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Gestational Age?
Here is my dilemma:
I found out about 1 1/2 weeks ago that I'm going to be a dad......of twins. The mother of the babies just found out as well, even though she is around 5 months pregnant.
She was on the birth control shot and the Dr.'s told her that her period would be very sporadic and absent for up to a year so she wasn't alarmed about missing her menstruation cycle. She also didn't have any morning sickness to speak of. Another important point is, she doesn't drink or smoke (thank god).
She is 20 years old and we had a short relationship that ended on good terms. We are now in a pickle.
I'll give you the exact details about her Menstruation cycle and the date we were together and hopefully you can let me know if I have reason to be concerned about her honesty.
1.) We were together on 9/2/07 Sunday and she claims this is the first day of her LMP. I do know she was on her period that day, 100% positive, although I'm not sure if it was her first day.
2.) We had unprotected sex on 9/15/07 Saturday.... (Probably right smack dab in the middle of her ovulation cycle...so based on this I'm thinking they are mine). I did not ejaculate in her. If I did impregnate her on this night the gestational age of the baby would be about 23 weeks 4 days, 165 days from her LMP. Based on a 37 week pregnancy (common for twins) the due date would be around mid-May.
3.) She got an ultrasound on 2/13/08 and everything looked healthy and no problems to speak of.
Here, however, is my dilemma. The report and analysis of the ultrasound reports that the big twin baby's gestational age is estimated to be around 19 weeks 4 days...and the smaller twin almost 1 week behind that and the probable due date being early July. That puts them at almost a full cycle behind where they should be.
In the research I've conducted, I realize that the accuracy of ultrasounds in determining gestational age can be sketchy at best the longer the pregnancy but they are usually only + or - two weeks.....not four weeks as in my case.
I also realize that growth rates may be different for twin babies as compared to singletons, however, that usually isn't recognized until the third trimester and twins usually grow faster.
She swears that she wasn't with anyone else around this time. Should she be trusted and should I be concerned about the health of my babies or both. Oh.....I do plan on getting a paternity test to make sure.
Question #1- Is it possible for the ultrasound to underestimate my babies gestational age by 4 weeks?
Question #2- If they are my kids and are small for gestational age (maybe due to malnourishment) what can be done now to catch up....if anything.
Question #3- What other concerns should I have? I'm going into the Dr. with her on Wednesday.
Thank you so much for your time.
nemt4paul
I found out about 1 1/2 weeks ago that I'm going to be a dad......of twins. The mother of the babies just found out as well, even though she is around 5 months pregnant.
She was on the birth control shot and the Dr.'s told her that her period would be very sporadic and absent for up to a year so she wasn't alarmed about missing her menstruation cycle. She also didn't have any morning sickness to speak of. Another important point is, she doesn't drink or smoke (thank god).
She is 20 years old and we had a short relationship that ended on good terms. We are now in a pickle.
I'll give you the exact details about her Menstruation cycle and the date we were together and hopefully you can let me know if I have reason to be concerned about her honesty.
1.) We were together on 9/2/07 Sunday and she claims this is the first day of her LMP. I do know she was on her period that day, 100% positive, although I'm not sure if it was her first day.
2.) We had unprotected sex on 9/15/07 Saturday.... (Probably right smack dab in the middle of her ovulation cycle...so based on this I'm thinking they are mine). I did not ejaculate in her. If I did impregnate her on this night the gestational age of the baby would be about 23 weeks 4 days, 165 days from her LMP. Based on a 37 week pregnancy (common for twins) the due date would be around mid-May.
3.) She got an ultrasound on 2/13/08 and everything looked healthy and no problems to speak of.
Here, however, is my dilemma. The report and analysis of the ultrasound reports that the big twin baby's gestational age is estimated to be around 19 weeks 4 days...and the smaller twin almost 1 week behind that and the probable due date being early July. That puts them at almost a full cycle behind where they should be.
In the research I've conducted, I realize that the accuracy of ultrasounds in determining gestational age can be sketchy at best the longer the pregnancy but they are usually only + or - two weeks.....not four weeks as in my case.
I also realize that growth rates may be different for twin babies as compared to singletons, however, that usually isn't recognized until the third trimester and twins usually grow faster.
She swears that she wasn't with anyone else around this time. Should she be trusted and should I be concerned about the health of my babies or both. Oh.....I do plan on getting a paternity test to make sure.
Question #1- Is it possible for the ultrasound to underestimate my babies gestational age by 4 weeks?
Question #2- If they are my kids and are small for gestational age (maybe due to malnourishment) what can be done now to catch up....if anything.
Question #3- What other concerns should I have? I'm going into the Dr. with her on Wednesday.
Thank you so much for your time.
nemt4paul
This is some of what the Dr. had to say.....
Question #1.....He said that ultrasounds are generally more accurate than LMP at 20 weeks and that is why they will continue to use the due date as determined by the 1st ultrasound.
