The Validity of Gestational Age Estimation by Menstrual Dating in Term, Preterm, and Postterm Gestations

TLDR

Gestational age estimated from the last normal menstrual period is known to be error‑prone, with the magnitude and direction of the error varying according to the LNMP estimate. The study compared LNMP‑based GA estimates to early second‑trimester ultrasound biparietal diameter measurements in 11,045 pregnancies. Most term deliveries had LNMP estimates within ±7 days of ultrasound, but as the LNMP GA moved away from term the error grew, with PPV dropping from .949 at term to .119 at postterm, underscoring the risk of unnecessary interventions and morbidity. Published in JAMA 1988;260:3306‑3308.

Abstract

Despite recognition that estimation of gestational age (GA) based on maternal recollection of the last normal menstrual period (LNMP) is fraught with error, it is not generally appreciated that the magnitude and direction of this error vary as a function of the LNMP estimate. Early second-trimester (16 to 18 weeks) ultrasound determinations of the fetal biparietal diameter were used as the "gold standard" to test the validity of LNMP-based GA estimates in 11 045 women. The large majority of deliveries occurring at or near term showed LNMP estimates that were valid within plus or minus seven days of the ultrasound estimate. As the LNMP GA deviated progressively toward earlier or later GAs, however, the discrepancies became quite marked, especially for postterm dates. The positive predictive values of the LNMP GA estimates decreased dramatically from term (.949) to preterm (.775) to postterm (.119) deliveries. These systematic errors in menstrual GA estimates have profound implications for unnecessary induction, dysfunctional labor and cesarean section, and resultant neonatal and maternal morbidity. (<i>JAMA</i>1988;260:3306-3308)