Gestational age assessment in malaria pregnancy cohorts: a prospective ultrasound demonstration project in Malawi

Wylie, Blair J.; Kalilani-Phiri, Linda; Madanitsa, Mwayi; Membe, Gladys; Nyirenda, Osward; Mawindo, Patricia; Kuyenda, Redson; Malenga, Albert; Masonbrink, Abbey; Makanani, Bonus; Thesing, Phillip C.; Laufer, Miriam K.

doi:10.1186/1475-2875-12-183

Cited by 44 publications

(68 citation statements)

References 38 publications

(42 reference statements)

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“…Sentinel sites should be equipped with a minimum package of resources to ascertain outcomes accurately, such as PTD. Ultrasound studies to determine EGA would require the ultrasound machine, continuous supplies, and a trained health care worker with months of mentorship [30]. Although gestational age estimation would improve, health care costs in resource-limited settings would rise with unlikely reduction of adverse pregnancy outcomes [31].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes and birth defects from an antiretroviral drug safety study of women in South Africa and Zambia

Liu

Farahani

Mashamba

et al. 2014

Aids

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Objective To evaluate the safety of combination antiretroviral therapy (ART) in conception and pregnancy in different health systems. Design A pilot ART registry to measure the prevalence of birth defects and adverse pregnancy outcomes in South Africa and Zambia. Methods HIV-infected pregnant women on ART prior to conception were enrolled until delivery, and their infants were followed until 1 year old. Results Between October 2010 and April 2011, 600 women were enrolled. The median CD4+ cell count at study enrollment was lower in South Africa than Zambia (320 vs. 430 cells/μl; P < 0.01). The most common antiretroviral drugs at the time of conception included stavudine, lamivudine, and nevirapine. There were 16 abortions (2.7%), one ectopic pregnancy (0.2%), 12 (2.0%) stillbirths, and 571 (95.2%) live infants. Deliveries were more often preterm (29.7 vs. 18.4%; P = 0.01) and the infants had lower birth weights (2900 vs. 2995 g; P = 0.11) in Zambia compared to South Africa. Thirty-six infants had birth defects: 13 major and 23 minor. There were more major anomalies detected in South Africa and more minor ones in Zambia. No neonatal deaths were attributed to congenital birth defects. Conclusions An Africa-specific, multi-site antiretroviral drug safety registry for pregnant women is feasible. Different prevalence for preterm delivery, delivery mode, and birth defect types between women on preconception ART in South Africa and Zambia highlight the potential impact of health systems on pregnancy outcomes. As countries establish ART drug safety registries, documenting health facility limitations may be as essential as the specific ART details.

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Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes and birth defects from an antiretroviral drug safety study of women in South Africa and Zambia

Liu

Farahani

Mashamba

et al. 2014

Aids

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“…Trained health care workers could have an adjunctive role in ultrasound screening for high-risk OB conditions where access to care is limited. There have been several published studies on basic OB ultrasound training courses for health care workers in LMIC 1, 2, 3, 4, 8, 9, 10, 11. Although adequate performance after training is crucial,12, 13 reporting of quality control (QC) activities has been limited.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Focused Obstetric Ultrasound Examinations by Health Care Personnel in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia

