scholarly journals Gestational age dating using newborn metabolic screening: A validation study in Busia, Uganda

2021 ◽  
Vol 11 ◽  
Author(s):  
Scott P Oltman ◽  
Elizabeth A Jasper ◽  
Richard Kajubi ◽  
Teddy Ochieng ◽  
Abel Kakuru ◽  
...  
Keyword(s):  
Gestational Age ◽  
Validation Study ◽  
Age Dating ◽  
Metabolic Screening

scholarly journals Early Identification of Preterm Neonates at Birth With a Tablet App for the Simplified Gestational Age Score (T-SGAS) When Ultrasound Gestational Age Dating Is Unavailable: Protocol for a Validation Study (Preprint)

2018 ◽  
Author(s):  
Archana B Patel ◽  
Kunal Kurhe ◽  
Amber Prakash ◽  
Savita Bhargav ◽  
Suchita Parepalli ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Validation Study ◽  
Scoring System ◽  
Age Dating ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Care Facilities

BACKGROUND Although rates of preterm birth continue to increase globally, identification of preterm from low birth weight infants remains a challenge. The burden of low birth weight vs preterm is greatest in resource-limited settings, where gestational age (GA) prior to delivery is frequently not known because ultrasound in early pregnancy is not available and estimates of the date of the mother’s last menstrual period (LMP) may not be reliable. An alternative option is to assess GA at birth to optimize referral and care of preterm newborns. We previously developed and pilot-tested a system to measure the simplified gestational age score (SGAS) based on 4 easily observable neonatal characteristics. OBJECTIVE The objective of this study is to adapt the scoring system as a tablet app (potentially scalable approach) to assess feasibility of use and to validate whether the scoring system accurately predicts prematurity by itself, over and above birth weight in a large sample of newborns. METHODS The study is based in Nagpur, India, at the Research Unit of the National Institute of Child Health and Human Development’s Global Network for Women’s and Children’s Health Research. The Android tablet app for the SGAS (T-SGAS) displays de-identified photographs of skin, breasts, and genitalia across a range of GAs and line drawings of infant posture. Each item is associated with a score. The user is trained to choose the photograph or line drawing that most closely matches the newborn being evaluated, and the app determines the neonate’s GA category (preterm or term) from the cumulative score. The validation study will be conducted in 3 second level care facilities (most deliveries in India occur in hospitals, and women known to be at risk of preterm birth are referred to second level care facilities). Within 24 hours of delivery, women and their babies who are stable will be enrolled in the study. Two auxiliary nurse midwives (ANMs) blinded to prior GA assessments will use the T-SGAS to estimate the GA status of the newborn. An independent data collector will abstract the GA from the ultrasound recorded in the hospital chart and record the date of the mother’s LMP. Eligibility for analysis is determined by the ultrasound and LMP data being collected within 1 week of each other to have a rigorous assessment of true GA. RESULTS Publication of the results of the study is anticipated in 2019. CONCLUSIONS Until GA dating by ultrasound is universally available and easy to use in resource-limited settings, and where there are restrictions on ultrasound use due to their use for sex determination and abortion of female fetuses, this study will determine whether the T-SGAS app can accurately assess GA in risk categories at birth. CLINICALTRIAL ClinicalTrials.gov NCT02408783; https://clinicaltrials.gov/ct2/show/NCT02408783 (Archived by Webcite at http://www.webcitation.org/75S2kmr3T) INTERNATIONAL REGISTERED REPORT DERR1-10.2196/11913

scholarly journals Reinventing the Pregnancy Wheel to Improve Pregnancy Dating and Antenatal Care Visits: A Pilot Randomized Trial in Malawi

2021 ◽  
Vol 10 (1) ◽  
pp. 139-145
Author(s):  
Mary Stokes ◽  
Amber Olson ◽  
Mtisunge Chan'gombe ◽  
Bakari Rajab ◽  
Isabel Janmey ◽  
...  
Keyword(s):  
Global Health ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Randomized Trial ◽  
Gestational Age ◽  
Age Dating ◽  
World Health ◽  
Secondary Outcome ◽  
Time Of Presentation ◽  
Antenatal Visits

Background and Objectives: The purpose of this study was to evaluate the feasibility of a customized, culturally sensitive pregnancy wheel given to pregnant women to improve gestational age dating accuracy at the time of delivery and to improve antenatal care attendance. Methods: This was a pilot randomized trial involving pregnant women presenting to a regional hospital in Lilongwe, Malawi. The primary outcome was accuracy of gestational age at the time of presentation to the hospital in labor. The secondary outcome was the number of antenatal visits. Results: At final analysis, 14 subjects were included in the pregnancy wheel (intervention) arm and 11 in the standard care arm. Fifty percent (n=7) of women in the intervention arm were accurately dated at the time of presentation for delivery, compared to only 9% (n=1) in the standard antenatal care arm (p=0.04). There was not a significant difference in the number of antenatal visits between the two study arms. No patients met the World Health Organization’s recommended eight antenatal care visits for prenatal care. Conclusion and Global Health Implications: The customized pregnancy wheel given to patients could improve gestational age dating accuracy, and as a result, clinical decision making. However, the barriers to greater antenatal care access are more complex and likely require a more complex solution. Significant attrition in this pilot trial limited statistical power, suggesting the need for future larger interventions. Accurate gestational dating requires access to ultrasonography and early antenatal care initiation, both of which are inadequate in Malawi. Although the customized pregnancy wheel did not improve antenatal care attendance, it improved gestational age dating accuracy in a pilot study at a central hospital in Lilongwe, Malawi.   Copyright © 2021 Stokes et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Postnatal Gestational Age Estimation Using Newborn Metabolic Profiles: A Validation Study in Matlab, Bangladesh

2018 ◽  
Author(s):  
Malia SQ Murphy ◽  
Steven Hawken ◽  
Wei Cheng ◽  
Lindsay A. Wilson ◽  
Monica Lamoureux ◽  
...  
Keyword(s):  
Gestational Age ◽  
Validation Study ◽  
Age Estimation ◽  
Metabolic Profiles ◽  
Gestational Age Estimation

Do Gestational Age Dating Criteria Matter in Medically Indicated Late Preterm, Early-Term, and Full-Term Inductions of Labor?

