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Early Pregnancy

Shieva Ghofrany: [00:00:00] Morning guys, we're gonna talk quickly about, um, early pregnancy and when to call your doctor and what can happen in the early, early parts, right when you found out you have a pregnancy test. And then later this week, I promise to all my gynecology. Ladies, I'm gonna talk, I haven't talked for a while about herpes H P V. 

Irregular perimenopausal, bleeding. I owe you guys to talk about that and treatment for it because that includes, um, ablations and a bunch of other things that people have been asking. So I promise. I promise there's so much to talk about. Not enough time. Okay. , you just found out you're pregnant, like you literally peed on the stick. 

What do you do? First of all, let's back up. Patients say to me, I'm not due for my period for five days. Can I get the early, early, early pregnancy test? You can do whatever you want, but I do not advise those early ones. Um, I just think they make two issues. One, if they're positive, it merely increases your anxiety and the amount of time that you're obsessing over being [00:01:00] pregnant. 

Am I. . Yes, I am. So that's one, actually, three reasons. Two, there are a decent number of very early pregnancies that unfortunately go away. They're probably what we refer to as chemical pregnancies, meaning the egg and the sperm got together, but they didn't actually ever create the correct genetic material. 

They were never really going to turn into a true pregnancy. Are they actually miscarriages or not? It's a controversial question. Um, but when you find out you're pregnant, I know this is true. Ladies, having been through six miscarriage, The minute you see that positive pregnancy test you have planned, like you're everything about it. 

So then seeing that it goes away is even more upsetting. And if it's an early, early chemical pregnancy that was really probably never destined to become a full viable pregnancy anyway, then even more so, I don't want you to know about that so early when it's not gonna change what you do. So that's reason number two. 

And reason number three, um, is if it's negative, I'm still gonna tell you to. So you're just wasting money and anxiety. [00:02:00] So let's say you take the pregnancy test the day you've missed your period. If you have a 28 day cycle, and then what? It's positive. Oh my gosh. Now let's go back to what if you don't have a 28 day cycle? 

The ideal would be if you happen to know the length of your cycle. Let's say for example, it's 32 days. Then you would know if you listened to any of my prior posts that you ovulated on. What? day 18, because you take the length of your cycle, subtract 14 because you will always ovulate 14 days before you get your period and you'll say, okay, I'm not gonna take my p my pregnancy test on day 28. 

Like Vox might say, I'm gonna take it the day I've missed it, which would be day 32. That means that when they ask you what your last period was, and they try to tell you that if your last period. 32 days ago, they're gonna tell you you're actually four weeks pregnant. That's actually not true because again, all of the modeling that we do about pregnancy being 40 weeks from your last period is based on a 28 day cycle. 

So you'll have [00:03:00] to adjust that. Okay. So. , if you take your pregnancy test, you're positive. Oh my gosh. I'm gonna tell you what happens in our practice, and I'm assuming it's fairly standard throughout the country and world. You call, Hey, I'm pregnant. You're the secretary is going to say to you, oh, what's your last period? 

And they're always going to assume you're on a 28 day cycle because it's just too hard to have the understanding that everybody knows when they ovulate. So we kind of always operate on a 28 day cycle to start, and they will give you an appoint. Anywhere from seven to eight ish weeks for your new OB visit where you come in, we do an ultrasound, we look at that little bean, that little nugget, we see the flickering, we measure that bean, and we're gonna get back to measuring in a sec. 

Um, and then we talk about your pregnancy. Now the alternatives would be two. . If you're having issues like spotting or bleeding or lateralized pain, I like to call it meaning pain on one side or the other, not cramps like a period because that's really common, but real pain on one side or the [00:04:00] other, or spotting and bleeding, meaning it could be just spotting and bleeding. 

It could be just pain. You really should go in and see the doctor because there's always a small chance that you have an ectopic, which is the pregnancy that grows outside of the. Usually in your tube and when you go to the doctor, they will do a variety of things, including but not limited to. And again, this is our practice. 

I'm not your doctor. It's pretty standard though. Um, they'll do an ultrasound to look and make sure they don't see an ectopic, but because you're so early in pregnancy, they won't yet see the pregnancy in your uterus. So they'll also have to do blood tests and then they usually will repeat the blood tests over a 48 hour period to make sure they are moving in the right direction. 

We have calculations, so we. What number the H C G hormone will be or should be. Um, and they might also do a progesterone blood test that's not available in all the labs very quickly, so that's not a standard. But progesterone can be helpful. If it's below five, it often means it's not a viable pregnancy and might be an ectopic, not is, [00:05:00] but might be. 

