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Preterm or Not – An Evaluation of Estimates of Gestational Age in a Cohort of Women from Rural Papua New Guinea

BACKGROUND: Knowledge of accurate gestational age is required for comprehensive pregnancy care and is an essential component of research evaluating causes of preterm birth. In industrialised countries gestational age is determined with the help of fetal biometry in early pregnancy. Lack of ultrasoun...

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Autores principales: Karl, Stephan, Li Wai Suen, Connie S. N., Unger, Holger W., Ome-Kaius, Maria, Mola, Glen, White, Lisa, Wangnapi, Regina A., Rogerson, Stephen J., Mueller, Ivo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422681/
https://www.ncbi.nlm.nih.gov/pubmed/25945927
http://dx.doi.org/10.1371/journal.pone.0124286
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author Karl, Stephan
Li Wai Suen, Connie S. N.
Unger, Holger W.
Ome-Kaius, Maria
Mola, Glen
White, Lisa
Wangnapi, Regina A.
Rogerson, Stephen J.
Mueller, Ivo
author_facet Karl, Stephan
Li Wai Suen, Connie S. N.
Unger, Holger W.
Ome-Kaius, Maria
Mola, Glen
White, Lisa
Wangnapi, Regina A.
Rogerson, Stephen J.
Mueller, Ivo
author_sort Karl, Stephan
collection PubMed
description BACKGROUND: Knowledge of accurate gestational age is required for comprehensive pregnancy care and is an essential component of research evaluating causes of preterm birth. In industrialised countries gestational age is determined with the help of fetal biometry in early pregnancy. Lack of ultrasound and late presentation to antenatal clinic limits this practice in low-resource settings. Instead, clinical estimators of gestational age are used, but their accuracy remains a matter of debate. METHODS: In a cohort of 688 singleton pregnancies from rural Papua New Guinea, delivery gestational age was calculated from Ballard score, last menstrual period, symphysis-pubis fundal height at first visit and quickening as well as mid- and late pregnancy fetal biometry. Published models using sequential fundal height measurements and corrected last menstrual period to estimate gestational age were also tested. Novel linear models that combined clinical measurements for gestational age estimation were developed. Predictions were compared with the reference early pregnancy ultrasound (<25 gestational weeks) using correlation, regression and Bland-Altman analyses and ranked for their capability to predict preterm birth using the harmonic mean of recall and precision (F-measure). RESULTS: Average bias between reference ultrasound and clinical methods ranged from 0–11 days (95% confidence levels: 14–42 days). Preterm birth was best predicted by mid-pregnancy ultrasound (F-measure: 0.72), and neuromuscular Ballard score provided the least reliable preterm birth prediction (F-measure: 0.17). The best clinical methods to predict gestational age and preterm birth were last menstrual period and fundal height (F-measures 0.35). A linear model combining both measures improved prediction of preterm birth (F-measure: 0.58). CONCLUSIONS: Estimation of gestational age without ultrasound is prone to significant error. In the absence of ultrasound facilities, last menstrual period and fundal height are among the more reliable clinical measures. This study underlines the importance of strengthening ultrasound facilities and developing novel ways to estimate gestational age.
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spelling pubmed-44226812015-05-12 Preterm or Not – An Evaluation of Estimates of Gestational Age in a Cohort of Women from Rural Papua New Guinea Karl, Stephan Li Wai Suen, Connie S. N. Unger, Holger W. Ome-Kaius, Maria Mola, Glen White, Lisa Wangnapi, Regina A. Rogerson, Stephen J. Mueller, Ivo PLoS One Research Article BACKGROUND: Knowledge of accurate gestational age is required for comprehensive pregnancy care and is an essential component of research evaluating causes of preterm birth. In industrialised countries gestational age is determined with the help of fetal biometry in early pregnancy. Lack of ultrasound and late presentation to antenatal clinic limits this practice in low-resource settings. Instead, clinical estimators of gestational age are used, but their accuracy remains a matter of debate. METHODS: In a cohort of 688 singleton pregnancies from rural Papua New Guinea, delivery gestational age was calculated from Ballard score, last menstrual period, symphysis-pubis fundal height at first visit and quickening as well as mid- and late pregnancy fetal biometry. Published models using sequential fundal height measurements and corrected last menstrual period to estimate gestational age were also tested. Novel linear models that combined clinical measurements for gestational age estimation were developed. Predictions were compared with the reference early pregnancy ultrasound (<25 gestational weeks) using correlation, regression and Bland-Altman analyses and ranked for their capability to predict preterm birth using the harmonic mean of recall and precision (F-measure). RESULTS: Average bias between reference ultrasound and clinical methods ranged from 0–11 days (95% confidence levels: 14–42 days). Preterm birth was best predicted by mid-pregnancy ultrasound (F-measure: 0.72), and neuromuscular Ballard score provided the least reliable preterm birth prediction (F-measure: 0.17). The best clinical methods to predict gestational age and preterm birth were last menstrual period and fundal height (F-measures 0.35). A linear model combining both measures improved prediction of preterm birth (F-measure: 0.58). CONCLUSIONS: Estimation of gestational age without ultrasound is prone to significant error. In the absence of ultrasound facilities, last menstrual period and fundal height are among the more reliable clinical measures. This study underlines the importance of strengthening ultrasound facilities and developing novel ways to estimate gestational age. Public Library of Science 2015-05-06 /pmc/articles/PMC4422681/ /pubmed/25945927 http://dx.doi.org/10.1371/journal.pone.0124286 Text en © 2015 Karl et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Karl, Stephan
Li Wai Suen, Connie S. N.
Unger, Holger W.
Ome-Kaius, Maria
Mola, Glen
White, Lisa
Wangnapi, Regina A.
Rogerson, Stephen J.
Mueller, Ivo
Preterm or Not – An Evaluation of Estimates of Gestational Age in a Cohort of Women from Rural Papua New Guinea
title Preterm or Not – An Evaluation of Estimates of Gestational Age in a Cohort of Women from Rural Papua New Guinea
title_full Preterm or Not – An Evaluation of Estimates of Gestational Age in a Cohort of Women from Rural Papua New Guinea
title_fullStr Preterm or Not – An Evaluation of Estimates of Gestational Age in a Cohort of Women from Rural Papua New Guinea
title_full_unstemmed Preterm or Not – An Evaluation of Estimates of Gestational Age in a Cohort of Women from Rural Papua New Guinea
title_short Preterm or Not – An Evaluation of Estimates of Gestational Age in a Cohort of Women from Rural Papua New Guinea
title_sort preterm or not – an evaluation of estimates of gestational age in a cohort of women from rural papua new guinea
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422681/
https://www.ncbi.nlm.nih.gov/pubmed/25945927
http://dx.doi.org/10.1371/journal.pone.0124286
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