldn't get the results for a couple of days on that. If the levels are off, then they'll probably schedule you an U/S to check on things early.

If your character had funky symptoms before 8 weeks, like bleeding, they'd have her come in ASAP and do a blood test and possibly schedule an U/S. At such an early point in pregnancy, miscarriage is pretty common, so they'd be checking for that. In most cases, the medical visit/blood test is done at the doctor or midwife's office and the U/S is done as a separate appointment at a hospital or special facility.

Hope that helps!

ETA: I did have a blood test done at one of my ultrasounds, as well. It was at the hospital and for an early at-risk type of situation. Again, no results until the next day or two.

With my first and second child I had a transvaginal ultrasound with both at seven weeks. I was not considered high risk. It was performed by the physician as they had their own ultrasound machine in the office. They utilized it to ensure the embryo was attached within the uterus and not the fallopian tubes.

A second ultrasound, this one external, was completed around 14 weeks. It was at this time they could have determined the sex of the baby.

With my oldest, I had a third ultrasound a month before my due date. While doing the ultrasound the doctor said "This baby is too small. I'm concerned something is wrong." He based his concerns on the femur measurements, one of numerous measurements taken during ultrasounds. He immediately asked how tall I was (5'10") but once I explained to him my mother in law was 5'0" he relaxed. She was born one week later (three weeks early) and was perfectly healthy. She was, however, 5lbs 11 ounces and 17 3/4 inches.

With each of my three children, additional ultrasounds were ordered because I was "measuring small". At each appointment, the doctor or nurse will measure from your pubic bone to the top of your uterus. A lack of growth is an indicator for further diagnostic testing.

In Blighty the first ultrasound is at the twelve week mark or there abouts, unless there is a pre-existing condition that might prompt an earlier scan.

At the first scan of our first child they took measurements and brought our due date forward by about two weeks, even though we knew exactly when we conceived because we were "assisted".

The room was darkened and there were two monitors on which to view the scan, both parents to-be wept joyfully at the first glimpse of their unborn little one.

Incidentally, we had the first midwife visit today at week 13 for bambino 2. We won't hear the heart beat until about week 18-20 if memory serves.

the hormone level tests are called beta blood draws (assuming you are asking about hcg testing) and they are considered quantitative pregnancy tests.

They are done in cases of pregnancy after infertility or pregnancy where multiples are suspected, in cases of prior miscarriage or increased risk of miscarriage, etc. and they are generally done two within 48 hours of each other around 4 weeks gestation (approx. the time of the missed period, positive pregnancy test).

What the doctor is looking for in these tests is that the amount of hcg in the woman's blood has doubled within 48 hours.

Hope that helps.

Two pregnancies in the US, never had an ultrasound until 18-20 weeks. My doctor didn't do 12-week scans unless there was a high risk or something, or maybe my insurance only covered one; I don't know. I was always so jealous reading about 12-week scans, because I never got one.

(The night before I was induced with my first, though, I was having contractions and went to the hospital. They decided to do a u/s before discharging me, and at one point the scanner hit just the right angle and we saw, in perfect detail, our sleeping baby's sweet little face. It was pretty damn cool.)

Stacia Kane said:

Two pregnancies in the US, never had an ultrasound until 18-20 weeks. My doctor didn't do 12-week scans unless there was a high risk or something, or maybe my insurance only covered one; I don't know. I was always so jealous reading about 12-week scans, because I never got one.

(The night before I was induced with my first, though, I was having contractions and went to the hospital. They decided to do a u/s before discharging me, and at one point the scanner hit just the right angle and we saw, in perfect detail, our sleeping baby's sweet little face. It was pretty damn cool.)

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Awwww that is cool!

I had the opposite experience. I had two ultrasounds in the 6th week, one at 7, one at 8w, 10w, 12w, 20w, 22w, 26w and then every other week until I delivered at 38 1/2 weeks.

But, I was high risk (multiples)