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My dates don't match my midwife's estimate
I am ten weeks pregnant with my fifth baby. My midwife said that I was large for these dates. In fact, she estimates that I am six weeks further along than I thought. I am confident of my dates. Why don't our estimates match?
Women can experience bleeding during early pregnancy, which they believe is a period. Then, when they come in for their exam, the uterus is larger and they are due sooner than expected. A uterus may also be larger, of course, if there is a multiple gestation, or in rare cases when a molar pregnancy or pelvic tumour is present.
Women can be smaller than their dates would indicate if they had experienced scant bleeding — which they mistakenly didn't count as a menstrual period — and then ovulation and conception took place after the spotting. Or, although this is somewhat uncommon, the woman may have conceived, miscarried and then conceived again. In that case, the woman might be erroneously counting from the previous pregnancy dates.
An irregular cycle is the most common reason for being ‘small’ or ‘large’ for the assumed dates. I had a client a few weeks ago who had regular cycles, but once in a great while she would skip a period. She was keeping careful records because she wanted to conceive. When she did, her last menstrual period indicated an eight-week interval, but the uterus was not enlarged. Her test was positive, but a later ultrasound indicated that she was a month less along than she had thought.
As you appear to be ‘large’ there are several things to ask. Is your midwife experienced in early pregnancy assessment? The results of an exam can be very subjective and your health-care provider can be out by several weeks. If she is ascertaining that you are ‘large’ based on abdominal measurements, this is a rather inaccurate gauge early on in the pregnancy. It is best to assess uterine size through a good bimanual exam.
Was your bladder full? This can also alter the abdominal measurement.
The most common explanation would be that after several children your uterus does not return to a true ‘non-pregnant size’ and is always a bit large. Women who have had more than one child (multiparas) can be ‘large for their dates’ early in pregnancy, but by the second or third visit are standard size again. Fibroids can also be fairly common in multiparas and may increase uterine size, but they usually cause no difficulty during pregnancy.
Another explanation is that the uterus grows in spurts and your midwife caught you during a growth spurt. If you are still ‘large’ at your next visit, I am sure your midwife will recommend an ultrasound to rule out multiple gestation.
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