obstetrics Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...

, gestational age is a measure of the age of a

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

which is taken from the beginning of the woman's

last menstrual period Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of horm ...

(LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. Such methods include adding 14 days to a known duration since

fertilization Fertilisation or fertilization (see spelling differences), also known as generative fertilisation, syngamy and impregnation, is the fusion of gametes to give rise to a new individual organism or offspring and initiate its development. Proce ...

(as is possible in

in vitro fertilization In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) ...

), or by

obstetric ultrasonography Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus (womb). The procedure is a stan ...

. The popularity of using this definition of gestational age is that menstrual periods are essentially always noticed, while there is usually a lack of a convenient way to discern when fertilization occurred. Gestational age is contrasted with fertilization age which takes the date of

as the start date of

gestation Gestation is the period of development during the carrying of an embryo, and later fetus, inside viviparous animals (the embryo develops within the parent). It is typical for mammals, but also occurs for some non-mammals. Mammals during pregna ...

. The initiation of pregnancy for the calculation of gestational age can differ from definitions of initiation of pregnancy in context of the abortion debate or

beginning of human personhood The beginning of human personhood is the moment when a human is first recognized as a person. There are differences of opinion as to the precise time when human personhood begins and the nature of that status. The issue arises in a number of fi ...

Methods

According to

American College of Obstetricians and Gynecologists The American College of Obstetricians and Gynecologists (ACOG) is a professional association of physicians specializing in obstetrics and gynecology in the United States. Several Latin American countries are also represented within Districts of ...

, the main methods to calculate gestational age are:Obstetric Data Definitions Issues and Rationale for Change - Gestational Age & Term
from Patient Safety and Quality Improvement at

American Congress of Obstetricians and Gynecologists The American College of Obstetricians and Gynecologists (ACOG) is a professional association of physicians specializing in obstetrics and gynecology in the United States. Several Latin American countries are also represented within Districts of ...

. Created November 2012. * Directly calculating the days since the beginning of the last menstrual period * Early

obstetric ultrasound Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus (womb). The procedure is a stan ...

, comparing the size of an

embryo An embryo is an initial stage of development of a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male spe ...

fetus A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal deve ...

to that of a

reference group In the social sciences, social groups can be categorized based on the various group dynamics that define social organization.Boundless team.Types of Social Groups" ''Social Groups and Organization'' Open_educational_resources">OER_course.html" ...

of pregnancies of known gestational age (such as calculated from last menstrual periods) and using the mean gestational age of other embryos or fetuses of the same size. If the gestational age as calculated from an early ultrasound is contradictory to the one calculated directly from the last menstrual period, it is still the one from the early ultrasound that is used for the rest of the pregnancy. * In case of

, calculating days since

oocyte retrieval Transvaginal oocyte retrieval (TVOR), also referred to as oocyte retrieval (OCR), is a technique used in in vitro fertilization (IVF) in order to remove oocytes from the ovary of a woman, enabling fertilization outside the body. Transvaginal oocyt ...

co-incubation In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) ...

and adding 14 days. Gestational age can also be estimated by calculating days from

ovulation Ovulation is the release of eggs from the ovaries. In women, this event occurs when the ovarian follicles rupture and release the secondary oocyte ovarian cells. After ovulation, during the luteal phase, the egg will be available to be fertilized ...

if it was estimated from related signs or ovulation tests, and adding 14 days by convention. A more complete listing of methods is given in following table:A Simple Solution to Dating Discrepancies: The Rule of Eights
As a general rule, the official gestational age should be based on the actual beginning of the last menstrual period, unless any of the above methods gives an estimated date that differs more than the variability for the method, in which case the difference cannot probably be explained by that variability alone. For example, if there is a gestational age based on the beginning of the last menstrual period of 9.0 weeks, and a first-trimester obstetric ultrasonography gives an estimated gestational age of 10.0 weeks (with a 2 SD variability of ±8% of the estimate, thereby giving a variability of ±0.8 weeks), the difference of 1.0 weeks between the tests is larger than the 2 SD variability of the ultrasonography estimate, indicating that the gestational age estimated by ultrasonography should be used as the official gestational age. Once the estimated due date (EDD) is established, it should rarely be changed, as the determination of gestational age is most accurate earlier in the pregnancy. Following are diagrams for estimating gestational age from

, by various target parameters: File:Gestational sac diameter by gestational age.png, By

gestational sac The gestational sac is the large cavity of fluid surrounding the embryo. During early embryogenesis it consists of the extraembryonic coelom, also called the chorionic cavity. The gestational sac is normally contained within the uterus. It is the o ...

diameter File:Crown-rump length by gestational age.png , By

crown-rump length Crown-rump length (CRL) is the measurement of the length of human embryos and fetuses from the top of the head (crown) to the bottom of the buttocks (rump). It is typically determined from ultrasound imagery and can be used to estimate gestationa ...

(CRL) File:Biparietal diameter by gestational age.png, By

biparietal diameter Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus (womb). The procedure is a st ...

