Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh
ObjectiveTo 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.DesignProspective pregnancy cohort...
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doaj-06db0a605d0b41e19f309bb303dbe9092021-06-02T11:31:54ZengBMJ Publishing GroupBMJ Open2044-60552020-03-0110310.1136/bmjopen-2019-034942Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, BangladeshSalahuddin Ahmed0Nazma Begum1Abdullah H Baqui2Sayedur Rahman3Syed Mamun Ibne Moin4Bernard Rosner5Anne C C Lee6Nazmun Nahar Bably7Lauren E Schaeffer8Mohammad Abdul Quaiyum9James A Litch10Blair J Wylie112 Johns Hopkins University, Dhaka, Bangladesh Projahnmo Research Foundation, Dhaka, BangladeshInternational Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA2 Johns Hopkins University, Dhaka, Bangladesh 2 Johns Hopkins University, Dhaka, Bangladesh Biostatistics, Harvard Medical School, Boston, Massachusetts, USAPediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USAHealth Section, United Nations Childrens Fund, Rangpur, BangladeshPediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USACentre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshGlobal Alliance to Prevent Prematurity and Stillbirth (GAPPS), Lynnwood, Washington, USADepartment of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USAObjectiveTo 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.DesignProspective pregnancy cohort study.SettingRural communities in Sylhet, Bangladesh.Participants1516 women with singleton pregnancies with early pregnancy ultrasound dating (<20 weeks); 1486 completed follow-up.MethodsSFH 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 measureGA at subsequent ANC visits, as defined by early ultrasound dating.Results1486 (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.ConclusionsWe 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 numberNCT01572532https://bmjopen.bmj.com/content/10/3/e034942.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Salahuddin Ahmed Nazma Begum Abdullah H Baqui Sayedur Rahman Syed Mamun Ibne Moin Bernard Rosner Anne C C Lee Nazmun Nahar Bably Lauren E Schaeffer Mohammad Abdul Quaiyum James A Litch Blair J Wylie |
spellingShingle |
Salahuddin Ahmed Nazma Begum Abdullah H Baqui Sayedur Rahman Syed Mamun Ibne Moin Bernard Rosner Anne C C Lee Nazmun Nahar Bably Lauren E Schaeffer Mohammad Abdul Quaiyum James A Litch Blair J Wylie Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh BMJ Open |
author_facet |
Salahuddin Ahmed Nazma Begum Abdullah H Baqui Sayedur Rahman Syed Mamun Ibne Moin Bernard Rosner Anne C C Lee Nazmun Nahar Bably Lauren E Schaeffer Mohammad Abdul Quaiyum James A Litch Blair J Wylie |
author_sort |
Salahuddin Ahmed |
title |
Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh |
title_short |
Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh |
title_full |
Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh |
title_fullStr |
Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh |
title_full_unstemmed |
Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh |
title_sort |
prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in sylhet, bangladesh |
publisher |
BMJ Publishing Group |
series |
BMJ Open |
issn |
2044-6055 |
publishDate |
2020-03-01 |
description |
ObjectiveTo 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.DesignProspective pregnancy cohort study.SettingRural communities in Sylhet, Bangladesh.Participants1516 women with singleton pregnancies with early pregnancy ultrasound dating (<20 weeks); 1486 completed follow-up.MethodsSFH 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 measureGA at subsequent ANC visits, as defined by early ultrasound dating.Results1486 (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.ConclusionsWe 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 numberNCT01572532 |
url |
https://bmjopen.bmj.com/content/10/3/e034942.full |
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