Determining Gestational Age in a Low-resource Setting: Validity of Last Menstrual Period

Abstract Background: Preterm births have a high risk of mortality. Therefore, knowledge of the gestational age (GA) at birth is crucial to guide the appropriate management of a newborn. Common methods for estimating GA such as the last menstrual period, ultrasonography, and post-natal Ballard scoring have some limitations and are often unavailable in low-resource areas. This study aimed to determine the relationship between foot length and GA in order to develop an equation for predicting GA of the neonates born in Pakistan, a region with high rates of preterm birth and newborn mortality.Methods: We conducted a prospective study in a large obstetric hospital in Pakistan. Data for this analysis were extracted from the hospital files of eligible women by trained study midwives. Midwives were also trained in performing the Ballard examination and taking foot length using a disposable measuring tape within an hour of the birth. The GA was calculated using an android-based GA calculator, which used a report of last menstrual period, ultrasound examination, and Ballard examination. Simple and multiple linear regression were used to construct predicting equations for GA.Results: Both the foot length and GA were available for 1,542 cases. The median GA was 34.5 weeks with an interquartile range (IQR 4.7) and the median foot length was 7 cm (IQR 1.4). There was a positive linear relationship between foot length and GA (r2 81.7%, p-value < 0.001). Stratified analysis showed an r2 of 81.7% for males and 81.6% for females. The r2 for stillbirths was 84.1% and, 82.3% for live births. The r2 for macerated stillbirths was 88.6% and 90.6% for fresh stillbirths.Conclusion: In resource poor settings, the use of foot length can estimate GA in both live births and stillbirths and can easily identify preterm infants. This tool could facilitate early management of preterm births in low-resource settings.

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Clinical Evaluations Have Low Sensitivity for Identifying Preterm Infants in a Clinical Trial in a Limited Resource Setting

Global Pediatric Health ◽

10.1177/2333794x19857402 ◽

2019 ◽

Vol 6 ◽

pp. 2333794X1985740

Author(s):

Andrea G. Buchwald ◽

Ibrahima Teguete ◽

Moussa Doumbia ◽

Fadima C. Haidara ◽

Flanon Coulibaly ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Limited Resource ◽

Menstrual Period ◽

Last Menstrual Period ◽

Low Birth Weight Infants ◽

Resource Setting

Preterm birth is a primary outcome of interest in maternal vaccination trials but determination of gestational age is challenging in limited-resource settings. This study compares the New Ballard Score and fundal height measurements with the current standard of early ultrasound for sensitivity of predicting preterm birth. A trial of maternal influenza vaccination was conducted in Bamako, Mali. The New Ballard Score and fundal height were collected on 4038 infants born in the trial, ultrasound data were available for 1893 of those infants. New Ballard Score and fundal height were compared, consecutively, to all ultrasound results, early ultrasound results from the first trimester, and the date of last menstrual period for estimation of gestational age. Sensitivity of the New Ballard Score for identifying preterm infants was 0.33 compared with early ultrasound and 0.1 compared with the last menstrual period based estimates of gestational age. Sensitivity of low birth weight alone was 0.43 compared with early ultrasound. New Ballard Score estimated gestational age within 1 week of ultrasound more frequently than fundal height (53% compared with 7.6%, respectively) yet New Ballard Score identified few infants as preterm (1.8% vs 5.8% by early ultrasound), and was biased toward categorizing low birth weight infants and infants requiring hospitalization as preterm. New Ballard Score is not an ideal measure for identifying preterm births in low-resource settings. Despite the time and cost of training required for correct measurement of New Ballard Score, measurement of low birth weight alone performed better than New Ballard Score for identifying preterm infants.

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VP34.27: Qualitative assessment of the feasibility and acceptability of a low‐cost device for gestational age assessment in a low‐resource setting

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.22860 ◽

2020 ◽

Vol 56 (S1) ◽

pp. 204-204

Author(s):

A.K. Etyang ◽

P. Musitia ◽

G. Mwashigadi ◽

M. Kinshella ◽

M. Vidler ◽

...

