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The American College of Obstetricians and Gynecologists recommends that ultrasound-established dates should take preference over menstrual dates when the discrepancy between ultrasound dating and LMP is "Because of the risk of redating a small fetus that may be growth restricted, management decisions based on third-trimester ultrasonography alone are especially problematic; they need to be guided by careful consideration of the entire clinical picture and may require closer surveillance, including repeat ultrasonography to ensure appropriate interval growth." [24]. Birth weight from pregnancies dated by ultrasonography in a multicultural British population.

Other Methods For Estimating the Gestational Age Clinical Examination A pelvic examination supported by good menstrual records in the first trimester has been reported to be a reliable method for dating of pregnancy [9].

Human Chorionic Gonadotropin Pregnancy Test Human chorionic gonadotropin first becomes detectable in the mother's blood and urine between 6 and 14 days after fertilization (3 to 4 weeks gestational age) [11-13].

The gestational age would, therefore, be at least 3 to 4 weeks at the time of a reliable h CG pregnancy test.

The accuracy of the ultrasound estimate of the gestational age varies according to the gestational age. Determining the Estimated Due Date The estimated due date (EDD or EDC) is the date that spontaneous onset of labor is expected to occur. Conceptional age, menstrual age, and ultrasound age: a second-trimester comparison of pregnancies of known conception date with pregnancies dated from the last menstrual period. The due date may be estimated by adding 280 days ( 9 months and 7 days) to the first day of the last menstrual period (LMP). The accuracy of the EDD derived by this method depends on accurate recall by the mother, assumes regular 28 day cycles, and that ovulation and conception occurs on day 14 of the cycle. Observed Gestational Age at Delivery The table below shows the average age of infants delivered in the United States according to the number of fetuses being carried (plurality) [29]. Savitz DA, Terry Jr JW, Dole N, et al: Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination. The earlier age at delivery of multiple gestations is a reflection of the increased incidence of preterm labor and obstetric intervention for complications such as preeclampsia, abruptio placentae, fetal growth restriction, and increased risk for stillbirth that occurs as the number of fetuses increases [30-33]. Mongelli M, Wilcox M, Gardosi J.: Estimating the date of confinement: ultrasonographic biometery versus certain menstrual dates.

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