ULTRASONOGRAPHIC DATING OF PREGNANCY CAUSES SIGNIFICANT ERRORS IN DOWN-SYNDROME RISK ASSESSMENT THAT MAY BE MINIMIZED BY USE OF BIPARIETAL DIAMETER BASED MEANS

OBJECTIVES: Gestational dates assessed by ultrasonographic measurement of fetal dimensions are usually quoted in terms of complete weeks because the uncertainty of ultrasonographic measurement is approximately +/- 7 days. This study examines the effect of ultrasonographic dating on Down syndrome risk assessment. STUDY DESIGN: The effect of small changes in measured biparietal diameter resulting in a change in estimated gestational week and the benefits of a more precise measure of fetal gestational age (raw biparietal diameter) are examined mathematically. RESULTS: If maternal serum alpha-fetoprotein and human chorionic gonadotropin are used to assess Down syndrome risk, risks assessed with ultrasonographically determined dates may be less-than-or-equal-to 45% too high for fetuses with biparietal diameter at the lowest end of the size band and less-than-or-equal-to 22% too low with biparietal diameter at the top of the size band. If the results for maternal serum alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol are used, these figures become less-than-or-equal-to 150% and less-than-or-equal-to 60%, respectively. CONCLUSION: If ultrasonography is used to assess gestational age, the raw biparietal diameter and not the estimated week of gestation must be used to derive means for calculation of multiples of the mean.