These are all abbreviations denoting delivery date.

Estimated Date of Confinement - EDC

Estimated Date of Delivery - EDD
Estimated Date of Birth - EDB
EDC is an older term meaning the women is confined to the hospital for the birth of her child. As
records are noted, the phrase such as on the third day of confinement patient would be used.
This term is used quite a bit today.
EDC is figured by using Naegels Rule:
This method for estimating the expected date of delivery is named after Franz Karl Naegele who
was a director and professor in Heidelberg, Germany in the early 1800s. A picture of his
forceps along with pictures of an old birthing room in Germany can be found here.
His rule takes the last menstrual period (LMP) adds a year, subtracts three months and adds
seven days to that date. LMP = 2 May 2007
+1 year = 2 May 2008
-3 months = 2 February 2008
+7 days = 9 February 2008
or +9 months and +7 days only, or according to our book:
Ngeles (different spelling) rule is subtract 3 months, add 7 days. These all come up with a
similar estimated date.
10.2.1 How to measure fundal height using the nger method
If the top of the uterus is below the bellybutton, measure how many fingers below the bellybutton
it is. If the top of the uterus is above the bellybutton, measure how many fingers above the
bellybutton it is.

View larger image

Figure 10.2 Measuring fundal height using the finger method. The woman is lying on her back.
Each line represents the width of two fingers.

Look carefully at Figure 10.2. If the baby is growing normally, by how many fingerwidths should the uterus rise in the second trimester (3-6 months of pregnancy, or 15-27
completed weeks of gestation)?

Figure 10.3 Fundal height at 7 months gestation.

Hide answer

Fundal height should increase by 6 finger-widths (two finger-widths every month) in the
second trimester.

How many fingers above the bellybutton should the top of the uterus be at 7 months
gestation?
Hide answer

See Figure 10.3 for the answer.

How do you explain the position of the dotted line at 9 months in Figure 10.2, which is
below the line showing fundal height at 8 to 9 months?
Hide answer

Babies may drop lower in the weeks just before birth (look back at Box 10.1).

Look at the diagrams in Figure 10.4 (a) and (b). How many weeks pregnant is the woman
in each case, based on the finger method of measuring fundal height shown in Figure
10.2?

View larger image

Figure 10.4 (a) and (b) How many months of pregnancy do you think each of these
diagrams shows?
Hide answer

In Figure 10.4(a) the woman is about 4 months pregnant. In Figure 10.4 (b) she is about
6 months pregnant (three fingers above the bellybutton).

When you measure fundal height at every antenatal visit, write down the number of fingers you
used to measure the height of the uterus on the womans antenatal record card. Put a + (plus)
sign in front of the number if the top of the uterus is above the bellybutton. Put a (minus) sign
in front of the number if the top of the uterus is below the bellybutton.

How would you record the measurements shown in Figure 10.4(a) and (b)?

Hide answer

The measurement in Figure 10.4(a) would be recorded as -2. The measurement in Figure
10.4(b) would be +3.

Limitations of the finger method

You need to be aware that the finger method for estimating gestational age (the number of
weeks/months of pregnancy) has some limitations that affect its accuracy.

Look at your own hands. Can you suggest why the finger method might give a different
estimate of gestational age if two different health workers used this method to measure
the same womans fundal height?
Hide answer

Because of the big variation in the thickness of our fingers, there could be up to three
weeks difference between the fundal height measurement of the same woman made by
two different people. (This is known as inter-observer variation, i.e. variation between
different observers.)

Even if the same health worker measures the fundal height of the same woman several times on
the same day, the answer may be different each time, because the finger method is not very
precise. (This is known as intra-observer variation, i.e. variation by a single observer at
different times.)
Finally, you might have realised that the distance between the symphysis pubis (pubic bone) and
the umbilicus (bellybutton) varies between women when they are not pregnant, and this variation
affects the accuracy of the fundal height measurement using the finger method. For example, it
assumes that the distance between the pubic symphysis and the umbilicus is 20 cm at 20 weeks
gestation, but it can be as long as 30 cm and as short as 14 cm.
To overcome these limitations, it is recommended that you measure fundal height using a soft
tape measure if you have one, as described next.
10.2.2 How to measure fundal height using a soft tape measure
You can use this method when the top of the uterus grows as high as the womans bellybutton.
During the second half of pregnancy, the size of the uterus in centimetres is close to the number
of weeks that the woman has been pregnant. For example, if it has been 24 weeks since her last
normal menstrual period, the uterus will usually measure 22-26 cm. The uterus should grow
about 1 cm every week, or 4 cm every month.
1. Lay a cloth or soft plastic measuring tape on the mothers abdomen, holding the 0 (zero)
on the tape at the top of the pubic bone (see the arrow in Figure 10.5a).

2. Follow the curve of her abdomen, and hold the tape at the top of her uterus (Figure
10.5b).
3. Write down the number of centimetres (cm) from the top of the pubic bone to the top of
the uterus.

