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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/35165
Title: Preterm or not - An evaluation of estimates of gestational age in a cohort of women from rural Papua New Guinea
Authors: Stephan Karl
Connie S.N. Li Wai Suen
Holger W. Unger
Maria Ome-Kaius
Glen Mola
Lisa White
Regina A. Wangnapi
Stephen J. Rogerson
Ivo Mueller
Walter and Eliza Hall Institute of Medical Research
University of Melbourne
Papua New Guinea Institute of Medical Research
University of Papua New Guinea
Nuffield Department of Clinical Medicine
Mahidol University
Instituto de Salud Global de Barcelona
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology
Issue Date: 6-May-2015
Citation: PLoS ONE. Vol.10, No.5 (2015)
Abstract: © 2015 Karl et al. 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 lowresource 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.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84929096246&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/35165
ISSN: 19326203
Appears in Collections:Scopus 2011-2015

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