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Reliability and validity of last menstrual period for gestational age estimation in a low-to-middle-income setting.

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cam.issuedOnline2018-09-06
dc.contributor.authorMacaulay, Shelley
dc.contributor.authorBuchmann, Eckhart J
dc.contributor.authorDunger, David B
dc.contributor.authorNorris, Shane A
dc.contributor.orcidMacaulay, Shelley [0000-0001-6899-672X]
dc.contributor.orcidDunger, David B [0000-0002-2566-9304]
dc.contributor.orcidNorris, Shane A [0000-0001-7124-3788]
dc.date.accessioned2018-11-14T00:30:41Z
dc.date.available2018-11-14T00:30:41Z
dc.date.issued2019-01
dc.description.abstractAIM: 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.
dc.description.sponsorshipThe 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.
dc.format.mediumPrint-Electronic
dc.identifier.doi10.17863/CAM.32397
dc.identifier.eissn1447-0756
dc.identifier.issn1341-8076
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/285027
dc.languageeng
dc.language.isoeng
dc.publisherWiley
dc.publisher.urlhttp://dx.doi.org/10.1111/jog.13801
dc.subjectSouth Africa
dc.subjectgestational age
dc.subjectlast menstrual period
dc.subjectultrasound
dc.subjectAdult
dc.subjectFemale
dc.subjectGestational Age
dc.subjectHumans
dc.subjectLongitudinal Studies
dc.subjectMenstruation
dc.subjectPregnancy
dc.subjectPrenatal Diagnosis
dc.subjectReproducibility of Results
dc.subjectSensitivity and Specificity
dc.subjectSouth Africa
dc.subjectUltrasonography, Prenatal
dc.titleReliability and validity of last menstrual period for gestational age estimation in a low-to-middle-income setting.
dc.typeArticle
dcterms.dateAccepted2018-08-07
prism.endingPage225
prism.issueIdentifier1
prism.publicationDate2019
prism.publicationNameJ Obstet Gynaecol Res
prism.startingPage217
prism.volume45
pubs.funder-project-idMedical Research Council (G1001333)
pubs.funder-project-idMedical Research Council (MC_UU_12012/5)
pubs.funder-project-idMedical Research Council (MC_PC_12012)
rioxxterms.licenseref.startdate2019-01
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionAM
rioxxterms.versionofrecord10.1111/jog.13801

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