Cited by 46Maternal and Neonatal HealthcareGlobal Maternal and Child HealthMaternal and Perinatal Health Interventions

Estimating Gestational Age in Late Presenters to Antenatal Care in a Resource-Limited Setting on the Thai-Myanmar Border

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Moore, Kerryn A., Simpson, Julie A., Thomas, Kyla H., Rijken, Marcus J., White, Lisa J., Lu Moo Dwell, Saw, Paw, Moo Kho, Wiladphaingern, Jacher +4 more·2015·PLOS ONE

Abstract

Estimating gestational age in resource-limited settings is prone to considerable inaccuracy because crown-rump length measured by ultrasound before 14 weeks gestation, the recommended method for estimating gestational age, is often unavailable. Judgements regarding provision of appropriate obstetric and neonatal care are dependent on accurate estimation of gestational age. We determined the accuracy of the Dubowitz Gestational Age Assessment, a population-specific symphysis-fundal height formula, and ultrasound biometry performed between 16 and 40 weeks gestation in estimating gestational age using pre-existing data from antenatal clinics of the Shoklo Malaria Research Unit on the Thai-Myanmar border, where malaria is endemic. Two cohorts of women who gave birth to live singletons were analysed: 1) 250 women who attended antenatal care between July 2001 and May 2006 and had both ultrasound crown-rump length (reference) and a Dubowitz Gestational Age Assessment; 2) 975 women attending antenatal care between April 2007 and October 2010 who had ultrasound crown-rump length, symphysis-fundal measurements, and an additional study ultrasound (biparietal diameter and head circumference) randomly scheduled between 16 and 40 weeks gestation. Mean difference in estimated newborn gestational age between methods and 95% limits of agreement (LOA) were determined from linear mixed-effects models. The Dubowitz method and the symphysis-fundal height formula performed well in term newborns, but overestimated gestational age of preterms by 2.57 weeks (95% LOA: 0.49, 4.65) and 3.94 weeks (95% LOA: 2.50, 5.38), respectively. Biparietal diameter overestimated gestational age by 0.83 weeks (95% LOA: -0.93, 2.58). Head circumference underestimated gestational age by 0.39 weeks (95% LOA: -2.60, 1.82), especially if measured after 24 weeks gestation. The results of this study can be used to quantify biases associated with alternative methods for estimating gestational age in the absence of ultrasound crown-rump length to inform critical clinical judgements in this population, and as a point of reference elsewhere.

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Authors
Moore, K. A., Simpson, J. A., Thomas, K. H., Rijken, M. J., White, L. J., Lu Moo Dwell, S., Paw, M. K., Wiladphaingern, J., Pukrittayakamee, S., Nosten, F., Fowkes, F. J. I., & McGready, R.
Affiliations
  • Burnet Institute (AU)
  • The University of Melbourne (AU)
  • Mahidol University (TH)
Corresponding author
Moore, Kerryn A.
Venue
PLOS ONE
Published
2015-06-26
Volume
10
Issue
6
Pages
e0131025
ISSN
1932-6203 (ISSN-L)
OpenAlex
W1621288097
Cited by
46
References
48
Citations by year
2026: 2 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 4 · 2020: 1 · 2019: 6 · 2018: 9 · 2017: 8 · 2016: 6
FWCI
14.02
Type
journal article
Language
en
Open access
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Bristol Research (University of Bristol) (publishedVersion, other-oa)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Monash University Research Portal (Monash University) (submittedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Explore Bristol Research (submittedVersion, other-oa)
Funders
  • Eli Lilly and Company
  • Burnet Institute
  • Wellcome Trust
  • Australian Government
  • National Institute for Health and Care Research (CL-2013-25-003)
  • Academy of Medical Sciences (AMS-SGCL12-Thomas)
  • University of Oxford
  • Mahidol University
  • Faculty of Tropical Medicine, Mahidol University
Topics
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
gestational age estimation, ultrasound biometry, biparietal diameter, head circumference, crown-rump length, preterm birth, resource-limited settings, Thai-Myanmar border
MeSH terms
Adolescent, Adult, Myanmar, Cephalometry, Female, Gestational Age, Health Resources, Humans, Infant, Newborn, Male, Middle Aged, Patient Compliance, Poverty Areas, Pregnancy, Prenatal Care, Retrospective Studies, Thailand, Ultrasonography, Prenatal, Crown-Rump Length, Young Adult

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