title: A color-coded tape for uterine height measurement: a tool to identify preterm pregnancies in low resource settings.
abstract: BACKGROUND
  Neonatal mortality associated with preterm birth can be reduced with antenatal corticosteroids (ACS), yet <10% of eligible pregnant women in low-middle income countries. The inability to accurately determine gestational age (GA) leads to under-identification of high-risk women who could receive ACS or other interventions. To facilitate better identification in low-resource settings, we developed a color-coded tape for uterine height (UH) measurement and estimated its accuracy identifying preterm pregnancies.
  
  
  METHODS
  We designed a series of colored-coded tapes with segments corresponding to UH measurements for 20-23.6 weeks, 24.0-35.6 weeks, and >36.0 weeks GA. In phase 1, UH measurements were collected prospectively in the Democratic Republic of Congo, India and Pakistan, using distinct tapes to address variation across regions and ethnicities. In phase 2, we tested accuracy in 250 pregnant women with known GA from early ultrasound enrolled at prenatal clinics in Argentina, India, Pakistan and Zambia. Providers masked to the ultrasound GA measured UH. Receiver operating characteristics (ROC) analysis was conducted.
  
  
  RESULTS
  1,029 pregnant women were enrolled. In all countries the tapes were most effective identifying pregnancies between 20.0-35.6 weeks, compared to the other GAs. The ROC areas under the curves and 95% confidence intervals were: Argentina 0.69 (0.63, 0.74); Zambia 0.72 (0.66, 0.78), India 0.84 (0.80, 0.89), and Pakistan 0.83 (0.78, 0.87). The sensitivity and specificity (and 95% confidence intervals) for identifying pregnancies between 20.0-35.6 weeks, respectively, were: Argentina 87% (82%-92%) and 51% (42%-61%); Zambia 91% (86%-95%) and 50% (40%-60%); India 78% (71%-85%) and 89% (83%-94%); Pakistan 63% (55%-70%) and 94% (89%-99%).
  
  
  CONCLUSIONS
  We observed moderate-good accuracy identifying pregnancies ≤ 35.6 weeks gestation, with potential usefulness at the community level in low-middle income countries to facilitate the preterm identification and interventions to reduce preterm neonatal mortality. Further research is needed to validate these findings on a population basis.
authors.affiliation: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Althabe
authors.affiliation: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: Mabel
authors.initials: M
authors.lastname: Berrueta
authors.affiliation: RTI International; Durham, North Carolina, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hemingway-Foday
authors.affiliation: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: Agustina
authors.initials: A
authors.lastname: Mazzoni
authors.affiliation: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: Carolina Astoul
authors.initials: CA
authors.lastname: Bonorino
authors.affiliation: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gowdak
authors.affiliation: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: Luz
authors.initials: L
authors.lastname: Gibbons
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: M B
authors.initials: MB
authors.lastname: Bellad
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: M C
authors.initials: MC
authors.lastname: Metgud
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Shivaprasad
authors.initials: S
authors.lastname: Goudar
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Bhalchandra S
authors.initials: BS
authors.lastname: Kodkany
authors.affiliation: Christiana Care, Newark, Delaware, United States of America.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi Pakistan.
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleem
authors.affiliation: Department of Obstetrics, Sobhraj Maternity Hospital, Karachi, Pakistan.
authors.forename: Samina
authors.initials: S
authors.lastname: Iqbal
authors.affiliation: Department of Obstetrics, Sindh Government Qatar Hospital, Karachi Pakistan.
authors.forename: Syed Hasan
authors.initials: SH
authors.lastname: Ala
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States of America.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of North Carolina, Chapel Hill, North Carolina, United States of America.
authors.forename: Albert
authors.initials: A
authors.lastname: Manasyan
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Melody
authors.initials: M
authors.lastname: Chiwila
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Edna
authors.initials: E
authors.lastname: Imenda
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Florence
authors.initials: F
authors.lastname: Mbewe
authors.affiliation: Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Tshefu
authors.affiliation: Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
authors.forename: Victor
authors.initials: V
authors.lastname: Lokomba
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina, United States of America.
authors.forename: Carl L
authors.initials: CL
authors.lastname: Bose
authors.affiliation: RTI International; Durham, North Carolina, United States of America.
authors.forename: Janet
authors.initials: J
authors.lastname: Moore
authors.affiliation: RTI International; Durham, North Carolina, United States of America.
authors.forename: Sreelatha
authors.initials: S
authors.lastname: Meleth
authors.affiliation: RTI International; Durham, North Carolina, United States of America.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Eunice Kennedy Shriver NICHD, Bethesda, Maryland, United States of America.
authors.forename: Marion
authors.initials: M
authors.lastname: Koso-Thomas
authors.affiliation: School of Public Health and Tropical Medicine, Tulane University, Louisiana, United States of America.
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
authors.affiliation: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: José M
authors.initials: JM
authors.lastname: Belizán
mesh_terms: D000328:Adult; D001837:Body Weights and Measures; D059019:Clinical Coding / Q000379:methods*; D003906:Developing Countries; D005260:Female; D005865:Gestational Age; D006801:Humans; D008991:Monitoring, Physiologic; D011247:Pregnancy; D047928:Premature Birth; D011295:Prenatal Care; D012372:ROC Curve; D014599:Uterus / Q000033:anatomy & histology*; D055815:Young Adult
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