Gestational age - Wikipedia https://en.wikipedia.

org/wiki/Gestational_age

Gestational age
Gestational age is a measure of the age of a pregnancy which is taken from the woman's last menstrual period (LMP), or the corresponding age of the
gestation as estimated by a more accurate method if available. Such methods include adding 14 days to a known duration since fertilization (as is
possible in in vitro fertilization), or by obstetric ultrasonography. The popularity of using such a definition of gestational age is that menstrual periods
are essentially always noticed, while there is usually a lack of a convenient way to discern when fertilization occurred.

The initiation of pregnancy for the calculation of gestational age can be different from definitions of initiation of pregnancy in context of the abortion
debate or beginning of human personhood.

Contents
Methods
Comparison to fertilization age
Uses
Estimation of due date
Medical fetal viability
Birth classification
In classifying perinatal deaths, stillbirths and infant deaths
Postnatal use

Heritability
See also
References

Methods
According to American Congress of Obstetricians and Gynecologists, the main methods to calculate gestational age are:[1]

Directly calculating the days since the beginning of the last menstrual period
Early obstetric ultrasound, comparing the size of an embryo or fetus to that of a reference group of pregnancies of
known gestational age (such as calculated from last menstrual periods), and using the mean gestational age of
other embryos or fetuses of the same size. If the gestational age as calculated from an early ultrasound is
contradictory to the one calculated directly from the last menstrual period, it is still the one from the early
ultrasound that is used for the rest of the pregnancy. [1]
In case of in vitro fertilization, calculating days since oocyte retrieval or co-incubation and adding 14 days.[2]
Gestational age can also be estimated by calculating days from ovulation if it was estimated from related signs or ovulation tests, and adding 14 days
by convention.[3]

A more complete listing of methods is given in following table:[4]

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Variability (2 standard
Method of estimating gestational age
deviations)[4]

Days from oocyte retrieval or co-incubation in in vitro fertilisation + 14

±1 day
days

Days from estimated ovulation in Ovulation induction + 14 days ±3 days

Days from artificial insemination + 14 days ±3 days

Days from known single sexual intercourse + 14 days ±3 days

Days from estimated ovulation by basal body temperature record + 14

±4 days
days

First-trimester physical examination ±2 weeks

Second-trimester physical examination ±4 weeks

Third-trimester physical examination ±6 weeks

First-trimester obstetric ultrasonography (crown-rump length) ±8% of the estimate

Second-trimester obstetric ultrasonography (head circumference, femur

±8% of the estimate
length)

Third-trimester obstetric ultrasonography (head circumference, femur

±8% of the estimate
length)

As a general rule, the official gestational age should be based on the actual beginning of the last menstrual period, unless any of the above methods
gives an estimated date that differs more than the variability for the method, in which case the difference cannot probably be explained by that
variability alone.[4] For example, if there is a gestational age based on the beginning of the last menstrual period of 9.0 weeks, and a first-trimester
obstetric ultrasonography gives an estimated gestational age of 10.0 weeks (with a 2 SD variability of ±8% of the estimate thereby giving a variability
of ±0.8 weeks), the difference of 1.0 weeks between the tests is larger than the 2 SD variability of the ultrasonography estimate, indicating that the
gestational age estimated by ultrasonography should be used as the official gestational age.[4]

Once the estimated due date (EDD) is established, it should rarely be changed, as the determination of gestational age is most accurate earlier in the
pregnancy.[5]

Following are diagrams for estimating gestational age from obstetric ultrasound, by various target parameters:

By gestational sac diameter By crown-rump length (CRL)

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By biparietal diameter (BPD)

Comparison to fertilization age

The fertilization age (also called embryonic age and later fetal age) is the time from the fertilization. It usually occurs within a day of ovulation, which,
in turn, occurs on average 14.6 days after the beginning of the preceding menstruation (LMP).[6] There is also considerable variability in this interval,
with a 95% prediction interval of the ovulation of 9 to 20 days after menstruation even for an average woman who has a mean LMP-to-ovulation time
of 14.6.[7] In a reference group representing all women, the 95% prediction interval of the LMP-to-ovulation is 8.2 to 20.5 days.[6] The actual
variability between gestational age as estimated from the beginning of the last menstrual period (without the use of any additional method mentioned
in previous section) is substantially larger because of uncertainty which menstrual cycle gave rise to the pregnancy. For example, the menstruation
may be scarce enough to give the false appearance that an earlier menstruation gave rise to the pregnancy, potentially giving an estimated gestational
age that is approximately one month too large. Also, vaginal bleeding occurs during 15-25% of first trimester pregnancies,[8] and may be mistaken as
menstruation, potentially giving an estimated gestational age that is too low.

