Agreement between antenatal gestational age by ultrasound and clinical records at birth: A prospective cohort in the Brazilian Amazon

Autor(es)

Lourenco, Barbara Hatzlhoffer ^[1] ; Lima, Daniel Leal ^[2] ; Vivanco, Edwin ^[2] ; Fernandes, Rachelle de Brito ^[3] ; Duarte, Mirian ; Ribeiro Neves, Paulo Augusto ^{[1, 4]} ; de Castro, Marcia Caldas ^[5] ; Cardoso, Marly Augusto ^[1] ; Grp, MINA-Brazil Study

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Publ Hlth, Dept Nutr, Sao Paulo - Brazil

^[2] Jurua Womens & Childrens Hosp, Cruzeiro Do Sul - Brazil

^[3] Municipal Hlth Secretariat Cruzeiro do Sul, Cruzeiro Do Sul - Brazil

^[4] Univ Fed Pelotas, Postgrad Program Epidemiol, Pelotas, RS - Brazil

^[5] Harvard TH Chan Sch Publ Hlth, Dept Global Hlth & Populat, Boston, MA - USA

• Tipo de documento: Artigo Científico
• Fonte: PLoS One; v. 15, n. 7 JUL 14 2020.
• Citações Web of Science: 0

Resumo

This study aimed to assess agreement between antenatal estimates of gestational age by ultrasound and clinical records at birth in the Brazilian Amazon. Ultrasound examinations were scheduled during the second trimester for 578 pregnant women prospectively screened at primary health care units, following a standardized protocol for image quality control. A multistage algorithm was used to assess the best estimate of gestational age during the antenatal period, considering reliability of last menstrual period (LMP) and acceptable differences in relation to ultrasound estimates derived from fetal biparietal diameter and femur length. Agreement of antenatal estimates of gestational age confirmed by ultrasound and clinical records at birth was analyzed with Bland-Altman plots and kappa coefficients (preterm and postterm births). Overall, ultrasound examinations presented high quality (>90% of satisfactory images), and were adopted as the best estimate of gestational age among 83.4% of pregnant women, confirming reliable LMP in the remaining proportion. On average, difference in gestational age between antenatal estimates and clinical records was 0.43 week (95% CI: 0.32, 0.53). Classification of preterm births had a good agreement (kappa: 0.82, p<0.001), but a poor performance was observed for postterm births (kappa: -0.06, p = 0.92). Higher differences in gestational age were noted for participants with >11 years of education and cases of caesarean deliveries. In conclusion, high-quality ultrasound images from the second trimester of pregnancy based the assessment of gestational age, while reliability of LMP was limited. Information from clinical records at birth presented an acceptable agreement on average and for classification of preterm births, which is relevant for properly interpreting perinatal outcomes. Discrepancies in caesarean deliveries may warrant further investigation. (AU)

• Processo FAPESP: 16/00270-6 - Estudo MINA - Materno-Infantil no Acre: coorte de nascimentos da Amazônia Ocidental Brasileira
• Beneficiário: Marly Augusto Cardoso
• Modalidade de apoio: Auxílio à Pesquisa - Temático