The assessment of gestational age

A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine

Holger Unger, Kamala Thriemer, Benedikt Ley, Halidou Tinto, Maminata Traoré, Innocent Valea, Harry Tagbor, Gifty Antwi, Prosper Gbekor, Michael Nambozi, Jean Bertin Bukasa Kabuya, Modest Mulenga, Victor Mwapasa, Gertrude Chapotera, Mwayiwawo Madanitsa, Stephen Rulisa, Maaike De Crop, Yves Claeys, Raffaella Ravinetto, Umberto D'Alessandro

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    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.

    Original languageEnglish
    Article number12
    JournalBMC Pregnancy and Childbirth
    Volume19
    Issue number1
    DOIs
    Publication statusPublished - 8 Jan 2019

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    Pubic Bone
    Reproductive Medicine
    Africa South of the Sahara
    Malaria
    Gestational Age
    Pediatrics
    Pregnancy
    Health
    Premature Birth
    Technology
    Sensitivity and Specificity
    Falciparum Malaria
    Third Pregnancy Trimester
    Second Pregnancy Trimester
    Randomized Controlled Trials
    Infection
    Population

    Cite this

    Unger, Holger ; Thriemer, Kamala ; Ley, Benedikt ; Tinto, Halidou ; Traoré, Maminata ; Valea, Innocent ; Tagbor, Harry ; Antwi, Gifty ; Gbekor, Prosper ; Nambozi, Michael ; Kabuya, Jean Bertin Bukasa ; Mulenga, Modest ; Mwapasa, Victor ; Chapotera, Gertrude ; Madanitsa, Mwayiwawo ; Rulisa, Stephen ; De Crop, Maaike ; Claeys, Yves ; Ravinetto, Raffaella ; D'Alessandro, Umberto. / The assessment of gestational age : A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine. In: BMC Pregnancy and Childbirth. 2019 ; Vol. 19, No. 1.
    @article{f1007d6f923c48919da599179cf3c6ff,
    title = "The assessment of gestational age: A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine",
    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.",
    keywords = "Ballard score, Gestational age, Last menstrual period, Low income country, Methods, Pregnancy, Symphysio-pubis fundal height, Ultrasound",
    author = "Holger Unger and Kamala Thriemer and Benedikt Ley and Halidou Tinto and Maminata Traor{\'e} and Innocent Valea and Harry Tagbor and Gifty Antwi and Prosper Gbekor and Michael Nambozi and Kabuya, {Jean Bertin Bukasa} and Modest Mulenga and Victor Mwapasa and Gertrude Chapotera and Mwayiwawo Madanitsa and Stephen Rulisa and {De Crop}, Maaike and Yves Claeys and Raffaella Ravinetto and Umberto D'Alessandro",
    year = "2019",
    month = "1",
    day = "8",
    doi = "10.1186/s12884-018-2128-z",
    language = "English",
    volume = "19",
    journal = "BMC Pregnancy and Childbirth",
    issn = "1471-2393",
    publisher = "BioMed Central",
    number = "1",

    }

    Unger, H, Thriemer, K, Ley, B, Tinto, H, Traoré, M, Valea, I, Tagbor, H, Antwi, G, Gbekor, P, Nambozi, M, Kabuya, JBB, Mulenga, M, Mwapasa, V, Chapotera, G, Madanitsa, M, Rulisa, S, De Crop, M, Claeys, Y, Ravinetto, R & D'Alessandro, U 2019, 'The assessment of gestational age: A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine', BMC Pregnancy and Childbirth, vol. 19, no. 1, 12. https://doi.org/10.1186/s12884-018-2128-z

    The assessment of gestational age : A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine. / Unger, Holger; Thriemer, Kamala; Ley, Benedikt; Tinto, Halidou; Traoré, Maminata; Valea, Innocent; Tagbor, Harry; Antwi, Gifty; Gbekor, Prosper; Nambozi, Michael; Kabuya, Jean Bertin Bukasa; Mulenga, Modest; Mwapasa, Victor; Chapotera, Gertrude; Madanitsa, Mwayiwawo; Rulisa, Stephen; De Crop, Maaike; Claeys, Yves; Ravinetto, Raffaella; D'Alessandro, Umberto.

    In: BMC Pregnancy and Childbirth, Vol. 19, No. 1, 12, 08.01.2019.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - The assessment of gestational age

    T2 - A comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine

    AU - Unger, Holger

    AU - Thriemer, Kamala

    AU - Ley, Benedikt

    AU - Tinto, Halidou

    AU - Traoré, Maminata

    AU - Valea, Innocent

    AU - Tagbor, Harry

    AU - Antwi, Gifty

    AU - Gbekor, Prosper

    AU - Nambozi, Michael

    AU - Kabuya, Jean Bertin Bukasa

    AU - Mulenga, Modest

    AU - Mwapasa, Victor

    AU - Chapotera, Gertrude

    AU - Madanitsa, Mwayiwawo

    AU - Rulisa, Stephen

    AU - De Crop, Maaike

    AU - Claeys, Yves

    AU - Ravinetto, Raffaella

    AU - D'Alessandro, Umberto

    PY - 2019/1/8

    Y1 - 2019/1/8

    N2 - 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.

    AB - 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.

    KW - Ballard score

    KW - Gestational age

    KW - Last menstrual period

    KW - Low income country

    KW - Methods

    KW - Pregnancy

    KW - Symphysio-pubis fundal height

    KW - Ultrasound

    UR - http://www.scopus.com/inward/record.url?scp=85059796053&partnerID=8YFLogxK

    U2 - 10.1186/s12884-018-2128-z

    DO - 10.1186/s12884-018-2128-z

    M3 - Article

    VL - 19

    JO - BMC Pregnancy and Childbirth

    JF - BMC Pregnancy and Childbirth

    SN - 1471-2393

    IS - 1

    M1 - 12

    ER -