GESTATIONAL ASSESSMENT ASSESSED

Aims-To review the accuracy with which obstetric information on gestat ion is recorded in the neonatal records; and the reliability of the me thods used for assessing gestational age after birth. Methods-Service information on all babies born in 1989, and research information an al l babies of < 32 weeks gestation born in the Northern Region in 1990-9 1, were reviewed to determine the accuracy with which antenatally coll ected information had been recorded in the neonatal records after birt h, A prospective study was also mounted To assess how reliably paediat ric staff could assess the gestational age of babies born to mothers w ith certain obstetric dates under service conditions. Paediatric resid ents looked at 347 babies of > 32 weeks gestation, and senior staff lo oked at 105 babies of < 30 weeks gestation. Results-The best technique s for estimating gestation immediately after birth were only half as a ccurate (95% CI +/- 17 days) as estimates based on antenatal ultrasoun d at 15-19 weeks gestation. Assessments that relied on the tone, postu re, and appearance of the baby at birth in these of < 32 weeks gestati on 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 duri ng the transfer of antenatal information into over 10% of postnatal re cords. Conclusions-Current ultrasound techniques for ''dating'' pregna ncy antenatally are better than any of the methods of postnatal assess ment. Given the reliability of the antenatal information now available , it is regrettable that so many inaccuracies have been allowed to cre ep, into the routine computation and recording of gestation at birth.