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To compare the accuracy of the reported date of the last menstrual period LMP with that of symphysis-fundal height SFH in the estimation of gestational age GA , using an ultrasound US scan as reference. Gestational age was concurrently assessed by the 3 methods in this prospective, population-based, pregnancy-outcome study conducted in Hyderabad, Pakistan, from June 18, , through August 31, , with women between 20 and 26 weeks of a singleton pregnancy.

Knowing gestational age GA accurately is essential for optimal prenatal, delivery, and postnatal care. The expected date of delivery, correct diagnosis of preterm or post-term labor, and differentiation between premature birth and intrauterine growth restriction rest on the estimated GA, as do prenatal counseling and interventions for poor fetal growth as well as the avoidance of unnecessary hospitalization, testing, and interventions such as induction of labor and tocolytic treatment [ 1 , 2 , 3 ].

Furthermore, a close estimation of GA informs research toward improving maternal and neonatal outcomes. And an accurately predicted delivery date PDD is obviously useful to the pregnant woman and her family. As a fetal ultrasound US scan is based on biometric measurements of the fetus, it is considered the gold standard for establishing GA when done before 20 weeks of gestation, when the biologic variations in fetal size and the effects of growth restriction are still small.

The accuracy is less if the scan is performed during the third trimester [ 3 , 4 , 5 ]. In many high-resource countries, a first-trimester US scan and a second scan between 18 and 22 weeks are essential parts of obstetric practice because they establish GA and screen for fetal anomalies [ 3 , 6 ]. However, US equipment is often unavailable in low-resource countries, especially in rural and peri-urban areas.

And where available, the equipment is expensive to use, often of poor quality, and operated by undertrained technicians. In addition, women often seek prenatal care late in pregnancy, which further limits the use of ultrasound to assess GA [ 1 , 3 ].

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