Discordant dating of pregnancy by LMP and ultrasound and its implications in perinatal statistics

Abstract

Context: High perinatal mortality in India may be caused by inaccurate dating of pregnancy resulting from suboptimal uptake of antenatal care and ultrasound services during pregnancy. Aim: To determine the discrepancy in the last menstrual period (LMP) assigned expected date of delivery (EDD) and ultrasound assigned EDD in pregnant women in a rural district of central India. Methods: Data from an ongoing cross-sectional screening program providing fetal radiology imaging in Guna district of Madhya Pradesh from 2012–2019 was analyzed for recall of LMP and discordance between LMP and ultrasound assigned EDD. The discrepancy was present when EDD assigned by ultrasound differed by 3 or more days at gestational ages less than 8+6 weeks, 5–7 days at gestational ages 8+6 weeks till 14 weeks, and 7–10 days at gestational ages 14–20 weeks. Results: The program screened 14,701 pregnant women of which 4,683 (31.8+6%, 95% CI: 31.11, 32.61) could not recall LMP. EDD assigned by LMP and ultrasound matched in 7,035 (70.22%, 95% CI: 69.32, 71.12) of the remaining 10,018 pregnant women. EDD was overestimated by LMP for 26.06% (95% CI: 25.21, 26.93) women; these foetuses were at risk of being misclassified as a term fetus. In 2018, the project had no maternal deaths, infant mortality rate of 24.7, low birth weight rate of 9.69%, and 100% antenatal coverage. Conclusion: Accurate dating of pregnancy and systematic follow-up integrating radiology imaging and obstetrics care for appropriate risk-based management of pregnant women can significantly improve perinatal statistics of India.

Estimation of gestational age using foetal kidney length during second and third trimester in south Indian population

“…This sub-optimal uptake explains why the perinatal problems are still high, despite 80% of deliveries happening at institutions (26). Sharma et al emphasize that the dating of pregnancy and gestational age estimation is an integral component of various risk models that predict the risk of preeclampsia in preterm births and foetal growth retardation (27). With further improvements in imaging techniques and with an increasing awareness of the indirect ways of gestational age assessment, peri-natal complications can largely be avoided.…”

Influence of different methods for calculating gestational age at birth on prematurity and small for gestational age proportions: a systematic review with meta-analysis

“…The inclusion criteria were: [ 1 ] to have the GA at birth calculated by LMP and obstetric USG up to 24 weeks of gestation; [ 2 ] to have information about the data source for calculating the GA; [ 3 ] to have specific information about the standard fetal growth curve used to diagnose SGA. Primary studies, cohorts, epidemiological analyses, and database studies were also considered.…”

“…A qualified gestational age (GA) is essential to support healthcare decisions and to guarantee reliable perinatal health indicators for planning public policies [ 1 ]. The difference between the date of birth and the last menstrual period (LMP) is a useful method for GA calculation.…”

“…Affecting perinatal statistics, the scarcity of healthcare funding is still one determinant of the low access to prenatal USG in low-income countries (LMIC). This contributes to poor prenatal care coverage and makes estimating GA reliability even more difficult [ 1 , 13 ]. The evaluation of GA by USG in early pregnancy with the crow-rump length (CRL) assessment is currently the most accurate method for redating pregnancy, but it requires high-cost equipment, early prenatal care, and a specialized health professional [ 2 ].…”

Feto-Maternal Outcomes of Medical Induction of Labour in Post-Dated Pregnancies

“…2 It is possible to arrive at different estimates of the prevalence of PTP depending on whether the calculation is performed solely on the basis of the patient's medical history and the clinical examination, or whether an early pregnancy ultrasound examination is performed in order to determine the gestational age. 3,4 After 41 weeks and 0 days have passed, the ACOG suggests that routine induction or expectant management be offered to the patient. 5 In order to reduce the likelihood of adverse health outcomes associated with a protracted pregnancy, the British Guidelines recommend that women with uncomplicated pregnancies be given induction of labor (IOL) between 41 and 42 weeks of pregnancy.…”