Uses
Gestational age is used for example for:

The events of prenatal development, which usually occur at specific gestational ages. Hence, the gestational timing
of a fetal toxin exposure, fetal drug exposure or vertically transmitted infection can be used to predict the potential
consequences to the fetus.
Estimation of due date
Scheduling prenatal care
Estimation of fetal viability
Calculating the results of various prenatal tests, (for example, in the triple test).
Birth classification into for example preterm, term or postterm.
Classification of infant deaths and stillbirths
Postnatally (after birth) to estimate various risk factors

Timeline of pregnancy by gestational age.

Estimation of due date

The mean pregnancy length has been estimated to be 283.4 days of gestational age as timed from the first day of the last menstrual period and 280.6
days when retrospectively estimated by obstetric ultrasound measurement of the fetal biparietal diameter (BPD) in the second trimester.[10] Other

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algorithms take into account other variables, such as whether this is the first or subsequent
child, the mother's race, age, length of menstrual cycle, and menstrual regularity. In order to
have a standard reference point, the normal pregnancy duration is assumed by medical
professionals to be 280 days (or 40 weeks) of gestational age. Furthermore, actual childbirth
has only a certain probability of occurring within the limits of the estimated due date. A
study of singleton live births came to the result that childbirth has a standard deviation of 14
days when gestational age is estimated by first trimester ultrasound, and 16 days when
estimated directly by last menstrual period.[9]

The most common system used among healthcare professionals is Naegele's rule, which
estimates the expected date of delivery (EDD) by adding a year, subtracting three months,
and adding seven days to the first day of a woman's last menstrual period (LMP) or
corresponding date as estimated from other means. Distribution of gestational age at
childbirth among singleton live births,
given both when gestational age is
Medical fetal viability estimated by first trimester ultrasound
and directly by last menstrual period.[9]
There is no sharp limit of development, gestational age, or weight at which a human fetus
automatically becomes viable.[11] According to studies between 2003 and 2005, 20 to 35
percent of babies born at 23 weeks of gestation survive, while 50 to 70 percent of babies born at 24 to 25 weeks, and more than 90 percent born at 26
to 27 weeks, survive.[12] It is rare for a baby weighing less than 500 g (17.6 ounces) to survive.[11] A baby's chances for survival increases 3-4% per
day between 23 and 24 weeks of gestation and about 2-3% per day between 24 and 26 weeks of gestation. After 26 weeks the rate of survival increases
at a much slower rate because survival is high already.[13] Prognosis depends also on medical protocols on whether to resuscitate and aggressively
treat a very premature newborn, or whether to provide only palliative care, in view of the high risk of severe disability of very preterm babies.[14]

Stages in prenatal development, showing viability and point of 50% chance of survival (limit of viability) at bottom.
Weeks and months numbered by gestation,

Completed weeks of 21 and

22 23 24 25 26 27 30 34
gestation at birth less

Chance of survival[13] 0% 0-10% 10-35% 40-70% 50-80% 80-90% >90% >95% >98%

Birth classification
Using gestational age, births can be classified into broad categories:

Using the LMP (last menstrual period) method, a full-term human pregnancy is
considered to be 40 weeks (280 days), though pregnancy lengths between 38 and 42 Gestational Age in Weeks Classification
weeks are considered normal. A fetus born prior to the 37th week of gestation is < 37 0/7 Preterm
considered to be preterm. A preterm baby is likely to be premature and consequently
34 0/7 - 36 6/7 Late preterm[15]
faces increased risk of morbidity and mortality. An estimated due date is given by
Naegele's rule. 37 0/7 - 38 6/7 Early Term[16]

39 0/7 - 40 6/7 Full Term[16]

According to the WHO, a preterm birth is defined as "babies born alive before 37
weeks of pregnancy are completed."[17]According to this classification, there are three 41 0/7 - 41 6/7 Late Term[16]
sub-categories of preterm birth, based on gestational age: extremely preterm (less than > 42 0/7 Postterm
28 weeks), very preterm (28 to 32 weeks), moderate to late preterm (32 to 37

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weeks).[17] Various jurisdictions may use different classifications.

