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Committee opinion No. 688 Summary: Management of Suboptimally Dated Pregnancies

doi: 10.1097/AOG.0000000000001945
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Abstract: The American College of Obstetricians and Gynecologists considers first-trimester ultrasonography to be the most accurate method to establish or confirm gestational age. Pregnancies without an ultrasonographic examination confirming or revising the estimated due date before 22 0/7 weeks of gestation should be considered suboptimally dated. This document provides guidance for managing pregnancies in which the best clinical estimate of gestational age is suboptimal. There is no role for elective delivery in a woman with a suboptimally dated pregnancy. Although guidelines for indicated late-preterm and early-term deliveries depend on accurate determination of gestational age, women with suboptimally dated pregnancies should be managed according to these same guidelines because of the lack of a superior alternative. The best clinical estimate of gestational age should serve as the basis for decisions regarding antenatal corticosteroid exposure in women with suboptimally dated pregnancies who are at perceived risk of preterm delivery. Amniocentesis for fetal lung maturity is not recommended as a routine component of decision making when considering delivery in a woman with a suboptimally dated pregnancy. Late-term delivery is indicated at 41 weeks of gestation when gestational age is uncertain, using the best clinical estimate of gestational age. Initiation of antepartum fetal surveillance at 39–40 weeks of gestation may be considered for suboptimally dated pregnancies. During the antenatal care of a woman with a suboptimally dated pregnancy, it is reasonable to consider an interval ultrasonographic assessment of fetal weight and gestational age 3–4 weeks after the initial ultrasonographic study.

For a comprehensive overview of these recommendations, the full-text version of this Committee Opinion is available athttp://dx.doi.org/10.1097/AOG.0000000000001949.

Committee on Obstetric Practice:This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice in collaboration with committee members Russell S. Miller, MD, and R. Phillips Heine, MD.

This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.

Copyright March 2017 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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The American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920

Official Citation: Management of suboptimally dated pregnancies. Committee Opinion No. 688. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e29–32.

Received January 26, 2017

Accepted January 26, 2017

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Recommendations

The American College of Obstetricians and Gynecologists (the College) makes the following recommendations and conclusions:

  • Pregnancies without an ultrasonographic examination confirming or revising the estimated due date before 22 0/7 weeks of gestation should be considered suboptimally dated.
  • The timing of indicated delivery in a woman with a suboptimally dated pregnancy should be based on the best clinical estimate of gestational age.
  • There is no role for elective delivery in a woman with a suboptimally dated pregnancy.
  • Amniocentesis for fetal lung maturity is not recommended as a routine component of decision making when considering delivery in a woman with a suboptimally dated pregnancy.
  • During the antenatal care of a woman with a sub- optimally dated pregnancy, it is reasonable to consider an interval ultrasonographic assessment of fetal weight and gestational age 3–4 weeks after the initial ultrasonographic study. Although this follow-up examination is intended to support the working gestational age, interval fetal growth assessment potentially may detect cases of fetal growth restriction.
  • Given concern that a full-term or late-term suboptimally dated pregnancy could actually be weeks further along than it is believed to be, initiation of antepartum fetal surveillance at 39–40 weeks of gestation may be considered.
© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.