Validity of gestational age estimates by last menstrual period and neonatal examination compared to ultrasound in Vietnam

Nicholas P Deputy, Phuong H Nguyen, Hoa Pham, Son Nguyen, Lynnette Neufeld, Reynaldo Martorell, Usha Ramakrishnan, Nicholas P Deputy, Phuong H Nguyen, Hoa Pham, Son Nguyen, Lynnette Neufeld, Reynaldo Martorell, Usha Ramakrishnan

Abstract

Background: Accurate estimation of gestational age is important for both clinical and public health purposes. Estimates of gestational age using fetal ultrasound measurements are considered most accurate but are frequently unavailable in low- and middle-income countries. The objective of this study was to assess the validity of last menstrual period and Farr neonatal examination estimates of gestational age, compared to ultrasound estimates, in a large cohort of women in Vietnam.

Methods: Data for this analysis come from a randomized, placebo-controlled micronutrient supplementation trial in Vietnam. We analyzed 912 women with ultrasound and prospectively-collected last menstrual period estimates of gestational age and 685 women with ultrasound and Farr estimates of gestational age. We used the Wilcoxon signed rank sum test to assess differences in gestational age estimated by last menstrual period or Farr examination compared to ultrasound and computed the intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC) to quantify agreement between methods. We computed the Kappa coefficient (κ) to quantify agreement in preterm, term and post-term classification.

Results: The median gestational age estimated by ultrasound was 273.9 days. Gestational age was slightly overestimated by last menstrual period (median 276.0 days, P < 0.001) and more greatly overestimated by Farr examination (median 286.7 days, P < 0.001). Gestational age estimates by last menstrual period and ultrasound were moderately correlated (ICC = 0.78) and concordant (CCC = 0.63), whereas gestational age estimates by Farr examination and ultrasound were weakly correlated (ICC = 0.26) and concordant (CCC = 0.05). Last menstrual period and ultrasound estimates of gestational age were within ± 14 days for 88.4% of women; Farr and ultrasound estimates were within ± 14 days for 55.8% of women. Last menstrual period and ultrasound estimates of gestational age had higher agreement in term classification (κ = 0.41) than Farr and ultrasound (κ = 0.05).

Conclusion: In this study of women in Vietnam, we found last menstrual period provided a more accurate estimate of gestational age than the Farr examination when compared to ultrasound. These findings provide useful information about the utility and accuracy of different methods to estimate gestational age and suggest last menstrual period may be preferred over Farr examination in settings where ultrasound is unavailable.

Trial registration: The trial was registered at ClinicalTrials.Gov as NCT01665378 on August 13, 2012.

Keywords: Gestational age; Last menstrual period; Neonatal examination; Ultrasound; Vietnam.

Figures

Fig. 1
Fig. 1
Flow chart describing sample of eligible women and women included in analysis from PRECONCEPT trial
Fig. 2
Fig. 2
Distribution of gestational age (GA) estimated by last menstrual period (LMP), Farr examination and ultrasound measurements (US). a Distribution of GA estimated by LMP (gray) and US (black). b Distribution of GA estimated by Farr examination (white) and US (black)
Fig. 3
Fig. 3
Bland-Altman plots depicting difference between (a) last menstrual period (LMP) and ultrasound estimates of gestational age or (b) Farr examination and ultrasound estimates of gestational age, plotted against the average of the two methods. Solid line indicates mean difference and dotted line indicates Bland-Altman 95% Limits of Agreement (LOA). Positive y-values indicate overestimation by (a) LMP estimates or (b) Farr estimates compared to ultrasound

