The Society of Obstetricians and Gynaecologists of Canada recommends the earliest ultrasound with a crown rump length equivalent to at least 7 weeks (or 10 mm) should be used to determine the gestational age .
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." . Birth weight from pregnancies dated by ultrasonography in a multicultural British population.
Otherwise "..avoid missing a situation of early intrauterine growth restriction in one twin, most experts agree that the clinician may consider dating pregnancy using the larger fetus." [22,23].
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) . Savitz DA, Terry Jr JW, Dole N, et al: Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination.
The American College of Obstetricians and Gynecologists.
Berghella V, et al., Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high-risk pregnancies?
Time of implantation of the conceptus and loss of pregnancy.
Daily immunoactive and bioactive human chorionic gonadotropin profiles in periimplantation urine samples. 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. Use of the LMP to establish the due date may overestimate the duration of the pregnancy, and can be subject to an error of more than 2 weeks [5-7]. The gestational age would, therefore, be at least 3 to 4 weeks at the time of a reliable h CG pregnancy test. Twins When a twin pregnancy is the result of in vitro fertilization determination of gestational age should be made from the date of embryo transfer. Clinical management guidelines for obstetricians-gynecologists. Number 55, September 2004 (replaces practice pattern number 6, October 1997). The gestational age should ,therefore, be at least 10 to 12 weeks if fetal heart tone are heard. Kramer MS, Mc Lean FH, Boyd ME, Usher RH: The validity of gestational age estimation by menstrual dating in term, preterm and postterm gestations. Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination.