title: Estimation of gestational age from fundal height: a solution for resource-poor settings.
abstract: Many women in resource-poor settings lack access to reliable gestational age assessment because they do not know their last menstrual period; there is no ultrasound (US) and methods of newborn gestational age dating are not practised by birth attendants. A bespoke multiple-measures model was developed to predict the expected date of delivery determined by US. The results are compared with both a linear and a nonlinear model. Prospectively collected early US and serial symphysis-pubis fundal height (SFH) data were used in the models. The data were collected from Karen and Burmese women attending antenatal care on the Thai-Burmese border. The multiple-measures model performed best, resulting in a range of accuracy depending on the number of SFH measures recorded per mother (for example six SFH measurements resulted in a prediction accuracy of ±2 weeks). SFH remains the proxy for gestational age in much of the resource-poor world. While more accurate measures should be encouraged, we demonstrate that a formula that incorporates at least three SFH measures from an individual mother and the slopes between them provide a significant increase in the accuracy of prediction compared with the linear and nonlinear formulae also using multiple SFH measures.
authors.affiliation: Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 7LJ, UK. lisa@tropmedres.ac
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: White
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Kasia
authors.initials: K
authors.lastname: Stepniewska
authors.forename: Julie A
authors.initials: JA
authors.lastname: Simpson
authors.forename: Saw Lu Mu
authors.initials: SL
authors.lastname: Dwell
authors.forename: Ratree
authors.initials: R
authors.lastname: Arunjerdja
authors.forename: Pratap
authors.initials: P
authors.lastname: Singhasivanon
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Francois
authors.initials: F
authors.lastname: Nosten
authors.forename: Rose
authors.initials: R
authors.lastname: McGready
mesh_terms: D001837:Body Weights and Measures; D005006:Ethnicity; D005260:Female; D005865:Gestational Age; D006801:Humans; D016014:Linear Models; D002052:Myanmar; D011237:Predictive Value of Tests; D011296:Prenatal Diagnosis / Q000379:methods*; D011631:Pubic Symphysis / Q000033:anatomy & histology; D014599:Uterus / Q000033:anatomy & histology*