2/20/23, 12:47 PM Gestational Age - Pediatrics - MSD Manual Professional Edition

Brought
to you ABOUT MSD MSD CAREERS RESEARCH WORLDWIDE
by

MSD MANUAL
Professional Version

Gestational Age
By Arcangela Lattari Balest , MD, University of Pittsburgh, School of Medicine
Last review/revision Oct 2022

https://www.msdmanuals.com/en-in/professional/pediatrics/perinatal-problems/gestational-age 1/4
2/20/23, 12:47 PM Gestational Age - Pediatrics - MSD Manual Professional Edition

Gestational age and growth parameters help identify the risk of neonatal pathology. Gestational age is
the primary determinant of organ maturity.

Gestational age is usually defined as the number of weeks between the first day of the mother's last
normal menstrual period and the date of delivery. More accurately, the gestational age is the
difference between 14 days before the date of conception and the day of delivery. However,
determining gestational age based on the last menstrual period may be inaccurate if the mother has
irregular menses. Gestational age is not the actual embryologic age of the fetus, but it is the universal
standard among obstetricians and neonatologists for discussing fetal maturation.

Embryologic age is the time elapsed from the date of conception to the date of delivery and is 2
weeks less than the gestational age. Women may estimate the date of conception based on their time
of ovulation as identified by in-home hormonal testing and/or basal body temperature
measurements. However, the date of conception is definitively known only when in vitro fertilization
or other assisted reproductive techniques are used.

Estimations of gestational age can be based on

First day of the last menstrual period and cycle length

Date of conception

Fetal ultrasonography

Physical parameters after birth (eg, using the Ballard score)

The estimated date of delivery (EDD) is the date birth is
expected (the due date). The EDD can be calculated as CLINICAL CALCULATOR:

Pregnancy Gestation by LMP

The date of conception + 266 days
and Ultrasound Biometry
The last menstrual period (LMP) + 280 days (40
weeks) for women with regular, 28-day menstrual
cycles

The LMP + 280 days + (cycle length – 28 days) for women with regular menstrual cycles other
than 28 days duration
When periods are regular and recorded contemporaneously, the menstrual history is relatively
reliable.

Ultrasonographic measurements of the fetus in the first trimester give the most accurate estimate
of gestational age when other information is lacking or unreliable. When the date of conception is
unknown and the menstrual cycles are irregular, unreliable, or information about them is not
available, ultrasonography may be the sole source of the estimated date of delivery. In cases where
the estimated date of delivery is calculated based on menstrual cycle data (see the American College
of Obstetricians and Gynecologists' [ACOG] Methods for Estimating Due Date), the ACOG recommends
using the ultrasonographic date if it differs from the calculated date by

At ≥ 8 6/7 weeks gestation: > 5 days

At 9 to 13 6/7 weeks gestation: > 7 days

Because ultrasonographic estimates are less accurate later in pregnancy, second and third trimester
ultrasonographic results should rarely be used to revise those done during the first trimester.

Newborn physical examination findings are used by clinicians to estimate gestational age, using
the new Ballard score. The Ballard score is accurate only within plus or minus 2 weeks. Newborn
https://www.msdmanuals.com/en-in/professional/pediatrics/perinatal-problems/gestational-age 2/4
2/20/23, 12:47 PM Gestational Age - Pediatrics - MSD Manual Professional Edition

clinical assessments of gestational age have been found to overestimate gestational age in preterm
infants and underestimate gestational age in©small-for-gestational-age
Copyright infants
2023 Merck & Co., Inc., Rahway, NJ, USA and(1). Therefore,
its affiliates. physical
All rights reserved.
examination assessment of gestational age should be used to assign gestational age and for decisions
regarding care only when there is no reliable obstetrical information about the estimated date of
delivery or there is a major discrepancy between the obstetrically defined gestational age and the
findings on physical examination.

The Ballard score is based on the neonate's physical and neuromuscular maturity and can be used up
to 4 days after birth (in practice, the Ballard score is usually used in the first 24 hours). The
neuromuscular components are more consistent over time because the physical components mature
quickly after birth. However, the neuromuscular components can be affected by illness and drugs (eg,
magnesium sulfate given during labor).

Assessment of gestational age—new Ballard score

Scores from neuromuscular and physical domains are added to obtain total score. (Adapted from
Ballard JL, Khoury JC, Wedig K, et al: New Ballard score, expanded to include extremely premature
infants. Pediatrics 119(3):417–423, 1991. doi: 10.1016/s0022-3476(05)82056-6; used with
permission of the CV Mosby Company.)

https://www.msdmanuals.com/en-in/professional/pediatrics/perinatal-problems/gestational-age 3/4
2/20/23, 12:47 PM Gestational Age - Pediatrics - MSD Manual Professional Edition

Based on gestational age, neonates are classified as (2)

Preterm: < 34 weeks gestation

Late preterm: 34 to 36 6/7 weeks

Early term: 37 0/7 weeks through 38 6/7 weeks

Full term: 39 0/7 weeks through 40 6/7 weeks

Late term: 41 0/7 weeks through 41 6/7 weeks

Postterm: ≥ 42 0/7 weeks and beyond

General references

1. Lee AC, Panchal P, Folger L, et al: Diagnostic accuracy of neonatal assessment for gestational age
determination: A systematic review. Pediatrics 140(6):e20171423, 2017. doi: 10.1542/peds.2017-1423

2. Spong CY: Defining "term" pregnancy: Recommendations from the Defining "Term" Pregnancy
Workgroup. JAMA 309(23):2445–2446, 2013. doi: 10.1001/jama.2013.6235

More Information
The following English-language resource may be useful. Please note that THE MANUAL is not
responsible for the content of this resource.

American College of Obstetricians and Gynecologists (ACOG): Methods for estimating due date

https://www.msdmanuals.com/en-in/professional/pediatrics/perinatal-problems/gestational-age 4/4