# name
Preterm or not - an evaluation of estimates of gestational age
                in a cohort of women from rural Papua New Guinea

# metadata.dc.description.abstract[].value
BACKGROUND: Knowledge of accurate gestational age is required
                for comprehensive pregnancy care and is an essential component
                of research evaluating causes of preterm birth. In
                industrialised countries gestational age is determined with the
                help of fetal biometry in early pregnancy. Lack of ultrasound
                and late presentation to antenatal clinic limits this practice
                in low-resource settings. Instead, clinical estimators of
                gestational age are used, but their accuracy remains a matter of
                debate. METHODS: In a cohort of 688 singleton pregnancies from
                rural Papua New Guinea, delivery gestational age was calculated
                from Ballard score, last menstrual period, symphysis-pubis
                fundal height at first visit and quickening as well as mid- and
                late pregnancy fetal biometry. Published models using sequential
                fundal height measurements and corrected last menstrual period
                to estimate gestational age were also tested. Novel linear
                models that combined clinical measurements for gestational age
                estimation were developed. Predictions were compared with the
                reference early pregnancy ultrasound (<25 gestational weeks)
                using correlation, regression and Bland-Altman analyses and
                ranked for their capability to predict preterm birth using the
                harmonic mean of recall and precision (F-measure). RESULTS:
                Average bias between reference ultrasound and clinical methods
                ranged from 0-11 days (95% confidence levels: 14-42 days).
                Preterm birth was best predicted by mid-pregnancy ultrasound
                (F-measure: 0.72), and neuromuscular Ballard score provided the
                least reliable preterm birth prediction (F-measure: 0.17). The
                best clinical methods to predict gestational age and preterm
                birth were last menstrual period and fundal height (F-measures
                0.35). A linear model combining both measures improved
                prediction of preterm birth (F-measure: 0.58). CONCLUSIONS:
                Estimation of gestational age without ultrasound is prone to
                significant error. In the absence of ultrasound facilities, last
                menstrual period and fundal height are among the more reliable
                clinical measures. This study underlines the importance of
                strengthening ultrasound facilities and developing novel ways to
                estimate gestational age.

# metadata.dc.relation.isformatof[].value
Reproducció del document publicat a:
                http://dx.doi.org/10.1371/journal.pone.0124286

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Preterm or not - an evaluation of estimates of gestational age
                in a cohort of women from rural Papua New Guinea