He also basically said in not so many words "she must not have ovulated at that time". In other words "she didn't conceive on the 15th of Sept.” The thing is we only had sex on that date.
Question #2....He said "catch up" growth is a possibility if they are behind.
Question #3....Explained IUGR....I learned nothing new about this. He did say, however, that generally babies in the first two trimesters aren't labeled SGA because they grow at the same rates and that IUGR usually are recognized in the third trimesters.
Question #4....Explained Symmetrical VS. Asymmetrical and said that Asymmetrical is better....generally they catch up in the third trimester.
Question #5....Said we could adjust the due date and find out more at the next ultrasound. The next ultrasound is in the process of being scheduled. We are going to a specialist for a higher definition ultrasound.
This is due to only one placenta being recognized in the 1st ultrasound. He wants to see if there is only one or there are two that are fused together.
Question #6....not much else information. Everything so far (with exception to the placenta question) seems to be healthy and on schedule.
I still have a gut feeling that these babies are mine and the Dr.'s are just flat wrong on this one. Most of the health professionals that I've spoken with aren't coming out and saying it.....but I'm getting the impression they don't think these babies were conceived on Sept. 15th.
I'll continue to be there until the end. I will know a lot more in late May or early June. If these babies are born after June 8th, then I'd have to say they aren't mine. I sure hope they are.
I also thought that the most common types of identical twins “share” a placenta with two amniotic sacs….don’t they?
Question #1.....He said that ultrasounds are generally more accurate than LMP at 20 weeks and that is why they will continue to use the due date as determined by the 1st ultrasound.
He also basically said in not so many words "she must not have ovulated at that time". In other words "she didn't conceive on the 15th of Sept.” The thing is we only had sex on that date.
Question #2....He said "catch up" growth is a possibility if they are behind.
Question #3....Explained IUGR....I learned nothing new about this. He did say, however, that generally babies in the first two trimesters aren't labeled SGA because they grow at the same rates and that IUGR usually are recognized in the third trimesters.
Question #4....Explained Symmetrical VS. Asymmetrical and said that Asymmetrical is better....generally they catch up in the third trimester.
Question #5....Said we could adjust the due date and find out more at the next ultrasound. The next ultrasound is in the process of being scheduled. We are going to a specialist for a higher definition ultrasound.
This is due to only one placenta being recognized in the 1st ultrasound. He wants to see if there is only one or there are two that are fused together.
Question #6....not much else information. Everything so far (with exception to the placenta question) seems to be healthy and on schedule.
I still have a gut feeling that these babies are mine and the Dr.'s are just flat wrong on this one. Most of the health professionals that I've spoken with aren't coming out and saying it.....but I'm getting the impression they don't think these babies were conceived on Sept. 15th.
I'll continue to be there until the end. I will know a lot more in late May or early June. If these babies are born after June 8th, then I'd have to say they aren't mine. I sure hope they are.
I also thought that the most common types of identical twins “share” a placenta with two amniotic sacs….don’t they?
There has been some new information regarding the preganancy that I'd like to share. Any comments are welcome. This is a copy of the letter that I sent our OB before we met with him last week:
Dear Dr. ***** :
My name is ***** and I am writing this letter in regards to the pregnancy of my girlfriend, *****. I hope to provide you with information that will be helpful in the management of her pregnancy. We have our first appointment with you at the ***** Clinic on 3/13/08.
Here are some important details surrounding the pregnancy:
-*****’s LMP was 9/2/07.
-The date of intercourse was 9/15/07.
-***** went in for an ultrasound on 2/13/08, and learned at that time of her pregnancy with twins.
- On 2/13/08, ultrasound dates of Twin A was 19w3d. Twin B was 18w6d.
According to LMP, the gestational age of the babies on 2/13/08 should have been 23 weeks, 4 days, a discrepancy of approximately four weeks. The due date of our twins by LMP is 6/8/08, but by ultrasound it is estimated at 7/8/08. From the research I've done, I understand that the later the first ultrasound is done, the less precise it is in determining the actual gestational age, but the literature all says it is within two weeks of the actual gestational age. I also realize that growth rates may be different for twin babies as compared to singletons, however, that usually isn't recognized until the third trimester. Please correct me if those assumptions are incorrect.
***** informed me last week that she was bulimic throughout the first twenty weeks of her pregnancy. This was hard for her to admit and she feels very guilty. She stopped vomiting on 2/13/08; the date she found out she was pregnant. I am doing my best to support her as we strive to have the healthiest pregnancy possible, and I know we can only control what is ahead, not what has already happened. ***** has agreed that she needs to bring this up with you at our appointment in order to be sure the twins get all the care they need.
