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Ultrasound estimation of gestational age in late pregnancy in low-income countries: made to measure or off-the-peg?

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Smith, Gordon Cs 
Nakimuli, Annettee 


Gestational age is one of the most important features of a pregnancy when making clinical decisions. In particular, decision-making around delivery, such as timing pre-labour caesarean section and induction of labour, is crucially informed by knowledge of gestational age. Over-estimation of gestational age may lead to iatrogenic prematurity and under-estimation of gestational age may expose the fetus to the higher risks of stillbirth post-term. Consequently, in high income countries (HIC), most women are offered an ultrasound scan at the end of the first trimester of pregnancy, when gestational age can most accurately be assessed using measurement of the crown rump length. Delivering this service requires that women are identified as being pregnant at an early stage, are appropriately referred and that ultrasound is available at scale. Obstacles to delivering include issues of geography, economics, society and healthcare capacity. These obstacles are frequently greatest and co-existing in low income countries (LIC). Consequently, women will commonly present in advanced pregnancy in the absence of early pregnancy gestational dating using ultrasound. For example, in Uganda, only 29% of women had their first antenatal visit during the first trimester of pregnancy.



Biometry, Cohort Studies, Developing Countries, Female, Gestational Age, Humans, Infant Health, Infant, Newborn, Pregnancy, Prospective Studies

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Lancet Glob Health

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Elsevier BV


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