(BPD)

Comparison to fertilization age

The fertilization or conceptional age (also called ''embryonic age'' and later ''fetal age'') is the time from the

. It usually occurs within a day of

, which, in turn, occurs on average 14.6 days after the beginning of the preceding menstruation (LMP). There is also considerable variability in this interval, with a 95%

prediction interval In statistical inference, specifically predictive inference, a prediction interval is an estimate of an interval in which a future observation will fall, with a certain probability, given what has already been observed. Prediction intervals are o ...

of the ovulation of 9 to 20 days after menstruation even for an average woman who has a mean LMP-to-ovulation time of 14.6.Derived from a

standard deviation In statistics, the standard deviation is a measure of the amount of variation or dispersion of a set of values. A low standard deviation indicates that the values tend to be close to the mean (also called the expected value) of the set, while ...

in this interval of 2.6, as given in: In a reference group representing all women, the 95% prediction interval of the LMP-to-ovulation is 8.2 to 20.5 days. The actual variability between gestational age as estimated from the beginning of the last menstrual period (without the use of any additional method mentioned in previous section) is substantially larger because of uncertainty which menstrual cycle gave rise to the pregnancy. For example, the menstruation may be scarce enough to give the false appearance that an earlier menstruation gave rise to the pregnancy, potentially giving an estimated gestational age that is approximately one month too large. Also, vaginal bleeding occurs during 15-25% of first trimester

pregnancies Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but can ...

, and may be mistaken as menstruation, potentially giving an estimated gestational age that is too low.

Uses

Gestational age is used for example for: * The events of

prenatal development Prenatal development () includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal devel ...

, which usually occur at specific gestational ages. Hence, the gestational timing of a fetal toxin exposure, fetal drug exposure or

vertically transmitted infection A vertically transmitted infection is an infection caused by pathogenic bacteria or Pathogenic virus, viruses that use mother-to-child transmission, that is, Transmission (medicine), transmission directly from the mother to an embryo, fetus, or ...

can be used to predict the potential consequences to the fetus. *

Estimated date of delivery The estimated date of delivery (EDD), also known as expected date of confinement, and estimated due date or simply due date, is a term describing the estimated delivery date for a pregnancy, pregnant woman. Normal pregnancies last between 38 and 42 ...

* Scheduling

prenatal care Prenatal care, also known as antenatal care, is a type of preventive healthcare. It is provided in the form of medical checkups, consisting of recommendations on managing a healthy lifestyle and the provision of medical information such as materna ...

* Estimation of

fetal viability Fetal viability is the ability of a human fetus to survive outside the uterus. Medical viability is generally considered to be between 23 and 24 weeks Gestational age (obstetrics), gestational age. Viability depends upon factors such as birth weigh ...

* Calculating the results of various prenatal tests, (for example, in the

triple test The triple test, also called triple screen, the Kettering test or the Bart's test, is an investigation performed during pregnancy in the second trimester to classify a patient as either high-risk or low-risk for chromosomal abnormalities (and neu ...

). * Birth classification into for example preterm, term or postterm. * Classification of infant deaths and stillbirths * Postnatally (after birth) to estimate various risk factors Pregnancy timeline

Estimation of due date

Distribution of gestational age at childbirth

The mean pregnancy length has been estimated to be 283.4 days of gestational age as timed from the first day of the

and 280.6 days when retrospectively estimated by

measurement of the

fetal biparietal diameter Obstetrics, Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus (womb). The procedu ...

(BPD) in the second trimester. Other algorithms take into account other variables, such as whether this is the first or subsequent child, the mother's race, age, length of menstrual cycle, and menstrual regularity. In order to have a standard reference point, the normal pregnancy duration is assumed by medical professionals to be 280 days (or 40 weeks) of gestational age. Furthermore, actual childbirth has only a certain probability of occurring within the limits of the estimated due date. A study of singleton live births came to the result that childbirth has a

of 14 days when gestational age is estimated by first-trimester

ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...

and 16 days when estimated directly by last menstrual period. The most common system used among healthcare professionals is Naegele's rule, which estimates the expected date of delivery (EDD) by adding a year, subtracting three months, and adding seven days to the first day of a woman's last menstrual period (LMP) or corresponding date as estimated from other means.

Medical fetal viability

There is no sharp limit of development, gestational age, or weight at which a human fetus automatically becomes viable.Moore, Keith and Persaud, T
''The Developing Human: Clinically Oriented Embryology''
p. 103 (Saunders 2003). According to studies between 2003 and 2005, 20 to 35 percent of babies born at 23 weeks of gestation survive, while 50 to 70 percent of babies born at 24 to 25 weeks, and more than 90 percent born at 26 to 27 weeks, survive.March of Dimes --> Neonatal Death
Retrieved on November 10, 2014. In turn citing: * * * It is rare for a baby weighing less than 500 g (17.6 ounces) to survive. A baby's chances for survival increases 3-4% per day between 23 and 24 weeks of gestation and about 2-3% per day between 24 and 26 weeks of gestation. After 26 weeks the rate of survival increases at a much slower rate because survival is high already.(). What are the chances that my baby will survive?. NLINEAvailable at: http://www.spensershope.org/chances_for_survival.htm . ast Accessed 14 November 2012 Prognosis depends also on medical protocols on whether to resuscitate and aggressively treat a very premature newborn, or whether to provide only

palliative care Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...

