Assessment of Gestational Age

Asheber Gaym M.D.

January 2009
 Outline

• Discuss definitions of gestational age

• Outline methods of gestational age
measurement
• Describe the different methods of gestational
age measurement
• Discuss the importance of gestational age
• Discuss early pregnancy milestones useful in
assessing gestational age
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 Definitions of relevance to measuring
gestational age
• Menstrual age – age of pregnancy measured
from the date of the last menstrual period
• Conceptual age – age of pregnancy measured
from the date of conception
• Gestational age- often measured as the
menstrual age as identifying the conceptual age
is difficult in most pregnancies except in
pregnancies following assisted reproductive
technologies
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 Challenges of measuring the age of pregnancy
using the menstrual age
• Assumptions of using the menstrual age:
– A regular menstrual cycle of 28 days
– Ovulation occurs at the middle of the cycle on the 14th day
– Both assumptions are often inaccurate ( menstrual cycle length
varies from 21-36 days normally and date of ovulation is highly
variable within the menstrual cycle)
– In menstrual cycles, length variation are due to variations in the
follicular phase; the luteal phase is often constant around 13-14 days
• When using the menstrual age, corrections must be made to
the variations in the cycle length; cycles longer than 28 days
will lead to a false diagnosis of longer gestational age than the
actual age and vice versa.

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 Challenges …. Continued

• Therefore, for cycles longer than 28 days the

additional days should be subtracted from the
calculated gestational age to avoid a false diagnosis
of post term pregnancy
• For cycles shorter than 28 days; the number of days
short should be added to the gestational age to get
the correct age
• Even after these corrections, the date is still variable
due to the variations in the exact date of ovulation
within the cycle
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 Methods of Gestational Age Measurement

• From a reliable last normal menstrual period

– Calculation of the EDC and Gestational age in completed
weeks
– Using the Menstrual Calendar or Chart
• Conceptual age from date of ovulation in pregnancies
conceived by artificial methods
• Ultrasonography
• Radiological methods – nowadays superseded by
ultrasonography
• Early pregnancy milestones
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 Menstrual age measurement from LNMP

• Steps
– Ascertain the reliability of the LNMP
• Regular cycles; last cycle similar to previous cycles in duration,
length and amount of flow; well remembered; no hormonal
contraception for the last two- three cycles; at least three
regular cycles following lactational amenorrhea last delivery
– Calculate the EDC
• European calendar – using Naegle’s rule ( add seven days and
subtract three months)
• Ethiopian calendar- add nine months and ten days if it doesn’t
pass pagume or 5/4 days if it passes pagume

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 Menstrual age measurement from LNMP

• Setback’s of measurement from LNMP

– Unknown LNMP- mothers with frequent deliveries;
irregular cycles; adolescents who become pregnant
before menarche; late initiation of antenatal care
(forgetting); lack of orientation to calendar ( rural
women)
• In developing societies the rate of unknown dates can be 30-
40%
– Mistakes in reporting LNMP- women confusing
implantation hemorrhage; early threatened abortion
and local cervical and vaginal conditions with the LNMP
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 Menstrual age from Menstrual Calendar or
Charts
• Office menstrual calendars or charts
– Prepared in the European as well as the Ethiopian
calendars for easy computation of EDC and
Gestational age from the LNMP

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Ultrasonographic estimation of gestational age-
by measurement of fetal biometric variables
Gestational age Biometric variable Accuracy of estimation
0-14 weeks Crown-rump length + 7 days
15-26 weeks Crown-rump length + 14 days (two weeks)
Biparietal diameter
Femur length
Head circumference
Abdominal circumference

> 26 weeks Biparietal diameters + 21 days ( three weeks)

Femur length
Abdominal circumference
Head circumference

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 Early measurements (milestones) that correlate well with gestational age

Measurement Corresponding Gestational

Age
Date of quickening Primigravida – 19-20 weeks;
Multigravida- 16-18 weeks
Uterine size measurement before 16 weeks during Correlates well with the
pelvic exam gestational age
Fundal height felt at umbilicus 20 weeks
First time fetal heart auscultated with fetal stethoscope 20 weeks
First time fetal heart auscultated with a doppler device 10 weeks
First day urinary pregnancy test was positive 6 weeks
The above early milestones if present can be used either to confirm the accuracy of
gestational age calculated from LNMP or can be used to estimate gestational age in
mothers with unknown LNMP.

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 Importance of accurate gestational age
measurement
• For assessing fetal growth by comparing to the
growth of the uterine fundus
• For decisions in terminating a high risk
pregnancy ( assuring fetal maturity)
• For decisions in terminating a pregnancy
according to the abortion law of the land
• For accurate diagnosis of post term pregnancy

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