I am concerned about the size of the babies because from what I’ve read, gestational age and due date are usually determined by the first ultrasound. The ultrasound due date, however, is a whole month after the LMP due date. I understand that if the babies were a whole month behind in size at 23 1/2 weeks, the twins’ growth rate lies below the 10th percentile for that gestational age and that must not be good. With the preceding details in place, I have written some of my questions down:
Question #1- Is it possible for the ultrasound to underestimate our babies’ gestational age by 4 weeks?
Question #2- If they are small for gestational age,(maybe due to malnourishment from the bulimia) what can be done now to catch up....if anything?
Question #3- If they are SGA, is there a way to find out if they are Intrauterine Growth Restricted?
Question #4- If the twins are IUGR; will you be able to determine whether or not they are Symmetrical Growth Restricted or Asymmetrical Growth Restricted
Based on the next ultrasound?
Question #5- Am I overreacting? Should I just wait until the next ultrasound for more information? When will the next ultrasound be?
Question #6- What other concerns should we have?
Thank you very much for taking the time to read this letter Dr. *****. I have heard great things about you and I am looking forward to meeting you. If there is anything that I can do, please don’t hesitate to ask or tell me. I will do whatever it takes to ensure that ***** and the babies are as healthy as possible.
Sincerely,
me
Dear Dr. ***** :
My name is ***** and I am writing this letter in regards to the pregnancy of my girlfriend, *****. I hope to provide you with information that will be helpful in the management of her pregnancy. We have our first appointment with you at the ***** Clinic on 3/13/08.
Here are some important details surrounding the pregnancy:
-*****’s LMP was 9/2/07.
-The date of intercourse was 9/15/07.
-***** went in for an ultrasound on 2/13/08, and learned at that time of her pregnancy with twins.
- On 2/13/08, ultrasound dates of Twin A was 19w3d. Twin B was 18w6d.
According to LMP, the gestational age of the babies on 2/13/08 should have been 23 weeks, 4 days, a discrepancy of approximately four weeks. The due date of our twins by LMP is 6/8/08, but by ultrasound it is estimated at 7/8/08. From the research I've done, I understand that the later the first ultrasound is done, the less precise it is in determining the actual gestational age, but the literature all says it is within two weeks of the actual gestational age. I also realize that growth rates may be different for twin babies as compared to singletons, however, that usually isn't recognized until the third trimester. Please correct me if those assumptions are incorrect.
***** informed me last week that she was bulimic throughout the first twenty weeks of her pregnancy. This was hard for her to admit and she feels very guilty. She stopped vomiting on 2/13/08; the date she found out she was pregnant. I am doing my best to support her as we strive to have the healthiest pregnancy possible, and I know we can only control what is ahead, not what has already happened. ***** has agreed that she needs to bring this up with you at our appointment in order to be sure the twins get all the care they need.
I am concerned about the size of the babies because from what I’ve read, gestational age and due date are usually determined by the first ultrasound. The ultrasound due date, however, is a whole month after the LMP due date. I understand that if the babies were a whole month behind in size at 23 1/2 weeks, the twins’ growth rate lies below the 10th percentile for that gestational age and that must not be good. With the preceding details in place, I have written some of my questions down:
Question #1- Is it possible for the ultrasound to underestimate our babies’ gestational age by 4 weeks?
Question #2- If they are small for gestational age,(maybe due to malnourishment from the bulimia) what can be done now to catch up....if anything?
Question #3- If they are SGA, is there a way to find out if they are Intrauterine Growth Restricted?
Question #4- If the twins are IUGR; will you be able to determine whether or not they are Symmetrical Growth Restricted or Asymmetrical Growth Restricted
Based on the next ultrasound?
Question #5- Am I overreacting? Should I just wait until the next ultrasound for more information? When will the next ultrasound be?
Question #6- What other concerns should we have?
Thank you very much for taking the time to read this letter Dr. *****. I have heard great things about you and I am looking forward to meeting you. If there is anything that I can do, please don’t hesitate to ask or tell me. I will do whatever it takes to ensure that ***** and the babies are as healthy as possible.
Sincerely,
me
WOW, I don't really have anything of value to add to this other than I am so impressed with your deep understanding and initiative in this ordeal! Very 'gray' area! I couldn't say either way! Please keep posting-I'd be interested to see how this all plays out! Good luck!
You sound like you are very well informed and I hope that these babies are yours- you sound like you'd be a good dad. The only way to know for sure will be a DNA test but I hope you continue to support your ex during her pregnancy and after no matter what the outcome is. I'm sure finding out at 5 months was quite the shock for both you and her, and I noticed she is quite a bit younger then you..be her rock through this.
Good luck!
Good luck!
As others said the DNA test would be the only way to put your mind in peace.. assumptions would only make it worse specially that the ultra sound is showing smaller babies as well as her period wasn't regular so would be hard to replay on lmp! be supportive which I am sure you are and be the father unless confirmed otherwise... best of luck
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