Reliability and validity of last menstrual period for gestational age estimation in a low-to-middle-income setting.
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Publication Date
2019-01Journal Title
J Obstet Gynaecol Res
ISSN
1341-8076
Publisher
Wiley
Volume
45
Issue
1
Pages
217-225
Language
eng
Type
Article
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Macaulay, S., Buchmann, E. J., Dunger, D. B., & Norris, S. A. (2019). Reliability and validity of last menstrual period for gestational age estimation in a low-to-middle-income setting.. J Obstet Gynaecol Res, 45 (1), 217-225. https://doi.org/10.1111/jog.13801
Abstract
AIM: Gestational age estimation by ultrasonography is the gold standard for dating pregnancies. However, the availability of prenatal ultrasonography in low-to-middle-income countries is limited. This study aimed to assess the reliability and validity of last menstrual period (LMP) as a gestational age dating method among women in Johannesburg, South Africa. METHODS: A total of 741 pregnant women were enrolled into a longitudinal study (June 2013 to July 2016). Gestational age was determined by LMP and ultrasonography. Differences in ultrasound-based and LMP-based gestational age estimates were assessed according to the American College of Obstetrics and Gynecologists' guidelines and women were classified as having discrepant results or not. Multiple statistical analyses determined the level of agreement between the two methods and validity of LMP estimates. RESULTS: Compared to ultrasound, dating by LMP assessed gestational age as 0.2 days longer. Women with discrepant results were of significantly lower weight and household socioeconomic status than those without discrepancies. While there was a substantial agreement (k = 0.64; 95% confidence interval, CI: 0.54, 0.71, P < 0.001) between the two methods, LMP only had a 29.0% (95% CI: 14.2, 48.0) sensitivity in identifying late-term neonates and a 33.3% (95% CI: 4.33, 77.7) sensitivity in identifying post-term neonates. CONCLUSION: In the absence of ultrasound, LMP is a reliable alternative for gestational age dating during early pregnancy. However, it is not sensitive in identifying late- and post-term pregnancies and should not be relied upon to make clinical decisions regarding elective cesarean section or induction of labor for supposed prolonged pregnancies.
Keywords
South Africa, gestational age, last menstrual period, ultrasound, Adult, Female, Gestational Age, Humans, Longitudinal Studies, Menstruation, Pregnancy, Prenatal Diagnosis, Reproducibility of Results, Sensitivity and Specificity, South Africa, Ultrasonography, Prenatal
Sponsorship
The authors wish to acknowledge their colleagues in the Department of Obstetrics and Gynaecology and the Fetal Medicine Unit at CHBAH as well as the research team at DPHRU and the study participants.
Funder references
Medical Research Council (G1001333)
Medical Research Council (MC_UU_12012/5)
Identifiers
External DOI: https://doi.org/10.1111/jog.13801
This record's URL: https://www.repository.cam.ac.uk/handle/1810/285027
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