OC08.01: Quality assessment of fetal biometry in locally trained sonographers in a developing country setting

Abstract

Methods: This was a prospective observational cohort study of 1435 women presenting to an early pregnancy unit. Prior to TVS women completed a detailed menstrual, prior obstetric and demographic questionnaire, a visual analogue score (VAS) for pain and pictorial assessment of blood loss (score 0-4). The main outcome measure was pregnancy viability at 11–14 weeks. Results: At 11–14 weeks 885 (61.7%) of pregnancies were viable with the remainder confirmed to have failed. The odds ratio for viability was 0.81 (95%CI 0.75–0.88) for age > 35 years, 0.21 (CI 0.16–0.28) for any bleeding, 0.75 (CI0.58–0.98) for any pain, 3.52 (CI2.48–4.99) for women requesting dating and 2.39 (CI1.17–4.86) for women with anxiety. VAS, prior obstetric history and ethnicity were not significant. Multivariate analysis showed age had no effect < 35 years but that the odds of a viable outcome dropped by 21.3% with each year of age thereafter. Bleeding score was highly significant with odds of viability dropping by 62.3% for each increase in score. Period-type pain in isolation was associated with 3x higher odds of viability but in the presence of bleeding was associated with 89% decrease in odds. A mathematical model gave an area under the curve of 0.736 (0.689–0.783) to predict 11–14 week viability. Conclusions: Only 62% of women presenting for early pregnancy assessment have ongoing pregnancies. Maternal age, bleeding score and period type pain are significant features for viability but in a model do not provide helpful prediction of outcome. This suggests such maternal variables are unlikely to provide useful information regarding likely viability, or appropriateness or timing of TVS.