Management of suboptimally dated pregnancy

1. Management of
Suboptimally Dated Pregnancy
ASRM, 2017
Prof. Aboubakr Elnashar
Benha university Hospital, Egypt
ABOUBAKR ELNASHAR

2. INTRODUCTION
Contemporary efforts to reduce elective deliveries
before 39 weeks of gestation are intended to
reduce risks of neonatal respiratory and
nonrespiratory morbidities that are more frequently
associated with early-term birth
Strategies to reduce non medically indicated early
deliveries is a best clinical estimate of gestational age
ABOUBAKR ELNASHAR

3. DEFINITION
Pregnancies without an ultrasonographic examination
confirming or revising the estimated due date before 22
0/7 weeks of gestation
First-trimester US
most accurate method to establish or confirm
gestational age
Second and third trimesters US
biometric dating has a range of inaccuracy that
increases with advancing gestational age.
ABOUBAKR ELNASHAR

4. A recommended 22-week cutoff
replaces an established historic threshold at 20 w.
The rationale
the same discrepancy of more than 10 days
between US dating and menstrual dating
applies to pregnancies from 16 0/7 w through 21
6/7 w
consistent with ASRM recommendation that the
optimal time for a single US at 18–22 w
{US during this time allows for
fetal anatomical assessment
accurate estimation of gestational age}
ABOUBAKR ELNASHAR

5. RECOMMENDATIONS
The timing of indicated delivery
 should be based on the best clinical estimate of
gestational age.
must balance the maternal and newborn risks of
late-preterm and early-term delivery with the risks of
further continuation of pregnancy.
Decisions must be individualized
ABOUBAKR ELNASHAR

6. Elective delivery
No role
Without a risk for the woman or the fetus that is
considered sufficient to warrant delivery, elective
delivery could introduce unnecessary risk of neonatal
morbidity if the pregnancy proves to be earlier in
gestation than originally estimated.
ABOUBAKR ELNASHAR

7. Amniocentesis for Fetal Lung Maturity
not recommended as a routine component of
decision making when considering delivery
{the lack of reliability for predicting newborn
pulmonary outcomes
an inability to predict non respiratory outcomes}
ABOUBAKR ELNASHAR

8. Antenatal corticosteroid
Based on the best clinical estimate of gestational
age
recommended before anticipated delivery between
24 w and 34 w
may be considered in the late-preterm period
(between 34 0/7 w and 36 6/7 w) for women at
imminent risk of preterm birth within 7 days based
upon eligibility
ABOUBAKR ELNASHAR

9. During the antenatal care
An interval ultrasonographic assessment of
fetal weight and
gestational age
3–4 w after the initial US study.
Aim:
to support the working gestational age
may detect cases of fetal growth restriction.
ABOUBAKR ELNASHAR

10. Initiation of antepartum fetal surveillance
at 39–40 w may be considered.
{full-term or late-term suboptimally dated pregnancy
could actually be weeks further along than it}
ABOUBAKR ELNASHAR

11. Late-term delivery is indicated at 41 weeks of
gestation
when gestational age is uncertain, using the best
clinical estimate of gestational age.
ABOUBAKR ELNASHAR

12. You can get:
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