For the purposes of research and surveillance, the best obstetric estimate, rather than estimates based on the LMP alone, should be used as the measure for gestational age.
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The American College of Obstetricians and Gynecologists, the American Institute of Ultrasound in Medicine, and the Society for Maternal—Fetal Medicine recognize the advantages of a single dating paradigm being used within and between institutions that provide obstetric care. Table 1 provides guidelines for estimating the due date based on ultrasonography and the LMP in pregnancy, and provides single-point cutoffs and ranges based on available evidence and expert opinion.
No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Methods for estimating the due date. American College of Obstetricians and Gynecologists. Women's Health Care Physicians. Recommendations The American College of Obstetricians and Gynecologists, the American Institute of Ultrasound in Medicine, and the Society for Maternal—Fetal Medicine make the following recommendations regarding the method for estimating gestational age and due date: As soon as data from the last menstrual period LMP , the first accurate ultrasound examination, or both are obtained, the gestational age and the EDD should be determined, discussed with the patient, and documented clearly in the medical record.
Introduction An accurately assigned EDD early in prenatal care is among the most important results of evaluation and history taking.
Clinical Considerations in the Second Trimester Using a single ultrasound examination in the second trimester to assist in determining the gestational age enables simultaneous fetal anatomic evaluation. Ultrasonography dating in the second trimester typically is based on regression formulas that incorporate variables such as the biparietal diameter and head circumference measured in transverse section of the head at the level of the thalami and cavum septi pellucidi; the cerebellar hemispheres should not be visible in this scanning plane the femur length measured with full length of the bone perpendicular to the ultrasound beam, excluding the distal femoral epiphysis the abdominal circumference measured in symmetrical, transverse round section at the skin line, with visualization of the vertebrae and in a plane with visualization of the stomach, umbilical vein, and portal sinus 8 Other biometric variables, such as additional long bones and the transverse cerebellar diameter, also can play a role.
Conclusion Accurate dating of pregnancy is important to improve outcomes and is a research and public health imperative. Fetal Imaging Workshop Invited Participants.
Methods for Estimating the Due Date - ACOG
A comparison of recalled date of last menstrual period with prospectively recorded dates. J Womens Health Larchmt ; Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination. Am J Obstet Gynecol ; Last menstrual period versus ultrasound for pregnancy dating.
Int J Gynaecol Obstet ; First trimester ultrasound screening is effective in reducing postterm labor induction rates: Ultrasound for fetal assessment in early pregnancy. Cochrane Database of Systematic Reviews , Issue 7. Predicting delivery date by ultrasound and last menstrual period in early gestation. New charts for ultrasound dating of pregnancy and assessment of fetal growth: Ultrasound Obstet Gynecol ; First- and second-trimester ultrasound assessment of gestational age. You may have gone to your doctor with vaginal bleeding or you may be anxious because of problems in a previous pregnancy such as miscarriage.
This ultrasound can routinely detect a heartbeat in your baby as early as weeks. Confirming the correct dates of your pregnancy. Some women are uncertain of their last menstrual period LMP or have irregular menstrual cycles, making it difficult for their doctor to correctly estimate when the baby is due. Establishing accurate dates can be important, especially if there are concerns about your baby later in the pregnancy for example, if the baby is not growing well.
Why would I have a dating scan?
An ultrasound in the first trimester can give an accurate estimated date of confinement EDC to within days. Confirming the location of your pregnancy. Your doctor may have concerns that your pregnancy is located in the fallopian tube ectopic pregnancy. This ultrasound will check if your pregnancy is developing normally within the uterus. Determining the number of babies present. Your doctor may be concerned about you having more than one baby for example, twins or triplets if your pregnancy was conceived with the help of clomiphene or IVF, you have a family history of twins, you have severe morning sickness or your uterus seems larger than expected.
This ultrasound can determine the number of babies, as well as the type of twins. Identifying pregnancies at increased risk of miscarriage or pregnancy loss. Checking other pelvic organs. Your doctor may want an ultrasound to check other things in your pelvis apart from your pregnancy, such as the uterus for example, if you have a history of fibroids and the ovaries for example, if you have pelvic pain and there is concern about an ovarian cyst.
Your doctor may be concerned about your pregnancy because of abdominal pain or vaginal bleeding. This early ultrasound can provide reassurance that everything is progressing normally. It may also detect a serious problem with either you or your pregnancy, some of which require further investigations or treatment.
Your doctor will discuss the reasons for such follow-up, if this is necessary. Assess the size of your baby. The baby is measured from one end to the other crown-rump-length, or CRL. Assess the location of the pregnancy. The pregnancy normally develops in the uterus, within the endometrium the lining of the uterus. Sometimes a pregnancy may not be developing in the correct place an ectopic pregnancy.
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The most common location for an ectopic pregnancy is the fallopian tube. Assess the gestation sac. The baby is growing inside a small sac, called the gestation sac. The size and appearance of this sac will be assessed. Assess the number of babies. We will confirm the presence of a heartbeat in your baby and measure the heart rate. The heart rate of babies is much quicker than adults. Many patients believe that the later in pregnancy an ultrasound is performed, the more reliable the EDC calculated by the ultrasound is.
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Perhaps this is because patients reason that since we can see more detail on ultrasound the further along one is where we can see noses, ears, fingers, the chambers of the heart, etc. However, in the first trimester there is very little variation in fetal size, and so it turns out that an ultrasound done between 7 and 13 weeks is the most accurate. How accurate, you say? Compare the maximum error that each ultrasound can potentially have, and you'll see what I mean:. This means that a pregnancy for which no period dates are available, and who did not get an exam or ultrasound until the third trimester, can have an EDC which could conceivably fall within a range as broad as 42 days!
This can sometimes lead, if one isn't careful, to unnecessary induction of labor, which can result in unnecessary cesarean section, or delivery of a premature baby, who then requires transfer to a special care nursery.