Daniel Frayne, MD Updated Jan 2012

Obstetrical Dating Guideline

MAHEC FM-OB Regional Collaborative

Background:

Precise knowledge of the age of the fetus is imperative for ideal obstetrical
management, especially preterm and postterm pregnancies. The EDC should be
established by 20 weeks gestation because dating becomes increasingly inaccurate
after this time.

Menstrual Dating:

Traditionally, the mean duration of pregnancy calculated from the first day of the
last normal menstrual period is very close to 280 days (40 weeks). Naegeles rule
(c. 1812) assumes a 28-day cycle with ovulation on day 14. By adding 7 to the first
day of the last normal menstrual period and counting back 3 months, the EDC is
reached. Pregnancy wheels use this calculation, but have inherent error of
reproducibility of approx. 3 days. This calculation becomes inaccurate if LMP is
(1) uncertain, (2) cycle is not of average duration (24-32 days), (3) ovulation is later
in cycle (4) hormonal contraceptives were used or a pregnancy occurred during
previous 3 months. In rare circumstances, the exact date of conception may be
known (i.e. IVF) and should be used to calculate EDC.

Ultrasound Dating:

Measurement of gestational age by ultrasound is an important tool in obtaining
accurate dating. In the 1
st
trimester (until 12 weeks), measurement of crown rump
length (CRL) by transvaginal ultrasound is considered the most accurate method of
determining gestation age. The standard error is 3-7 days, depending on
gestational age and technique. At MAHEC, the ranges used are as follows:

CRL EGA Accepted
Error
8 weeks 3 days
9-10 weeks 5 days
11-12
weeks
6 days

Dating by CRL has been shown to decrease post term inductions when compared to
menstrual dating but has not been proven to have significant enough benefit to
require this for all pregnancies.

Early 2
nd
trimester ultrasound (12-20 weeks) uses an average of multiple
measurements (biparietal diameter (BPD), head circumference (HC), abdominal
circumference (AC), and femur length (FL)) to determine gestational age
traditionally has a standard error of 10 days. Some studies have shown this
measurement to be more predictive of the actual delivery date than any other
method. At MAHEC, the ranges used are as follows:
Daniel Frayne, MD Updated Jan 2012

Composite
EGA
Accepted Error
12-14 weeks 7 days
15-20 weeks 10 days

Ultrasound measurements obtained after 21 weeks are increasingly inaccurate for
dating purposes. 21-28 weeks estimations are 14 days, and after 28 weeks, 21
days.

ACOG Standards for Good Dates:

ACOG guidelines regarding induction of labor and assessing fetal lung maturity
provide the basis for the definition of good dates. These guidelines infer fetal
maturity after 39 weeks gestation as defined by:

Fetal heart tones have been documented for 20 weeks by nonelectronic fetoscope
or for 30 weeks by Doppler
It has been 36 weeks since a serum or urine -HCG pregnancy test was found to
be positive by a reliable laboratory
Ultrasound measurement of the CRL at 6-12 weeks of gestation supports a
gestational age equal to or greater than 39 weeks
Ultrasound measurement at 13-20 weeks gestation supports a clinically
determined gestational age of 39 weeks or greater
Ultrasound may be considered confirmatory of menstrual dates if there is a
gestational age agreement within accepted standard of error by above ultrasound
methods. If any of the aforementioned criteria confirms a gestational age of 39
weeks or more in a patient with normal menstrual cycles (and no hormonal
contraceptive use prior to conception), it is appropriate to use menstrual dates.
(NOTE: Good dates cannot be established by menstrual dating alone)

Guideline for obtaining good dates:

Patient presents for 1
st
prenatal
visit at
IF: certain LMP, regular
menstrual cycle, no hormonal
contraceptive use, uterine size
correlates with LMP, THEN:
IF: unknown LMP or irregular
menstrual cycle or hormonal
contraceptive use, THEN:
12 weeks Document FHTs by Doppler at 10-12
weeks and confirm dates by US at
16-20 weeks
Obtain US to establish dates by CRL
> 12 weeks but 20 weeks Obtain US at 12-20 weeks to confirm
dates
No way to establish good dates by
criteria, obtain US for EDC 7-10
days
> 20 weeks No way to establish good dates by
criteria, obtain US for anatomy
No way to establish good dates by
criteria, obtain US for anatomy

Caveat: If there is a positive pregnancy test around the time of the missed menses, US
may not be required to establish good dates.

Daniel Frayne, MD Updated Jan 2012

Reference:

(1) ACOG educational bulletin: Assessment of fetal lung maturity. International Jo of Gyn and Obs 56 (1997)
191-198.
(2) ACOG practice bulletin No 10, Induction of Labor. Nov 1999.
(3) Demianczuk NN, et al. SOGC clinical practice guideline No. 135: The use of first trimester ultrasound. J
Obstet Gyn Can 2003; 25(10): 864-9.
(4) Baskett TF, Nagele F. Naegeles rule: a reappraisal. British J Obs and Gyn 2000; 107: 1433-1435. (Also
comment)
(5) Ott WJ. Accurate gestational dating: revisited. Am Jo of Perinatology 1994; 11(6): 404-8.
(6) Olesen AW, Thomsen SG. Prediction of delivery date by sonography in the first and second trimesters.
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(9) Bennett KA, et al. First trimester ultrasound screening is effective in reducing postterm labor induction rates:
A randomized controlled trial. Am Jo of Obs and Gyn 2004; 190: 1077-81.
(10) Harrington DJ, et al. Does a first trimester dating scan using crown rump length measurement reduce the rate
of induction of labour for prolonged pregnancy? An uncompleted randomized controlled trial of 463 women.
BJOG 2006; 113:171-176.
(11) Goldstein SR, Wolfson R. Endovaginal ultrasonographic measurement of early embryonic size as a means of
assessing gestational age. J Ultrasound Med 1994; 13:27-31.
(12) Rossavik IK, Fishburne JI. Conception age, menstrual age, and ultrasound age: A second-trimester
comparison of pregnancies of known conception date with pregnancies dated from the last menstrual period.
Obstetrics and Gyn 1989; 73(2):243-9.
(13) Robinson HP. Sonar Measurement of fetal crown-rump length as means of assessing maturity in first
trimester of pregnancy. BJOG 1973; 4: 28-31.