Keyword(s):

Gestational Age ◽

Low Cost ◽

Qualitative Assessment ◽

Age Assessment ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the Thailand-Myanmar border: a population cohort study

Wellcome Open Research ◽

10.12688/wellcomeopenres.10352.3 ◽

2018 ◽

Vol 1 ◽

pp. 32

Author(s):

Rose McGready ◽

Moo Kho Paw ◽

Jacher Wiladphaingern ◽

Aung Myat Min ◽

Verena I. Carrara ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Scale Up ◽

Limited Resource ◽

Heart Beat ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Individual Record ◽

Record Review

Background : No universal demarcation of gestational age distinguishes miscarriage and stillbirth or extreme preterm birth (exPTB). This study provides a synopsis of outcome between 22 to <28 weeks gestation from a low resource setting. Methods : A retrospective record review of a population on the Thailand-Myanmar border was conducted. Outcomes were classified as miscarriage, late expulsion of products between 22 to < 28 weeks gestation with evidence of non-viability (mostly ultrasound absent fetal heart beat) prior to 22 weeks; or exPTB (stillbirth/live born) between 22 to < 28 weeks gestation when the fetus was viable at ≥22 weeks. Termination of pregnancy and gestational trophoblastic disease were excluded. Results : From 1995-2015, 80.9% (50,046/ 61,829) of registered women had a known pregnancy outcome, of whom 99.8% (49,931) had a known gestational age. Delivery between 22 to <28 weeks gestation included 0.9% (472/49,931) of pregnancies after removing 18 cases (3.8%) who met an exclusion criteria. Most pregnancies had an ultrasound: 72.5% (n=329/454); 43.6% (n=197) were classified as miscarriage and 56.4% (n=257) exPTB. Individual record review of miscarriages estimated that fetal death had occurred at a median of 16 weeks, despite late expulsion between 22 to <28 weeks. With available data (n=252, 5 missing) the proportion of stillbirth was 47.6% (n=120), congenital abnormality 10.5% (24/228, 29 missing) and neonatal death was 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as exPTB rather than miscarriage. Conclusion : In this low resource setting few (<1%) pregnancy outcomes occurred in the 22 to <28 weeks gestational window; four in ten were miscarriage (late expulsion) and neonatal mortality approached 100%. In the scale-up to preventable newborns deaths (at least initially) greater benefits will be obtained by focusing on the viable newborns of ≥ 28 weeks gestation.

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Evaluation of a New Protocol of Insulin Dose Adjustment in a Low-Resource Setting

Diabetes ◽

10.2337/db18-93-lb ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 93-LB

Author(s):

EDDY JEAN BAPTISTE ◽

PHILIPPE LARCO ◽

MARIE-NANCY CHARLES LARCO ◽

JULIA E. VON OETTINGEN ◽

EDDLYS DUBOIS ◽

...

Keyword(s):

Dose Adjustment ◽

Insulin Dose ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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Quality indicators and post operative outcome of ERCP performed in a low resource setting ; can quality indicators from developed settings be applied?

10.26226/morressier.59a6b34bd462b80290b557f5 ◽

2017 ◽

Author(s):

Supun Kulatunge

Keyword(s):

Quality Indicators ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Operative Outcome

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Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting

BMJ Case Reports ◽

10.1136/bcr-2020-239250 ◽

2021 ◽

Vol 14 (4) ◽

pp. e239250

Author(s):

Vijay Anand Ismavel ◽

Moloti Kichu ◽

David Paul Hechhula ◽

Rebecca Yanadi

Keyword(s):

Plastic Material ◽

Successful Outcome ◽

Paraduodenal Hernia ◽

Transparent Plastic ◽

Low Resource ◽

Entire Small Bowel ◽

Resource Setting ◽

Low Resource Setting ◽

Right Paraduodenal Hernia ◽

Bowel Gangrene

We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.

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