References

    1. Alexander GR, Tompkins ME, Petersen DJ, Hulsey TC, Mor J. Discordance between LMP-based and clinically estimated gestational age: implications for research, programs, and policy. Public Health Rep. 1995;110(4):395–402.
    1. Alexander GR, Allen MC. Conceptualization, measurement, and use of gestational age. I. Clinical and public health practice. J Perinatol. 1996;16(1):53–9.
    1. Lynch CD, Zhang J. The research implications of the selection of a gestational age estimation method. Paediatr Perinat Epidemiol. 2007;21(Suppl 2):86–96. doi: 10.1111/j.1365-3016.2007.00865.x.
    1. Wegienka G, Baird DD. A comparison of recalled date of last menstrual period with prospectively recorded dates. J Women’s Health. 2005;14(3):248–52. doi: 10.1089/jwh.2005.14.248.
    1. Dietz PM, England LJ, Callaghan WM, Pearl M, Wier ML, Kharrazi M. A comparison of LMP-based and ultrasound-based estimates of gestational age using linked California livebirth and prenatal screening records. Paediatr Perinat Epidemiol. 2007;21(Suppl 2):62–71. doi: 10.1111/j.1365-3016.2007.00862.x.
    1. Vietnam Data, World Development Indicators. []. Accessed 8 Jan 2015.
    1. Alexander GR, de Caunes F, Hulsey TC, Tompkins ME, Allen M. Ethnic variation in postnatal assessments of gestational age: a reappraisal. Paediatr Perinat Epidemiol. 1992;6(4):423–33. doi: 10.1111/j.1365-3016.1992.tb00786.x.
    1. Latis GO, Simionato L, Ferraris G. Clinical assessment of gestational age in the newborn infant. Comparison of two methods. Early Hum Dev. 1981;5(1):29–37. doi: 10.1016/0378-3782(81)90068-2.
    1. Committee on Obstetric Practice Committee opinion no 611: method for estimating due date. Obstet Gynecol. 2014;124(4):863–6. doi: 10.1097/.
    1. Mongelli M, Wilcox M, Gardosi J. Estimating the date of confinement: ultrasonographic biometry versus certain menstrual dates. Am J Obstet Gynecol. 1996;174(1 Pt 1):278–81. doi: 10.1016/S0002-9378(96)70408-8.
    1. Tunon K, Eik-Nes SH, Grottum P. A comparison between ultrasound and a reliable last menstrual period as predictors of the day of delivery in 15,000 examinations. Ultrasound Obstet Gynecol. 1996;8(3):178–85. doi: 10.1046/j.1469-0705.1996.08030178.x.
    1. Wang W, Alva S, Wang S, Fort A. Levels and trends in the use of maternal health services in developing countries. In: DHS Comparative Reports No. 26. Calverton, Maryland, USA: ICF Macro; 2011.
    1. Rosenberg RE, Ahmed AS, Ahmed S, Saha SK, Chowdhury MA, Black RE, Santosham M, Darmstadt GL. Determining gestational age in a low-resource setting: validity of last menstrual period. J Health Popul Nutr. 2009;27(3):332–8.
    1. Neufeld LM, Haas JD, Grajeda R, Martorell R. Last menstrual period provides the best estimate of gestation length for women in rural Guatemala. Paediatr Perinat Epidemiol. 2006;20(4):290–8. doi: 10.1111/j.1365-3016.2006.00741.x.
    1. Nguyen PH, Lowe AE, Martorell R, Nguyen H, Pham H, Nguyen S, Harding KB, Neufeld LM, Reinhart GA, Ramakrishnan U. Rationale, design, methodology and sample characteristics for the Vietnam pre-conceptual micronutrient supplementation trial (PRECONCEPT): a randomized controlled study. BMC Public Health. 2012;12:898. doi: 10.1186/1471-2458-12-898.
    1. Lohman T, Roche A, Martorell R. Anthropometric standardization reference manual. Champaign: Human Kinetics Publishers; 1988.
    1. Cogill B. Anthropometric Indicators Measurement Guide. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington, D.C. 2003.
    1. Farr V, Mitchell RG, Neligan GA, Parkin JM. The definition of some external characteristics used in the assessment of gestational age in the newborn infant. Dev Med Child Neurol. 1966;8(5):507–11. doi: 10.1111/j.1469-8749.1966.tb01796.x.
    1. Farr V, Kerridge DF, Mitchell RG. The value of some external characteristics in the assessment of gestational age at birth. Dev Med Child Neurol. 1966;8(6):657–60.
    1. Papageorghiou AT, Kemp B, Stones W, Ohuma EO, Kennedy SH, Purwar M, Salomon LJ, Altman DG, Noble JA, Bertino E, et al. Ultrasound based gestational age estimation in late pregnancy. Ultrasound Obstet Gynecol. 2016;48:719-26.
    1. McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychol Methods. 1996;1(1):30–46. doi: 10.1037/1082-989X.1.1.30.
    1. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420–8. doi: 10.1037/0033-2909.86.2.420.
    1. Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45(1):255–68. doi: 10.2307/2532051.
    1. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8(2):135–60. doi: 10.1191/096228099673819272.
    1. Nguyen PH, Addo OY, Young M, Gonzalez-Casanova I, Pham H, Truong T, Nguyen S, Martorell R, Ramakrishnan U. Patterns of fetal growth based on ultrasound measurement and its relationship to small for gestational age birth in rural Vietnam. Paediatr Perinat Epidemiol. 2016;30(3):256–66. doi: 10.1111/ppe.12276.
    1. Sunjoh F, Njamnshi AK, Tietche F, Kago I. Assessment of gestational age in the Cameroonian newborn infant: a comparison of four scoring methods. J Trop Pediatr. 2004;50(5):285–91. doi: 10.1093/tropej/50.5.285.
    1. Jehan I, Zaidi S, Rizvi S, Mobeen N, McClure EM, Munoz B, Pasha O, Wright LL, Goldenberg RL. Dating gestational age by last menstrual period, symphysis-fundal height, and ultrasound in urban Pakistan. Int J Gynaecol Obstet. 2010;110(3):231–4. doi: 10.1016/j.ijgo.2010.03.030.
    1. Villar J, Altman DG, Purwar M, Noble JA, Knight HE, Ruyan P, Cheikh Ismail L, Barros FC, Lambert A, Papageorghiou AT, et al. The objectives, design and implementation of the INTERGROWTH-21st Project. BJOG. 2013;120(Suppl 2):9–26. doi: 10.1111/1471-0528.12047.
    1. Kalish RB, Thaler HT, Chasen ST, Gupta M, Berman SJ, Rosenwaks Z, Chervenak FA. First- and second-trimester ultrasound assessment of gestational age. Am J Obstet Gynecol. 2004;191(3):975–8. doi: 10.1016/j.ajog.2004.06.053.

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