Nathan

Swanson

et al. 2017

Current Problems in Diagnostic Radiology

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Prior studies have suggested that obstetrical (OB) ultrasound in low- and middle-income countries has aided in detection of high-risk conditions, which in turn could improve OB management. We are participating in a cluster-randomized clinical trial of OB ultrasound, which is designed to assess the effect of basic OB ultrasound on maternal mortality, fetal mortality, neonatal mortality, and maternal near-miss in 5 low-income countries. We designed a 2-week course in basic OB ultrasound, followed by 12 weeks of oversight, to train health care professionals with no prior ultrasound experience to perform basic OB ultrasound to screen for high-risk pregnancies. All patients with high-risk pregnancies identified by the trainees were referred to higher-level health facilities where fully trained sonographers confirmed the diagnoses before any actions were taken. Although there have been several published studies on basic OB ultrasound training courses for health care workers in low- and middle-income countries, quality control reporting has been limited. The purpose of this study is to report on quality control results of these trainees. Health care workers trained in similar courses could have an adjunctive role in ultrasound screening for high-risk OB conditions where access to care is limited. After completion of the ultrasound course, 41 trainees in 5 countries performed 3801 ultrasound examinations during a 12-week pilot period. Each examination was reviewed by ultrasound trainers for errors in scanning parameters and errors in diagnosis, using predetermined criteria. Of the 32,480 images comprising the 3801 examinations, 94.8% were rated as satisfactory by the reviewers. There was 99.4% concordance between trainee and reviewer ultrasound diagnosis. The results suggest that trained health care workers could play a role in ultrasound screening for high-risk OB conditions.

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“…16,17,31 The original neonatal maturity scores were developed when LMP was the gold standard, and used regression equations or scoring algorithms to predict LMP-based GA. Few studies have validated postnatal clinical assessment compared to early ultrasound GA in LMIC settings. In Malawi, Wylie et al 32 reported that 79% of infants classified as preterm by the Ballard performed by research nurses were full-term according to best obstetric estimate, including ultrasound (ie, 21% PPV). Taylor and colleagues 33 found that the external Ballard performed by midwives correlated poorly with ultrasound GA in the Gambia.…”

Section: Figurementioning

confidence: 99%

Validity of Newborn Clinical Assessment to Determine Gestational Age in Bangladesh

et al. 2016

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BACKGROUND: Gestational age (GA) is frequently unknown or inaccurate in pregnancies in low-income countries. Early identification of preterm infants may help link them to potentially life-saving interventions. METHODS: We conducted a validation study in a community-based birth cohort in rural Bangladesh. GA was determined by pregnancy ultrasound (<20 weeks). Community health workers conducted home visits (<72 hours) to assess physical/neuromuscular signs and measure anthropometrics. The distribution, agreement, and diagnostic accuracy of different clinical methods of GA assessment were determined compared with early ultrasound dating. RESULTS: In the live-born cohort (n = 1066), the mean ultrasound GA was 39.1 weeks (SD 2.0) and prevalence of preterm birth (<37 weeks) was 11.4%. Among assessed newborns (n = 710), the mean ultrasound GA was 39.3 weeks (SD 1.6) (8.3% preterm) and by Ballard scoring the mean GA was 38.9 weeks (SD 1.7) (12.9% preterm). The average bias of the Ballard was –0.4 weeks; however, 95% limits of agreement were wide (–4.7 to 4.0 weeks) and the accuracy for identifying preterm infants was low (sensitivity 16%, specificity 87%). Simplified methods for GA assessment had poor diagnostic accuracy for identifying preterm births (community health worker prematurity scorecard [sensitivity/specificity: 70%/27%]; Capurro [5%/96%]; Eregie [75%/58%]; Bhagwat [18%/87%], foot length <75 mm [64%/35%]; birth weight <2500 g [54%/82%]). Neonatal anthropometrics had poor to fair performance for classifying preterm infants (areas under the receiver operating curve 0.52–0.80). CONCLUSIONS: Newborn clinical assessment of GA is challenging at the community level in low-resource settings. Anthropometrics are also inaccurate surrogate markers for GA in settings with high rates of fetal growth restriction.

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Gestational age assessment in malaria pregnancy cohorts: a prospective ultrasound demonstration project in Malawi

Cited by 44 publications

References 38 publications

Pregnancy outcomes and birth defects from an antiretroviral drug safety study of women in South Africa and Zambia

Pregnancy outcomes and birth defects from an antiretroviral drug safety study of women in South Africa and Zambia

Evaluation of Focused Obstetric Ultrasound Examinations by Health Care Personnel in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia

Validity of Newborn Clinical Assessment to Determine Gestational Age in Bangladesh

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