, in view of the high risk of severe disability of very preterm babies. Prenatal development table

Birth classification

Using gestational age, births can be classified into broad categories: Using the LMP (last menstrual period) method, a full-term human pregnancy is considered to be 40 weeks (280 days), though pregnancy lengths between 38 and 42 weeks are considered normal. A fetus born prior to the 37th week of gestation is considered to be ''preterm''. A preterm baby is likely to be

premature Premature may refer to: * ''Premature'' (2014 film), an American comedy film * ''Premature'' (2019 film), an American romantic drama film * ''PREMature'', a 2015 British television drama miniseries See also * Premature aging, of an organism * P ...

and consequently faces increased risk of

morbidity A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

and

mortality Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...

. An estimated due date is given by Naegele's rule. According to the WHO, a preterm birth is defined as "babies born alive before 37 weeks of pregnancy are completed."
/ref> According to this classification, there are three sub-categories of preterm birth, based on gestational age: extremely preterm (fewer than 28 weeks), very preterm (28 to 32 weeks), moderate to late preterm (32 to 37 weeks). Various jurisdictions may use different classifications.

In classifying perinatal deaths, stillbirths and infant deaths

For most of the 20th Century, official definitions of a live birth and

infant death Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...

in the

Soviet Union The Soviet Union,. officially the Union of Soviet Socialist Republics. (USSR),. was a transcontinental country that spanned much of Eurasia from 1922 to 1991. A flagship communist state, it was nominally a federal union of fifteen national ...

and

Russia Russia (, , ), or the Russian Federation, is a List of transcontinental countries, transcontinental country spanning Eastern Europe and North Asia, Northern Asia. It is the List of countries and dependencies by area, largest country in the ...

differed from common international standards, such as those established by the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...

in the latter part of the century. Babies who were fewer than 28 weeks of gestational age, or weighed fewer than 1000 grams, or fewer than 35 cm in length – even if they showed some sign of life (breathing, heartbeat, voluntary muscle movement) – were classified as "live fetuses" rather than "live births." Only if such newborns survived seven days (168 hours) were they then classified as live births. If, however, they died within that interval, they were classified as stillbirths. If they survived that interval but died within the first 365 days they were classified as infant deaths. More recently, thresholds for "

fetal death Perinatal mortality (PNM) refers to the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. Variations in the precise definition of the perinatal mortality exist, specifically concerning the issue of inclusion o ...

" continue to vary widely internationally, sometimes incorporating weight as well as gestational age. The gestational age for statistical recording of fetal deaths ranges from 16 weeks in Norway, to 20 weeks in the US and Australia, 24 weeks in the UK, and 26 weeks in Italy and Spain. The WHO defines the

perinatal period Prenatal development () includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal deve ...

as "The perinatal period commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth." Perinatal mortality is the death of fetuses or neonates during the perinatal period. A 2013 study found that "While only a small proportion of births occur before 24 completed weeks of gestation (about 1 per 1000), survival is rare and most of them are either fetal deaths or live births followed by a neonatal death."

Postnatal use

Gestational age (as well as ''fertilization age'') is sometimes used postnatally (after birth) to estimate various risk factors. For example, it is a better predictor than postnatal age for risk of

intraventricular hemorrhage Intraventricular hemorrhage (IVH), also known as intraventricular bleeding, is a bleeding into the brain's ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. It can result from phys ...

premature babies Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...

treated with

extracorporeal membrane oxygenation Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequat ...

Factors affecting pregnancy length

Child's gestational age at birth (pregnancy length) is associated with various likely causal maternal non-genetic factors: stress during pregnancy, age, parity, smoking, infection and inflammation, BMI. Also, preexisting maternal medical conditions with genetic component, e.g.,

diabetes mellitus type 1 Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that originates when cells that make insulin (beta cells) are destroyed by the immune system. Insulin is a hormone required for the cells to use blood sugar f ...

systemic lupus erythematosus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Comm ...

anaemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, th ...

. Parental ancestral background (race) also plays a role in pregnancy duration. Gestational age at birth is on average shortened by various pregnancy aspects: twin pregnancy, prelabor rupture of (fetal) membranes,

pre-eclampsia Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease ...

eclampsia Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia. Pre-eclampsia is one of the hypertensive disorders of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of protein in ...

intrauterine growth restriction Intrauterine growth restriction (IUGR), or fetal growth restriction, refers to poor growth of a fetus while in the womb during pregnancy. IUGR is defined by clinical features of malnutrition and evidence of reduced growth regardless of an infant's ...

. The ratio between fetal growth rate and uterine size (reflecting uterine distension) is suspected to partially determine the pregnancy length.

Heritability of pregnancy length

Family-based studies showed that gestational age at birth is partially (from 25% to 40%) determined by genetic factors.

References

{{Human development Obstetrics Neonatology Demography Midwifery