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However, ultrasound determination of the date of ovulation has the same imprecision as does the ultrasound estimate of the gestational age and, therefore, a precise date of conception cannot usually be determined as with in vitro fertilization. In addition, although a woman is most likely to become pregnant if she has sex on the day of ovulation conception may also occur from live sperm still in her reproductive tract on the day of ovulation if she had sex for up to five days before ovulation [26,27]. From this point, many attempts were made to align the Republican calendar with the solar year including the addition of an extra month to certain years to supplant the lack of days in a particular year.In 46 BC, the calendar was further reformed by Julius Caesar, introducing an algorithm that removed the dependence of calendars from the observation of the new moon.Human Chorionic Gonadotropin Pregnancy Test Human chorionic gonadotropin first becomes detectable in the mother's blood and urine between 6 and 14 days after fertilization (3 to 4 weeks gestational age) [11-13]. The gestational age would, therefore, be at least 3 to 4 weeks at the time of a reliable h CG pregnancy test. "Ultrasound measurement of the embryo or fetus in the first trimester (up to and including 13 6/7 weeks of gestation) is the most accurate method to establish or confirm gestational age" [24]. The Society of Obstetricians and Gynaecologists of Canada recommends the earliest ultrasound with a crown rump length equivalent to at least 7 weeks (or 10 mm) should be used to determine the gestational age [28].

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Determining the Date of Conception Because the human egg is capable of fertilization for only 12 to 24 hours after ovulation the date of ovulation may be taken as being the date of conception.

The American College of Obstetricians and Gynecologists recommends that ultrasound-established dates should take preference over menstrual dates when the discrepancy between ultrasound dating and LMP is "Because of the risk of redating a small fetus that may be growth restricted, management decisions based on third-trimester ultrasonography alone are especially problematic; they need to be guided by careful consideration of the entire clinical picture and may require closer surveillance, including repeat ultrasonography to ensure appropriate interval growth." [24]. Birth weight from pregnancies dated by ultrasonography in a multicultural British population.

Other Methods For Estimating the Gestational Age Clinical Examination A pelvic examination supported by good menstrual records in the first trimester has been reported to be a reliable method for dating of pregnancy [9].

Observed Gestational Age at Delivery The table below shows the average age of infants delivered in the United States according to the number of fetuses being carried (plurality) [29]. Savitz DA, Terry Jr JW, Dole N, et al: Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination.

The earlier age at delivery of multiple gestations is a reflection of the increased incidence of preterm labor and obstetric intervention for complications such as preeclampsia, abruptio placentae, fetal growth restriction, and increased risk for stillbirth that occurs as the number of fetuses increases [30-33]. Mongelli M, Wilcox M, Gardosi J.: Estimating the date of confinement: ultrasonographic biometery versus certain menstrual dates.

This calendar allowed summer and winter months to become completely misplaced, leading to the adoption of more accurate calendars.

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