In classifying perinatal deaths, stillbirths and infant deaths

For most of the 20th Century, official definitions of a live birth and infant death in the Soviet Union and Russia differed from common international
standards, such as those established by the World Health Organization in the latter part of the century.[18][19] Babies who were less than 28 weeks of
gestational age, or weighed less than 1000 grams, or less than 35 cm in length – even if they showed some sign of life (breathing, heartbeat, voluntary
muscle movement) – were classified as "live fetuses" rather than "live births." Only if such newborns survived seven days (168 hours) were they then
classified as live births. If, however, they died within that interval, they were classified as stillbirths. If they survived that interval but died within the
first 365 days they were classified as infant deaths.

More recently, thresholds for "fetal death" continue to vary widely internationally, sometimes incorporating weight as well as gestational age. The
gestational age for statistical recording of fetal deaths ranges from 16 weeks in Norway, to 20 weeks in the US and Australia, 24 weeks in the UK, and
26 weeks in Italy and Spain.[20][21][22]

The WHO defines the perinatal period as "The perinatal period commences at 22 completed weeks (154 days) of gestation and ends seven completed
days after birth."[23] Perinatal mortality is the death of fetuses or neonates during the perinatal period. A 2013 study found that "While only a small
proportion of births occur before 24 completed weeks of gestation (about 1 per 1000), survival is rare and most of them are either fetal deaths or live
births followed by a neonatal death."[20]

Postnatal use
Gestational age (as well as fertilization age) is sometimes used postnatally (after birth) to estimate various risk factors. For example, it is a better
predictor than postnatal age for risk of intraventricular hemorrhage in premature babies treated with extracorporeal membrane oxygenation.[24]

Heritability
Family-based studies showed that gestational age is partially (from 25% to 40%) determined by genetic factors.[25]

See also
Pregnancy
Maternity
Prenatal development
Gestation periods in mammals
Abortion law
Reproductive rights
Fetal rights

References
1. Obstetric Data Definitions Issues and Rationale for Change - Gestational Age & Term (http://www.acog.org
/About_ACOG/ACOG_Departments/Patient_Safety_and_Quality_Improvement/~/media/Departments
/Patient%20Safety%20and%20Quality%20Improvement/201213IssuesandRationale-GestationalAgeTerm.pdf)
Archived (https://web.archive.org/web/20131106111500/http://www.acog.org/About_ACOG/ACOG_Departments
/Patient_Safety_and_Quality_Improvement/~/media/Departments
/Patient%20Safety%20and%20Quality%20Improvement/201213IssuesandRationale-GestationalAgeTerm.pdf)
2013-11-06 at the Wayback Machine. from Patient Safety and Quality Improvement at American Congress of
Obstetricians and Gynecologists. Created November 2012.
2. Tunon, K.; Eik-Nes, S. H.; Grøttum, P.; Von Düring, V.; Kahn, J. A. (2000). "Gestational age in pregnancies conceived
after in vitro fertilization: A comparison between age assessed from oocyte retrieval, crown-rump length and
biparietal diameter". Ultrasound in Obstetrics and Gynecology. 15 (1): 41–46.
doi:10.1046/j.1469-0705.2000.00004.x (https://doi.org/10.1046%2Fj.1469-0705.2000.00004.x). PMID 10776011
(https://www.ncbi.nlm.nih.gov/pubmed/10776011).

5 of 7 12/20/2017 06:29 AM
Gestational age - Wikipedia https://en.wikipedia.org/wiki/Gestational_age

