Why we should eliminate the due date: a truth in jest

Abstract

We currently use flawed calculations to set a woman's due date based on menstrual periods to determine gestational age. We use the estimated gestational age to make management decisions based on our patients' individual needs. This principle is in contrast to our patients' use of dating to set an estimated date of confinement. This date is seen as a very specific point in time. Patients and their families plan on that date and become distressed when the expected date is not met. Given that many patients are induced electively, that many will have their delivery dates changed, and that many will have delivery dates adjusted for medical reasons, and most importantly given that dating is inaccurate and unreliable, we propose eliminating the due date. We propose giving patients a calculated assigned week of delivery at 32 weeks. An assigned week of delivery allows for individualization of obstetric care based on the needs of our patients, their support systems, and hospital staffing. We believe an assigned week of delivery will improve obstetric practice and patient satisfaction.

Issues in Pregnancy Dating: Revisiting the Evidence

“…Not surprisingly, several authors support eliminating LMP dating altogether, stating that the margin of error on even the most accurate LMP recall, regardless of how the EDD is calculated, is still unacceptable in modern times 1,2,13,14 . Arguing in favor of ultrasound dating, they also reason that having the most accurate EDD will reduce anxiety for the pregnant woman and her family, especially in the postterm but undelivered clinical scenario 1,2,13 . Katz et al 2 further rationalize this stance by recommending that pregnant women be given an “assigned week of delivery” in lieu of the EDD, stating that this would eliminate the reassignment of due dates late in the pregnancy to correct or meet patient's expectations.…”

“…Arguing in favor of ultrasound dating, they also reason that having the most accurate EDD will reduce anxiety for the pregnant woman and her family, especially in the postterm but undelivered clinical scenario 1,2,13 . Katz et al 2 further rationalize this stance by recommending that pregnant women be given an “assigned week of delivery” in lieu of the EDD, stating that this would eliminate the reassignment of due dates late in the pregnancy to correct or meet patient's expectations. Although the title of their commentary suggests that Katz et al 2 at times approach these issues “in jest,” it seems feasible to consider a composite gestational age assessment based on all available methods.…”

“…Establishing an accurate “due date” is one of the most important assessments for a pregnant woman, one that has both social and medical significance. For women and their families, this estimated date of delivery (EDD) represents the long‐awaited birth day of their child and is a time frame around which many economic and social activities are planned 1,2 . For obstetric providers, this end point date provides guidance for the timing of specific maternal and fetal testing throughout pregnancy, gauges fetal growth parameters, and provides well‐established timelines for specific interventions in the management of prenatal complications 3,4 .…”

Women’s views about the timing of birth

“…8 Some have questioned whether the specificity of the EDB is helpful or necessary. 9 Alternative ways for communicating timing of birth information to women other than the EDB have been proposed. Whitehouse suggested that providing women with a delivered-by-date at 42 weeks after the LMP would decrease maternal anxiety and encourage women to see delivery at any week of term pregnancy as normal.…”

“…10 Others have suggested use of the EDB be eliminated, especially in early pregnancy, and instead at 32 weeks women be given an individualised 'assigned week of delivery' depending on their clinical circumstances. 9 To the best of our knowledge, no studies have been conducted that have explored women's views about the EDB or their preferences for alternatives.…”