Gestational assessment assessed
a Neonatal
Services, Royal Victoria Infirmary, Newcastle upon
Tyne, NE1 4LP, b Department of Paediatrics, South
Cleveland Hospital, Middlesborough
Correspondence to: Dr Wariyar.
Accepted 24 June 1997
AIMS
To review the accuracy with which obstetric
information on gestation is recorded in the neonatal records; and the
reliability of the methods used for assessing gestational age after birth.
METHODSService information on all babies
born in 1989, and research information on all babies of <32 weeks
gestation born in the Northern Region in 1990-91, were reviewed to
determine the accuracy with which antenatally collected information had
been recorded in the neonatal records after birth. A prospective study
was also mounted to assess how reliably paediatric staff could assess
the gestational age of babies born to mothers with certain obstetric dates under service conditions. Paediatric residents looked at 347 babies of > 32 weeks gestation, and senior staff looked
at 105 babies of < 30 weeks gestation.
RESULTSThe best techniques for estimating
gestation immediately after birth were only half as accurate (95% CI ± 17 days) as estimates based on antenatal ultrasound at
15-19 weeks gestation. Assessments that relied on the tone, posture,
and appearance of the baby at birth in those of < 32 weeks gestation
were less reliable than assessments based on a retrospective review of
when various reflex responses first appeared. They also tended to
overestimate true gestation. Antenatal information of high quality was
ignored, and arithmetic and transcription errors were introduced during the transfer of antenatal information into over 10% of postnatal records.
CONCLUSIONSCurrent ultrasound techniques for
"dating" pregnancy antenatally are better than any of the methods
of postnatal assessment. Given the reliability of the antenatal
information now available, it is regrettable that so many inaccuracies
have been allowed to creep into the routine computation and recording
of gestation at birth.
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© 1997 by Archives of Disease in Childhood
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