TY - JOUR
T1 - Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh
AU - Lee, Anne C.C.
AU - Whelan, Rachel
AU - Bably, Nazmun Nahar
AU - Schaeffer, Lauren E.
AU - Rahman, Sayedur
AU - Ahmed, Salahuddin
AU - Moin, Syed Mamun Ibne
AU - Begum, Nazma
AU - Quaiyum, Mohammad Abdul
AU - Rosner, Bernard
AU - Litch, James A.
AU - Baqui, Abdullah H.
AU - Wylie, Blair J.
N1 - Funding Information:
Funding This study was supported by the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00049, and the Every Preemie–SCALE programme consortium of the Global Alliance of Prematurity and Stillbirth (GAPPS), Project Concern International (PCI) and the American College of Nurse Midwives (ACNM), that provides practical, catalytic, and scalable approaches to expand the uptake of preterm birth and low birth weight interventions in 25 USAID maternal and child health priority countries in Africa and Asia. James A. Litch was principal investigator of the Every Preemie– SCALE Implementation Research Program, and provided inputs on the study design and interpretation of the data/results, as well as feedback on drafts of the manuscript.
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC.
PY - 2020/3/12
Y1 - 2020/3/12
N2 - 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.
AB - 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.
KW - estimated uterine volume
KW - gestational age
KW - preterm birth
KW - symphysis fundal height
KW - uterine fundal height
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U2 - 10.1136/bmjopen-2019-034942
DO - 10.1136/bmjopen-2019-034942
M3 - Article
C2 - 32169927
AN - SCOPUS:85082093852
SN - 2044-6055
VL - 10
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - 034942
ER -