Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
Juruá Women's and Children's Hospital, Cruzeiro do Sul, Brazil.
PLoS One. 2020 Jul 14;15(7):e0236055. doi: 10.1371/journal.pone.0236055. eCollection 2020.
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.
本研究旨在评估巴西亚马逊地区产前超声估计的孕周与出生时临床记录之间的一致性。对在基层医疗单位进行前瞻性筛查的 578 名孕妇进行了超声检查，检查在妊娠中期进行，遵循图像质量控制的标准化方案。采用多阶段算法来评估产前期间的最佳孕周估计值，同时考虑了末次月经周期（LMP）的可靠性以及与胎儿双项径和股骨长度衍生的超声估计值之间可接受的差异。通过 Bland-Altman 图和kappa 系数（早产和过期产）分析了超声确认的产前估计孕周与出生时临床记录的一致性。总体而言，超声检查质量较高（>90%的满意图像），在 83.4%的孕妇中被采纳为最佳孕周估计值，其余部分则确认了可靠的 LMP。平均而言，产前估计值与临床记录之间的孕周差异为 0.43 周（95%CI：0.32，0.53）。早产的分类具有良好的一致性（kappa：0.82，p<0.001），但过期产的表现不佳（kappa：-0.06，p = 0.92）。教育年限>11 年和剖宫产的参与者的孕周差异较大。总之，妊娠中期的高质量超声图像可用于评估孕周，而 LMP 的可靠性有限。出生时临床记录的信息平均具有可接受的一致性，并且对早产的分类具有相关性，这对于正确解释围产期结局很重要。剖宫产的差异可能需要进一步调查。
