The biologic error in gestational length related to the use of the first day of last menstrual period as a proxy for the start of pregnancy.
OBJECTIVE
In a large unselected population of normal spontaneous pregnancies, to estimate the biologic variation of the interval from the first day of the last menstrual period to start of pregnancy, and the biologic variation of gestational length to delivery; and to estimate the random error of routine ultrasound assessment of gestational age in mid-second trimester.


METHODS
Cohort study of 11,238 singleton pregnancies, with spontaneous onset of labour and reliable last menstrual period. The day of delivery was predicted with two independent methods: According to the rule of Nägele and based on ultrasound examination in gestational weeks 17-19. For both methods, the mean difference between observed and predicted day of delivery was calculated. The variances of the differences were combined to estimate the variances of the two partitions of pregnancy.


RESULTS
The biologic variation of the time from last menstrual period to pregnancy start was estimated to 7.0 days (standard deviation), and the standard deviation of the time to spontaneous delivery was estimated to 12.4 days. The estimate of the standard deviation of the random error of ultrasound assessed foetal age was 5.2 days.


CONCLUSIONS
Even when the last menstrual period is reliable, the biologic variation of the time from last menstrual period to the real start of pregnancy is substantial, and must be taken into account. Reliable information about the first day of the last menstrual period is not equivalent with reliable information about the start of pregnancy.
Nakling
Jakob
J
Department of Obstetrics and Gynecology, Central Hospital of Lillehammer, Norway.
Buhaug
Harald
H
Backe
Bjorn
B
D015331:Cohort Studies; D003951:Diagnostic Errors; D005260:Female; D005865:Gestational Age; D006801:Humans; D008598:Menstruation / Q000502:physiology*; D011237:Predictive Value of Tests; D011247:Pregnancy / Q000502:physiology*