Symphysis fundal height measurement in gestational age dating during second half of pregnancy among pregnant women in Butajira
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Date
2019-10
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Addis Abeba University
Abstract
Introduction: Accurate knowledge of gestational age is important for optimal prenatal,delivery, and postnatal care. Early ultrasound during first trimester can provide accurate gestational age but its use is limited in resource poor setting. Last menstrual period can predict gestational age well if cycle characteristics and the date of onset of the last menstrual bleed can be clearly established, yet this has proven difficult in many low income countries
settings as pregnant women in such setting seldom remember their last menstrual period. The use of symphysis fundal height in determining gestational age is not widely studied in low and middle income countries including Ethiopia.
Objective: This study was aimed to evaluate the validity of symphysis-fundal height measurement in dating gestational age during second half of pregnancy among pregnant women in Butajira demographic and surveillance site.
Methods: A community based prospective cross sectional study linked with health facility was conducted in Butajira on 186 pregnant women who were enrolled consecutively.
Symphysis fundal height measurement was taken by selected data collectors blinded of ultrasound result after women undergoes obstetric ultrasound scan. The difference in mean gestational age at birth between symphysis fundal height and ultrasound was tested by using paired t-test. Bland and Altman plot were used to assess the agreement between the methods
in gestational age estimation. Sensitivity, specificity, positive predictive value, negative predictive value and Kappa coefficient were calculated for the rate of preterm and post term birth classification. All analysis was performed by using SPSS 25 software. Ethical clearance from Addis Ababa University school of Public health and verbal informed consent from the study participant was obtained.
Results: A total of 172 pregnant women with gestational age less than 24 weeks at enrollment were included in the analysis. The mean gestational age at enrollment was 16.76(SD=4.28)weeks and the median age of pregnant women was 28 (IQR=5) years. The median gestational age at delivery was 40.28(IQR=2.68) weeks by ultrasound, 38.28(IQR=3.14) weeks by symphysis fundal height. There was a statistically significant difference in mean gestational age between symphysis fundal height and ultrasound (T=7.51, p value <0.001). At delivery,about 52% of gestational ages estimated by symphysis fundal height were within 2 weeks and about 71% were within 3 weeks of gestational age estimated by ultrasound. Moreover, using
ultrasound as a reference symphysis fundal height correctly classified 76%, 75% and 35.5% of preterm, term and post term birth, respectively (weighed kappa = 0.37).
Conclusion: In conclusion the accuracy of a single symphysis fundal height measurement icentimeter corresponding to gestational age in weeks during second half of pregnancy wapoor and improving ultrasound facilities and skills together with early attendance in rurahealth facilities are essential for accurate pregnancy dating.
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Symphysis fundal height, gestational age dating, Butajira rural health project