2016 ◽  
Vol 109 (3) ◽  
pp. 191-195
Author(s):  
Kristen Kelley ◽  
Kristen O’Dillon Goerg ◽  
Jessica Rhinehart-Ventura ◽  
Catherine Eppes ◽  
Haleh Sangi-Haghpeykar ◽  
...  
Keyword(s):  
Gestational Age ◽  
Full Term ◽  
Late Preterm ◽  
Age Dating ◽  
Early Term

scholarly journals Measurement error, microcephaly prevalence and implications for Zika: an analysis of Uruguay perinatal data

2019 ◽  
Vol 105 (5) ◽  
pp. 428-432 ◽  
Author(s):  
Emily W Harville ◽  
Pierre M Buekens ◽  
Maria Luisa Cafferata ◽  
Suzanne Gilboa ◽  
Giselle Tomasso ◽  
...  
Keyword(s):  
Information System ◽  
Gestational Age ◽  
Head Circumference ◽  
Measurement Precision ◽  
Age Dating ◽  
Population Differences ◽  
Lower Prevalence ◽  
Digit Preference ◽  
Perinatal Data ◽  
The Mean

Background and objectiveThe Zika virus outbreak has drawn attention to microcephaly, whose definition is based on head circumference measuring below a percentile or number of SDs below the mean. The objective of this analysis was to assess how differences in measurement precision might affect prevalence and trends of microcephaly.MethodsData from all births in Uruguay during 2010–2015 were obtained from the Perinatal Information System. The prevalence of births with microcephaly was calculated based on head circumference measurement at birth applying the INTERGROWTH-21st standards for sex and gestational age, and compared by method of ascertaining gestational age.ResultsRounding and digit preference was observed: 74% of head circumference measurements were reported as a whole centimetre value. The prevalence of births varied substantially by the criterion used to define microcephaly (<3 SD, <2 SD, <3rd percentile for gestational age) and could be halved or doubled based on adding or subtracting a half-centimetre from all reported head circumference measurements. If 4 days were added to gestational age calculations, rather than using completed gestational weeks (without days) for gestational age reporting, the prevalence was 1.7–2 times higher.DiscussionRounding in measurement of head circumference and reporting preferences of gestational age may have contributed to a lower prevalence of microcephaly than expected in this population. Differences in head circumference measurement protocols and gestational age dating have the potential to affect the prevalence of babies reported with microcephaly, and this limitation should be acknowledged when interpreting head circumference data collected for surveillance.

scholarly journals Adverse birth outcomes and their clinical phenotypes in an urban Zambian cohort

2019 ◽  
Vol 3 ◽  
pp. 1533
Author(s):  
Joan T Price ◽  
Bellington Vwalika ◽  
Katelyn J Rittenhouse ◽  
Humphrey Mwape ◽  
Jennifer Winston ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Phase I ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Sub Saharan Africa ◽  
Age Dating ◽  
Adverse Birth Outcomes ◽  
Short Cervix ◽  
Sub Saharan

Background: Few cohort studies of pregnancy in sub-Saharan Africa use rigorous gestational age dating and clinical phenotyping. As a result, incidence and risk factors of adverse birth outcomes are inadequately characterized. Methods: The Zambian Preterm Birth Prevention Study (ZAPPS) is a prospective observational cohort established to investigate adverse birth outcomes at a referral hospital in urban Lusaka. This report describes ZAPPS phase I, enrolled August 2015 to September 2017. Women were followed through pregnancy and 42 days postpartum. At delivery, study staff assessed neonatal vital status, birthweight, sex, and assigned a delivery phenotype. Primary outcomes were: (1) preterm birth (PTB; delivery <37 weeks), (2) small-for-gestational-age (SGA; <10th percentile weight-for-age at birth), and (3) stillbirth (SB; delivery of an infant without signs of life). Results: ZAPPS phase I enrolled 1450 women with median age 27 years (IQR 23–32). Most participants (68%) were multiparous, of whom 41% reported a prior PTB and 14% reported a prior stillbirth. Twins were present in 3% of pregnancies, 3% of women had short cervix (<25mm), 24% of women were HIV seropositive, and 5% were syphilis seropositive. Of 1216 (84%) retained at delivery, 15% were preterm, 18% small-for-gestational-age, and 4% stillborn. PTB risk was higher with prior PTB (aRR 1.88; 95%CI 1.32–2.68), short cervix (aRR 2.62; 95%CI 1.68–4.09), twins (aRR 5.22; 95%CI 3.67–7.43), and antenatal hypertension (aRR 2.04; 95%CI 1.43–2.91). SGA risk was higher with twins (aRR 2.75; 95%CI 1.81–4.18) and antenatal hypertension (aRR 1.62; 95%CI 1.16–2.26). SB risk was higher with short cervix (aRR 6.42; 95%CI 2.56–16.1). Conclusions: This study confirms high rates of PTB, SGA, and SB among pregnant women in Lusaka, Zambia. Accurate gestational age dating and careful ascertainment of delivery data are critical to understanding the scope of adverse birth outcomes in low-resource settings.

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