So, spotting, bleeding, pain on one side or the. You and your doctor are on a fact finding mission, and it is not always an easy answer, right? Then it is often a okay, right now you seem okay, we're gonna repeat this in two days and then we will know more. Okay? Now let's assume that didn't happen. You go to the office at seven or eight weeks. 

You think you are seven weeks and five days pregnant from that app that you looked up. Um, and then your doctor looks, and when she does the ultrasound, she actually. Lo and behold, maybe let's, let's have good news time. She sees the heartbeat and she sees that instead of being seven weeks and two days, you're actually eight weeks and three days pregnant. 

Meaning when she measures that little bean, the measurement translates into the computer as how many days pregnant because. , listen to this one. Ladies, all babies, whether they're gonna be 10 pounds or six pounds in that first trimester, they're gonna measure the same. It's one measurement of the crown to the rump, okay? 

Head to [00:06:00] butt, crown rump length. You'll see the word C r L, and that measurement is standard for all babies, no matter how big they're gonna be, no matter when they're gonna be born. So when she says to you, oh look, as it turns out, you are actually eight weeks and three days pregnant, which. , we would change your due date because you are more than five to seven days off, and that's kind of the range in which if our measurement is more than five to seven days off from your period, then we change the due date now. 

There are caveats to this. If I have patients who are absolutely held at shore on when they got pregnant or never had an irregular cycle, then I might say, okay, let's hold off, come back in two weeks and we'll do another ultrasound and just get two points on the line and then we can decide on a due date. 

Okay. Um, and here's something that I think is an, a nice way to illustrate this, if this makes sense. . I can never make this look bigger. Ooh. In a 2D picture, if you are looking at this pen, let's assume this was the crown rump. Let's say you're looking at this on a 2D picture [00:07:00] and let's say the little embryo tilts, cuz this is the baby, it looks like this curved. 

And let's say the baby tilts like that. , when you're looking 2d, that measurement from there to there is actually gonna be shorter. So I can sometimes measure a little embryo and mistakenly think it's behind in growth. Okay. But if I'm actually paying attention, I'll do a couple measurements. I'll try to get the right one, and I'll have other features that are, um, encouraging to be the things are okay, like the rate of the heartbeat. 

So again, I can make the, the little nugget, what we call a fetal pole look smaller if I look at it this way. But I cannot make. Measurement look bigger, right? There's no way to make these two ends look bigger, so once you get your date in the first trimester, , it is a massive mistake that unfortunately happens all the time to change your due date later, unless you had an ultrasound on a machine that wasn't very good, or you had, unfortunately a practitioner who wasn't used to doing it. 

And then maybe, maybe in your [00:08:00] early second trimester or at your anatomy ultrasound with a very. Skilled trained maternal fetal care doctor, they might change your due date, but the mistake is in the third trimester, a big baby, and people say, does that mean my due date changed? And the answer is no. If I change your due date in the third trimester, I am potentially delivering a big baby who is just immature or premature. 

And I'm saying, oh, maybe the baby's actually older. No, we should date the pregnancy. Ideally in the first trimester. There are certainly people throughout the country and world who don't have access to ultrasounds. So this is not a standard, standard practice, but it is increasingly becoming one. Um, and certainly by the anatomy ultrasound, which is at 18 to 20 weeks. 

If you are not sure of your due date, Or your due date is very off from your pre your period, then your due date might change at that point. Okay. Once you've seen the heartbeat in that first trimester, the likelihood of a miscarriage has dropped immensely. Data used to say to under 5%. It's hard to say because we're detecting pregnancies so much earlier, and you guys might know [00:09:00] this, that at least 20% of pregnancies end in miscarriage and some estimate over 50% if you're including all of those really early ones that we've hopefully missed. 

by not doing the early, early, early pregnancy tests. So you have your ultrasound, you have your little nugget, the little flickering with the bean, and now you think, is it still gonna be okay? And the answer is, this is how you have to think. Yes, the likelihood is it's gonna be okay. We're all mature women. 

We all know that people have miscarriages. I had six and you see my three little babies running around. I have more babies than I can handle now. So I want you all to take heart. If you did have a miscarriage, if you are having a miscarriage, We'll have a miscarriage. You will likely be okay, and it sucks to go through it, but once you've seen that heartbeat, the likelihood goes down a lot. 

Okay. All right. That was supposed to be quick. It was nine and a half minutes, but that was how you date the pregnancy. I hope that was helpful. Bye.