3. Robinson, H. P.; Fleming, J. E. E. (1975). "A Critical Evaluation of Sonar "crown-Rump Length" Measurements". BJOG:
an International Journal of Obstetrics and Gynaecology . 82 (9): 702. doi:10.1111/j.1471-0528.1975.tb00710.x
(https://doi.org/10.1111%2Fj.1471-0528.1975.tb00710.x).
4. A Simple Solution to Dating Discrepancies: The Rule of Eights (http://www.medscape.com/viewarticle/703501_4)
Hunter, L. A. (2009). "Issues in Pregnancy Dating: Revisiting the Evidence". Journal of Midwifery & Women's Health.
54 (3): 184–190. doi:10.1016/j.jmwh.2008.11.003 (https://doi.org/10.1016%2Fj.jmwh.2008.11.003).
5. "Committee Opinion No 611". Obstetrics & Gynecology. 124 (4): 863. 2014.
doi:10.1097/01.AOG.0000454932.15177.be (https://doi.org/10.1097%2F01.AOG.0000454932.15177.be).
6. Geirsson RT (May 1991). "Ultrasound instead of last menstrual period as the basis of gestational age assignment".
Ultrasound Obstet Gynecol. 1 (3): 212–9. doi:10.1046/j.1469-0705.1991.01030212.x (https://doi.org
/10.1046%2Fj.1469-0705.1991.01030212.x). PMID 12797075 (https://www.ncbi.nlm.nih.gov/pubmed/12797075).
7. Derived from a standard deviation in this interval of 2.6, as given in: Fehring RJ, Schneider M, Raviele K (2006).
"Variability in the phases of the menstrual cycle". J Obstet Gynecol Neonatal Nurs. 35 (3): 376–84.
doi:10.1111/j.1552-6909.2006.00051.x (https://doi.org/10.1111%2Fj.1552-6909.2006.00051.x). PMID 16700687
(https://www.ncbi.nlm.nih.gov/pubmed/16700687).
8. Snell, BJ (Nov–Dec 2009). "Assessment and management of bleeding in the first trimester of pregnancy". Journal of
midwifery & women's health. 54 (6): 483–91. doi:10.1016/j.jmwh.2009.08.007 (https://doi.org
/10.1016%2Fj.jmwh.2009.08.007). PMID 19879521 (https://www.ncbi.nlm.nih.gov/pubmed/19879521).
9. Hoffman, Caroline S.; Messer, Lynne C.; Mendola, Pauline; Savitz, David A.; Herring, Amy H.; Hartmann, Katherine E.
(2008). "Comparison of gestational age at birth based on last menstrual period and ultrasound during the first
trimester". Paediatric and Perinatal Epidemiology. 22 (6): 587–596. doi:10.1111/j.1365-3016.2008.00965.x
(https://doi.org/10.1111%2Fj.1365-3016.2008.00965.x). ISSN 0269-5022 (https://www.worldcat.org/issn/0269-5022).
10. Kieler, H; Axelsson, O; Nilsson, S; Waldenströ, U (1995). "The length of human pregnancy as calculated by
ultrasonographic measurement of the fetal biparietal diameter". Ultrasound in Obstetrics and Gynecology. 6 (5):
353. doi:10.1046/j.1469-0705.1995.06050353.x (https://doi.org/10.1046%2Fj.1469-0705.1995.06050353.x).
PMID 8590208 (https://www.ncbi.nlm.nih.gov/pubmed/8590208).
11. Moore, Keith and Persaud, T. The Developing Human: Clinically Oriented Embryology (https://books.google.com
/books?id=dbRpAAAAMAAJ&q=%22Prematurity+is+one+of+the+most+common+causes+of+morbidity%22&
dq=%22Prematurity+is+one+of+the+most+common+causes+of+morbidity%22&ei=lPzISYHyK4mqMqTGzOwN&
pgis=1), p. 103 (Saunders 2003).
12. March of Dimes --> Neonatal Death (http://www.marchofdimes.org/loss/neonatal-death.aspx) Retrieved on
November 10, 2014. In turn citing:
Tyson JE, Parikh NA, Langer J, Green C, Higgins RD (April 2008). "Intensive care for extreme prematurity--moving
beyond gestational age" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597069). N. Engl. J. Med. 358 (16):
1672–81. doi:10.1056/NEJMoa073059 (https://doi.org/10.1056%2FNEJMoa073059). PMC 2597069
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597069) . PMID 18420500 (https://www.ncbi.nlm.nih.gov
/pubmed/18420500).
Luke B, Brown MB (December 2006). "The changing risk of infant mortality by gestation, plurality, and race:
1989-1991 versus 1999-2001" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623686). Pediatrics. 118 (6):
2488–97. doi:10.1542/peds.2006-1824 (https://doi.org/10.1542%2Fpeds.2006-1824). PMC 3623686
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623686) . PMID 17142535 (https://www.ncbi.nlm.nih.gov
/pubmed/17142535).
The American College of Obstetricians and Gynecologists (September 2002). "ACOG Practice Bulletin: Clinical
Management Guidelines for Obstetrcian-Gynecologists: Number 38, September 2002. Perinatal care at the
threshold of viability". Obstet Gynecol. 100 (3): 617–24. PMID 12220792 (https://www.ncbi.nlm.nih.gov/pubmed
/12220792).
13. (). What are the chances that my baby will survive?. [ONLINE] Available at: http://www.spensershope.org
/chances_for_survival.htm. [Last Accessed 14 November 2012].
14. Verlato, Giovanna; Gobber, Daniela; Drago, Donatella; Chiandetti, Lino; Drigo, Paola; Working Group of Intensive
Care in the Delivery Room of Extremely Premature Newborns (2016). "Guidelines for Resuscitation in the Delivery
Room of Extremely Preterm Infants". Journal of Child Neurology. 19 (1): 31–4.
doi:10.1177/088307380401900106011 (https://doi.org/10.1177%2F088307380401900106011). PMID 15032380
(https://www.ncbi.nlm.nih.gov/pubmed/15032380).

