Abstract
In Tanzania, the estimated delivery date (EDD) is mainly determined by the last menstrual period (LMP), presumably leading to inaccurate estimates with a falsely high proportion of post-term and preterm deliveries. The study aimed to compare EDD determination by LMP and ultrasound in pregnant Tanzanian women and examine how the dating method affects the proportions born preterm, at term, and post-term and assess how maternal characteristics relate to wrongly EDD determination by LMP. 1123 women attending antenatal care in Moshi, Tanzania were included. Gestational age (GA) at birth was calculated according to LMP and ultrasound separately. The distribution of preterm (GA<259 days), term (GA 259-294 days), and post-term (GA >294 days) births was examined separately for LMP and ultrasound. According to LMP, 17.0% of deliveries were preterm and 17.6% post-term. According to ultrasound, 7.7% of deliveries were preterm and 3.4% post-term. Unplanned pregnancy was associated with an increased odds ratio of 3.06 (95% CI: 1.91-4.91) for preterm delivery when LMP was used for EDD determination instead of ultrasound. Parity 3+ was associated with an increased odds ratio of 2.12 (95%CI: 1.16-3.89) for post-term delivery when EDD was assessed by LMP. LMP based EDD increased the preterm birth rate two times and the post-term birth rate five times compared to ultrasound-based EDD. Key words: Gestational age, pregnancy length, last menstrual period (LMP), dating methods, preterm, post term, Africa.
Highlights
Optimal obstetric care that assures women access to quality antenatal care and relevant actions if needed is essential for maternal and child health (WHO, 2017).Ultrasound has proven to be extremely useful in antenatal care as it helps identify high-risk pregnancies (Whitworth et al, 2015)
1,123 pregnant women attended antenatal care at the two primary level health facilities and were eligible for inclusion and 872 women were eligible for data analysis (Figure 1)
Keeping in mind that Tanzanian is a resource constraint country where most births occur at home or in peripheral clinics, we suggest that nurse-midwives are trained to perform antenatal scanning to determine estimated date of delivery (EDD) and detect diagnosis of problems such as multiple pregnancy and placenta previa
Summary
Optimal obstetric care that assures women access to quality antenatal care and relevant actions if needed is essential for maternal and child health (WHO, 2017).Ultrasound has proven to be extremely useful in antenatal care as it helps identify high-risk pregnancies (Whitworth et al, 2015). Despite these recommendations, the vast majority of women in resource-constrained areas like Tanzania go through pregnancy without the benefit of an ultrasound examination. LMP has its limitations since dating may be difficult because of imperfect recall, irregular menstrual cycles, bleeding in early pregnancy, and lactation amenorrhea
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