Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh.

Autor:	Lee ACC; Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA alee6@bwh.harvard.edu.; Harvard Medical School, Boston, Massachusetts, USA., Whelan R; Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Bably NN; Health Section, United Nations Childrens Fund, Rangpur, Bangladesh., Schaeffer LE; Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Rahman S; Projahnmo Research Foundation, Dhaka, Bangladesh., Ahmed S; Projahnmo Research Foundation, Dhaka, Bangladesh., Moin SMI; Projahnmo Research Foundation, Dhaka, Bangladesh., Begum N; Projahnmo Research Foundation, Dhaka, Bangladesh., Quaiyum MA; Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh., Rosner B; Biostatistics, Harvard Medical School, Boston, Massachusetts, USA.; Channing Department of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Litch JA; Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Lynnwood, Washington, USA., Baqui AH; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Wylie BJ; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2020 Mar 12; Vol. 10 (3), pp. e034942. Date of Electronic Publication: 2020 Mar 12.
DOI:	10.1136/bmjopen-2019-034942
Abstrakt:	Objective: To improve the accuracy of the prediction of gestational age (GA) before birth with the standardised measurement of symphysis-fundal height (SFH), estimation of uterine volume, and statistical modelling including maternal anthropometrics and other factors. Design: Prospective pregnancy cohort study. Setting: Rural communities in Sylhet, Bangladesh. Participants: 1516 women with singleton pregnancies with early pregnancy ultrasound dating (<20 weeks); 1486 completed follow-up. Methods: SFH and abdominal girth were measured at subsequent antenatal care (ANC) visits by community health workers at 24 to 28, 32 to 36, and/or >37 weeks gestation. An estimated uterine volume (EUV) was calculated from these measures. Data on pregnancy characteristics and other maternal anthropometrics were also collected. Primary Outcome Measure: GA at subsequent ANC visits, as defined by early ultrasound dating. Results: 1486 (98%) women had at least one subsequent ANC visit, 1102 (74%) women had two subsequent ANC visits, and 748 (50%) had three visits. Using the common clinical practice of approximating the GA (in weeks) with the SFH measurement (cm), SFH systematically underestimated GA in late pregnancy (mean difference -4.4 weeks, 95% limits of agreement -12.5 to 3.7). For the classification of GA <28 weeks, SFH <26 cm had 85% sensitivity and 81% specificity; and for GA <34 weeks, SFH <29 cm had 83% sensitivity and 71% specificity. EUV had similar diagnostic accuracy. Despite rigorous statistical modelling of SFH, accounting for repeated longitudinal measurements and additional predictors, the best model without including a known last menstrual period predicted 95% of pregnancy dates within ±7.4 weeks of early ultrasound dating. Conclusions: We were unable to predict GA with a high degree of accuracy before birth using maternal anthropometric measures and other available maternal characteristics. Efforts to improve GA dating in low- and middle-income countries before birth should focus on increasing coverage and training of ultrasonography. Trial Registration Number: NCT01572532. Competing Interests: Competing interests: JAL was the principal investigator of Every Preemie–SCALE Implementation Research programme. (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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