View larger image

Figure 10.5 (a) The arrow points to the top of the pubic bone. Place the 0 (zero) of the tape
measure here. (b) Follow the curve of the womans abdomen and hold the tape at the top of her
uterus.
Doctors, nurses and many midwives are taught to count pregnancy by weeks instead of months.
They start counting at the first day of the last normal menstrual period (LNMP), even though the
woman probably got pregnant two weeks later. Counting this way makes most pregnancies 40
weeks long (or you can say a normal gestation is 40 weeks).
Estimating Gestational Age
If everyone had normal, regular periods, every 28 days, and could remember exactly when their
last period was, and ovulation always occurred on day #14 of the menstrual cycle, then
gestational age determination would be easy. These assumptions, however, are not always the
case. In real life, determining gestational age can be challenging.
The estimated delivery date is calculated by adding 280 days to the first day of the last menstrual
period. An alternative method of determining the due date is to add 7 days to the LMP, subtract
three months, and add one year. These calculations are made easier with the use of a pregnancy
wheel or Gestational Age Calculator.

MacDonald's Rule
(Cm of fundal height = weeks
gestation)

One way to approximate a pregnancy's current gestational age is to use a tape measure to
determine the distance from the pubic bone up over the top of the uterus to the very top. That
distance, measured in centimeters, is approximately equal to the weeks of gestation, from about
mid-pregnancy until nearly the end of pregnancy. This is known as MacDonald's Rule.
If a tape measure is unavailable, these rough guidelines can be used:

At 12 weeks, the uterus is just barely palpable above the pubic bone, using only an
abdominal hand.

At 16 weeks, the top of the uterus is 1/2 way between the pubic bone and the umbilicus.

At 20-22 weeks, the top of the uterus is right at the umbilicus.

At full term, the top of the uterus is at the level of the ribs. (xyphoid process).

Ultrasound can be used to determine gestational age. Measurement of a crown-rump length

during the first trimester (1-13 weeks) will give a gestational age that is usually accurate to
within 3 days of the actual due date. During the second trimester (14-28 weeks), measurement of
the biparietal diameter will accurately predict the due date within 10-14 days in most cases. In
the third trimester, the accuracy of ultrasound in predicting the due date is less, with a plus or
minus confidence range of as much as 3 weeks. A chart showing different ultrasound
measurements at different gestational ages in shown in the Ultrasound Gestational Age
Measurements chart.
1st Trimester Ultrasound Measurements
Gestational
Age (Weeks)

Sac Size

CRL

14

27

29

15

33

21

10

31

11

41

12

51

BPD

21

13

71

25

Determination Gestational Age During Pregnancy

Doctors use various methods to determine gestational age of a pregnancy. The most common test
is the ultrasound, which measures the size of the gestational sac and the length between crown
and rump to determine the age of the fetus in weeks. Other common methods of determining
gestational age include last menstrual period, bimanual exam and serum HCG testing.

Ultrasound: An ultrasound uses sound waves passed through the stomach and reflected
back to the ultrasound machine to create a physical, live picture of the fetus. During an
ultrasound, women may notice the doctor or ultrasound technician placing several
markers on the screen. These markers are used to measure the gestational sac and the
length between the crown (head) and rump. If the ultrasound is performed after the 6th
week gestation, the length of the fetus from crown to rump is added to 6 weeks to
determine gestational age. For instance, if the crown rump measurement is 21 mm, the
gestational age of the fetus is 9 weeks. (6 weeks plus 21 days = 9 weeks.) If an ultrasound
is performed before the 6th week gestation, age is determined based on other factors,
including size of the fetus and development of the gestational sac. Gestational sac
measurements are highly accurate from 4 weeks gestation.

Last Menstrual Period: Using the first day of your last menstrual cycle, gestational age
can be determined (plus or minus 2 weeks.) The doctor adds 280 days to the first day of
your last menstrual cycle to determine a due date. Based on that number and todays date,
gestational age is estimated. This number is not always accurate, but it is a good
indication of fetal size.

Bimanual Exam: During a bimanual exam, the gynecologist or obstetrician will place
two gloves fingers into the vagina and press on the cervix. The other hand is used to press
down on the uterus. The size, shape and firmness of the uterus is used to determine
pregnancy and, possibly, gestational age.

Serum HCG Testing: HCG or human chorionic gonadotropin is found in the blood of all
pregnant women. Serum HCG testing is often completed as part of the birth defect
screening tests done between weeks 15 and 20 of gestation, but in some cases
obstetricians and gynecologists require a pregnancy blood test before scheduling the first
prenatal appointment.
During the first three weeks of gestation, serum HCG levels range from 5 to 50, with
average levels measuring about 14, 21 and 42 miu/ml, respectively. Week 4 levels range

from 10 to 425 and week 5 levels range from 19 to 7,340. From there, HCG levels
continue to rise until they peak around the 12th week at around 288,000 miu/ml.
The broad range of overlapping HCG levels can make it hard to determine accurate
gestational age, but the test is highly effective at determining multiple pregnancy. More
than one fetus developing in the body means higher than normal HCG levels, which
could spark further testing, including an ultrasound to rule out multiple pregnancy.