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.
gestational age estimation last menstrual period accuracy, menstrual dating validity preterm postterm ultrasound comparison, LMP gestational age estimation error biparietal diameter, postterm pregnancy menstrual dating positive predictive value, last menstrual period estimation error cesarean induction, Kramer gestational age menstrual dating validation, second trimester ultrasound gold standard gestational age, menstrual dating preterm delivery accuracy prediction, systematic error LNMP gestational age clinical implications, unnecessary induction postterm menstrual dates inaccuracy
PMID 3054193 3054193 DOI 10.1001/jama.1988.03410220090034 10.1001/jama.1988.03410220090034
Cite this article
Kramer, M. S., McLean, F. H., Boyd, M. E., & Usher, R. H. (1988). The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations. JAMA, 260(22), 3306-3308. https://doi.org/10.1001/jama.1988.03410220090034
Kramer MS, McLean FH, Boyd ME, Usher RH. The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations. JAMA. 1988;260(22):3306-3308. doi:10.1001/jama.1988.03410220090034
Kramer, Michael S., et al. "The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations." JAMA, vol. 260, no. 22, 1988, pp. 3306-3308.
Keywords
Cohort Studies, Evaluation Studies As Topic, Female, Gestational Age, Humans, Menstruation, Obstetrics/methods, Pregnancy, Time Factors, Ultrasonography
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EndometriosisOvarian Cancer RiskLong-term Health Outcomes
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