The assessment of gestational age: a comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa

BMC Pregnancy and Childbirth

Holger Unger¹  Gertrude Chapotera²  Victor Mwapasa²  Mwayiwawo Madanitsa²  Halidou Tinto³  Innocent Valea³  Maminata Traoré³  Raffaella Ravinetto⁴  Benedikt Ley⁴  Yves Claeys⁴  Kamala Thriemer⁴  Maaike de Crop⁴  Prosper Gbekor⁵  Umberto D’Alessandro⁶  Gifty Antwi⁷  Harry Tagbor⁷  Jean-Bertin Bukasa Kabuya⁸  Michael Nambozi⁸  Modest Mulenga⁸  Stephen Rulisa⁹ 

[1] Department of Obstetrics and Gynaecology, Simpson Centre for Reproductive Health, Edinburgh Royal Infirmary;Department of Public Health, College of Medicine;Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN);Institute of Tropical Medicine;Juaben Government Hospital;MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine;School of Medicine, University of Health and Allied Sciences;Tropical Diseases Research Center;University of Rwanda, School of Medicine and Pharmacy;

关键词: Pregnancy;    Gestational age;    Methods;    Ultrasound;    Ballard score;    Last menstrual period;   

DOI  :  10.1186/s12884-018-2128-z

来源: DOAJ

【 摘 要 】

Abstract Background Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries. Methods Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson’s rho, and Bland Altman plots were used to calculate mean differences in findings with 95% limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies. Results A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95%CI: 38.6–38.8), by LMP, 38.4 weeks (95%CI: 38.0–38.9), by SFH, 38.3 weeks (95%CI: 38.2–38.5), and by BS 38.0 weeks (95%CI: 37.9–38.1) (p < 0.001). Correlation between US and any of the other three methods was poor to moderate. Sensitivity and specificity to determine prematurity were 0.63 (95%CI 0.50–0.75) and 0.72 (95%CI, 0.66–0.76) for LMP, 0.80 (95%CI 0.74–0.85) and 0.74 (95%CI 0.72–0.76) for SFH and 0.42 (95%CI 0.35–0.49) and 0.77 (95%CI 0.74–0.79) for BS. Conclusions In settings with limited access to ultrasound, and in women who had been treated with P. falciparum malaria, SFH may be the most useful antenatal tool to date a pregnancy when women present first in second and third trimester. The Ballard postnatal maturation assessment has a limited role and lacks precision. Improving ultrasound facilities and skills, and early attendance, together with the development of new technologies such as automated image analysis and new postnatal methods to assess gestational age, are essential for the study and management of preterm birth in low-income settings.

【 授权许可】

Unknown