D r

s o r
f e s n
r o h a
e P h K
i a t l l a
s o c i f u
s n
A Ha

GESTA
TIONAL
AGE
ESTIM
ATION &
OF D U E
DATES

1
 OBJECTIVE
S
• Importance of determination of
gestational age
• Definitions of important
terminology
• Methods of determination
of gestational age
• Proper estimation of GA &
EDD
2
IMPORTANCE OF DETERMINATION OF
GESTATIONAL AGE

• Accurate determination of the

D ue
Expected (EDD) - one of the m ost
im portant factors in early preg nancy
Date
assessment

• Healthcare professionals must take great

pains to determine accurate gestation &
EDD during booking

3
 Accurate dating is vital for

• the timing of appropriate antenatal care

• scheduling & interpretation of tests
• determining appropriate fetal growth
• intervention purposes
prevention of preterm birth
prevent postdates
prevent comorbidities
• for research purposes
4
Gestational age can be determined
by

Clinical History

Physical Examination

Ultrasound Scan

5
CLINICAL HISTORY

6
 Naegele’s Rule:
Determining the • E DD is 2 8 0 days from
the LNMP
gestational age • Must be regular cycles
for this to be accurate
using clinical history • Accuracy is up to 5 0 %
within 7 days on either side

• Reliant on knowledge Inaccurate in patients in the

following circumstances:-
of accurate • Oligomenorrhoea or
polymenorrhagia (irregular
menstrual period cycles)
• Bleeding in the first trimester
of pregnancy (implantation
• 1st day of bleeding)
• Pregnancy following the use
LMP of oral contraceptives or
• calculation based intrauterine devices
• Pregnancy in the postpartum
on Naegele’s rule period (lactational amenorrhoea)

If the interval of cycles is longer than 28/7, the extra days are to be added
and if the interval is shorter, the days are to be subtracted to get the EDD
7
Confirm by time of
onset of pregnancy
symptoms

Using dates, early

• Typically, these begin pregnancy symptoms
around 5+ weeks of should occur about
gestation 5 - 6 weeks
from the 1st day of
• commonly include the LMP
nausea, headache,
loss of appetite etc..

8
 Add 22/52 in
primigravidae & 24/52
in multiparae to the date
of quickening = EDD

Time of Can be used as an

Quickening estimation in the
absence of other more
reliable methods

Inaccurate

9
 PHYSICAL
EXAMINATIO
N

10
 •P/E b itself is
P/E augments y
inaccurate
history • What it can dois
confirm to the
historical
findings
• P/E is more helpful
in later pregnancy

Height of the Uterus

Refers to the
Symphysio- Fundal-Height
(SFH) Corresponds with the
Period of Gestation (POG)
Is widely influenced by the state
of the pregnancy - may be
smaller or larger than dates
11

Very late
pregnancy
• If the gestation is uncertain
late on..
• cervical assessment may
indicate maturity
• as a component of the
Bishop score, cervical
assessment may help
denote the likelihood of
successful vaginal delivery
12
If the cervix becomes
shorter and dilated, labour
is not far off
This suggests a term
pregnancy but cannot date
it conclusively
Cervical assessment
• cervical length, position and
consistency are most useful
• a short, anterior and soft cervix
is usually present after 3 8 weeks
maturity
• although cervical shortening &
position may not change,
changes in consistency almost
always do
Ultrasound scanning

13
 Not all scans during pregnancy
Ultrasonography serve the same purpose

early pregnancy
scans are the
most accurate
for dating

midtrimester
scans are used
for anomaly
assessment
Crown-Rump Length (CRL)
3rd trimester
scans may assess
liquor volume &
fetal weight
accurately but
are useless for
dating
14
 It is crucial that the mother
Early Pregnancy is questioned if a scan
was done early in
Scan pregnancy
If so, she should be asked
if the findings
• Termed as a scan done corresponded to the LMP
dates
b efore14weeks
gestation In clinical practice, if the
discrepancy between menstrual
• The CRL is the & u/s dates is < 7 days, the
desired measurement LMP dates should be employed
(as long as the periods are
• Accurate up to a day! regular)

• All mothers should have If the discrepancy is more then

this the EDD should be based on
ultrasonographic fetal biometry
15
The
EDD

16
 Estimation of the EDD

Amongst all the methods for EDD

assessment, a high quality ultrasound scan
early in pregnancy is the best estimate

EDD has traditionally been based on

LMP
but this has been found to be
unreliable as about half of women
cannot accurately recall the 1st day of their LMP,
have irregular menses
and the timing of ovulation varies
17
Summary

18
Estimation of GA & EDD is usually dependant on
history (LMP)

GA & EDD should be confirmed by other

historical features, physical exam and
ultrasound scan early

A high quality ultrasound measurement of the

embryo or fetes within the 1st 14 weeks is the
most accurate method of confirming GA &
establishing EDD

The GA & EDD should be documented clearly in

the records as soon as confirmation is made via
an accurate calculation of the LMP, u/s or both
19
 REFERENCES
• Konar H, D.C. Dutta’s Textbook of Obstetrics, 7 t h
Edition, New Central Book Agency, 2 0 1 0

• Mongelli M and Gardosi J, Update 1 9 April 2010,

Evaluation of Gestation, Emedicine.medscape.com,
Extracted from:
http://emedicine.medscape.com/
article/259269-overview

• New guidelines standardize pregnancy due

date estimates. Medscape. Sep 2 5 2 0 1 4

20
 Accurate!

Thank You Very Much

21