Assessment of fetal growth requires the most accurate possible estimate of gestational age, for the midwife or obstetrician deciding upon investigation or intervention, for the neonatologist calculating survival and handicap rates, and for the epidemiologist studying the prevalence and aetiology. Unfortunately, the pursuit of precision often leads to the exclusion from published studies of women with uncertain gestation. In a study of 11 602 women in a total population in Aberdeen such uncertainty was associated with irregular menstruation (present in 10.2% of all women), with oral contraceptive use (reported by 11.0% of all women), and with an uncertain last menstrual period (LMP) (in 8.9% of all women),(1) and with various other factors such as lactational amenorrhoea. Women with uncertain gestation are not a homogenous group, but tend to have poorer outcomes, so that their exclusion would mean omitting 37% of perinatal deaths, 34% of those with low birthweight babies, and 37% of preterm labours.(2) This is clearly inappropriate and it is therefore necessary to continue to take a careful clinical history, to examine women carefully, and make full use of available biophysical and biochemical tests when clinically indicated.
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