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Clinical management guidelines for obstetrician-gynecologists. Number 4, May 1999 (replaces educational bulletin Number 147, October 1990). 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]. In cases where the date of conception is known precisely, such as with in vitro fertilization, the EDD is calculated by adding 266 days to the date of conception. American College of Obstetricians and Gynecologists. Chorionic gonadotropin secretion by human embryos in vitro. Time of implantation of the conceptus and loss of pregnancy. Ameri-can College of Obstetricians and Gynecologists. The timing of the "fertile window" in the menstrual cycle: day specific estimates from a prospective study BMJ 2000; 321: 1259-1262. Effects on the probability of conception, survival of the pregnancy, and sex of the baby.

In addition, although a woman is most likely to become pregnant if she has sex on the day of ovulation conception may also occur from live sperm still in her reproductive tract on the day of ovulation if she had sex for up to five days before ovulation [26,27]. 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. 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].

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