6 of 7 12/20/2017 06:29 AM
Gestational age - Wikipedia https://en.wikipedia.org/wiki/Gestational_age

15. Late-Preterm Infants (http://www.acog.org/Resources_And_Publications/Committee_Opinions

/Committee_on_Obstetric_Practice/Late-Preterm_Infants) ACOG Committee Opinion 404
16. Ob-Gyns Redefine Meaning of "Term Pregnancy" (http://www.acog.org/About_ACOG/News_Room/News_Releases
/2013/Ob-Gyns_Redefine_Meaning_of_Term_Pregnancy), from American College of Obstetricians and Gynecologists.
October 22, 2013
17. http://www.who.int/mediacentre/factsheets/fs363/en/
18. Anderson, Barbara A; Silver, Brian D (1986). "Infant Mortality in the Soviet Union: Regional Differences and
Measurement Issues". Population and Development Review. 12 (4): 705–38. doi:10.2307/1973432 (https://doi.org
/10.2307%2F1973432). JSTOR 1973432 (https://www.jstor.org/stable/1973432).
19. Anderson,, Barbara A.; Silver, Brian D. (1994). "The Geodemography of Infant Mortality in the Soviet Union,
1950-1990" (https://www.psc.isr.umich.edu/pubs/abs/958). PSC Research Report No. 94-316: 8.
20. Mohangoo, Ashna D; Blondel, Béatrice; Gissler, Mika; Velebil, Petr; MacFarlane, Alison; Zeitlin, Jennifer (2013).
"International Comparisons of Fetal and Neonatal Mortality Rates in High-Income Countries: Should Exclusion
Thresholds Be Based on Birth Weight or Gestational Age?" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658983).
PLoS ONE. 8 (5): e64869. Bibcode:2013PLoSO...864869M (http://adsabs.harvard.edu/abs/2013PLoSO...864869M).
doi:10.1371/journal.pone.0064869 (https://doi.org/10.1371%2Fjournal.pone.0064869). PMC 3658983
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658983) . PMID 23700489 (https://www.ncbi.nlm.nih.gov/pubmed
/23700489).
21. Li, Z; Zeki, R; Hilder, L; Sullivan, EA (2012). "Australia's Mothers and Babies 2010" (http://www.aihw.gov.au
/WorkArea/DownloadAsset.aspx?id=60129542372). Perinatal statistics series no. 27. Cat. no. PER 57 . Australian
Institute of Health and Welfare National Perinatal Statistics Unit, Australian Government. Retrieved 4 July 2013.
22. Royal College of Obstetricians; Gynaecologists UK (April 2001). "Further Issues Relating to Late Abortion, Fetal
Viability and Registration of Births and Deaths" (https://web.archive.org/web/20131105042348/http:
//www.rcog.org.uk/womens-health/clinical-guidance/further-issues-relating-late-abortion-fetal-viability-
and-registrati). Royal College of Obstetricians and Gynaecologists UK. Archived from the original
(http://www.rcog.org.uk/womens-health/clinical-guidance/further-issues-relating-late-abortion-fetal-viability-
and-registrati) on 5 November 2013. Retrieved 4 July 2013.
23. http://www.who.int/maternal_child_adolescent/topics/maternal/maternal_perinatal/en/
24. Jobe, Alan H (2004). "Post-conceptional age and IVH in ECMO patients". The Journal of Pediatrics. 145 (2): A2.
doi:10.1016/j.jpeds.2004.07.010 (https://doi.org/10.1016%2Fj.jpeds.2004.07.010).
25. Clausson, Britt; Lichtenstein, Paul; Cnattingius, Sven (2000). "Genetic influence on birthweight and gestational
length determined by studies in offspring of twins". BJOG. 107 (3): 375–81.
doi:10.1111/j.1471-0528.2000.tb13234.x (https://doi.org/10.1111%2Fj.1471-0528.2000.tb13234.x). PMID 10740335
(https://www.ncbi.nlm.nih.gov/pubmed/10740335).

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