Reliability of last menstrual period recall, an early ultrasound and a Smartphone App in predicting date of delivery and classification of preterm and post-term births.

BACKGROUND: A reliable expected date of delivery (EDD) is important for pregnant women in planning for a safe delivery and critical for management of obstetric emergencies. We compared the accuracy of LMP recall, an early ultrasound (EUS) and a Smartphone App in predicting the EDD in South African pregnant women. We further evaluated the rates of preterm and post-term births based on using the different measures. METHODS: This is a retrospective sub-study of pregnant women enrolled in a randomized controlled trial between October 2017-December 2019. EDD and gestational age (GA) at delivery were calculated from EUS, LMP and Smartphone App. Data were analysed using SPSS version 25. A Bland-Altman plot was constructed to determine the limits of agreement between LMP and EUS. RESULTS: Three hundred twenty-five pregnant women who delivered at term (≥ 37 weeks by EUS) and without pregnancy complications were included in this analysis. Women had an EUS at a mean GA of 16 weeks and 3 days). The mean difference between LMP dating and EUS is 0.8 days with the limits of agreement 31.4-30.3 days (Concordance Correlation Co-efficient 0.835; 95%CI 0.802, 0.867). The mean(SD) of the marginal time distribution of the two methods differ significantly (p = 0.00187). EDDs were < 14 days of the actual date of delivery (ADD) for 287 (88.3%;95%CI 84.4-91.4), 279 (85.9%;95%CI 81.6-89.2) and 215 (66.2%;95%CI 60.9-71.1) women for EUS, Smartphone App and LMP respectively but overall agreement between EUS and LMP was only 46.5% using a five category scale for EDD-ADD with a kappa of .22. EUS 14-24 weeks and EUS < 14 weeks predicted EDDs < 14 days of ADD in 88.1% and 79.3% of women respectively. The proportion of births classified as preterm (< 37 weeks) was 9.9% (95%CI 7.1-13.6) by LMP and 0.3% (95%CI 0.1-1.7) by Smartphone App. The proportion of post-term (> 42 weeks gestation) births was 11.4% (95%CI 8.4-15.3), 1.9% (95%CI 0.9-3.9) and 3.4% (95%CI 1.9-5.9) by LMP, EUS and Smartphone respectively. CONCLUSIONS: EUS and Smartphone App were the most accurate to estimate the EDD in pregnant women. LMP-based dating resulted in misclassification of a significantly greater number of preterm and post-term deliveries compared to EUS and the Smartphone App.

[Definitions of expected date of delivery and post-term delivery]. / Comment définir la date présumée de l'accouchement et le dépassement de terme ?

The duration of pregnancy is between 280 and 290 days from the first day of the last menstrual period and varies according to the literature, the authors, the calculation methods and the characteristics of women. Assuming that the date of beginning of pregnancy is known, the expected date of delivery varies depending on the length of gestation. Thus, in literature and in obstetric practice, there is no consensus on the definition of expected date of delivery. From a medical point of view, it seems important to fix the date from which the monitoring should start and from which an induction of labour should be considered. Thus, arbitrarily, we can consider that the term period corresponds to a time interval located between 37(+0) SA and 41(+6) SA and the post-term period begins from 42(+0) SA. Because maternal and fetal risks increase at the end of the pregnancy, one can speak, arbitrarily, of prolonged pregnancy from 41(+0) SA (expert opinion).

Finalización electiva versus manejo expectante en el control de la gestación prolongada: estudio prospectivo de 200 gestantes / Elective termination versus expectant management in prolonged pregnancy: a prospective study of 200 pregnant women

Objetivo. Comparar la finalización electiva de la gestación prolongada versus el manejo expectante, en gestaciones de bajo riesgo obstétrico. Material y método. Ensayo clínico controlado y aleatorizado entre actuaciones activas y expectantes, sobre una muestra de 200 mujeres con gestación prolongada de bajo riesgo obstétrico entre febrero de 2003 y junio de 2005 en el Hospital Universitario Materno-Infantil de Canarias. Resultados. El grupo estudio está formado por 200 pacientes - 102 del grupo activa y 98 del grupo expectante -. No se encontraron diferencias epidemiológicas entre ambos grupos. El parto no fue inducido en un porcentaje de gestantes significativamente superior en el grupo activa frente al grupo expectante (51% vs 35,7%, p=0,02; OR 0,53 [CI 95% 0,3-0,94]), es decir, el número de inducciones es significativamente superior en el grupo de manejo expectante. Una tasa significativamente menor de gestantes del grupo activa presentó líquido amniótico meconial durante la dilatación (15,7% vs 28,6% p=0,02; OR 0,47 [IC 95% 0,23-0,93]). No existen diferencias significativas con relación al tipo de parto, no obstante el porcentaje de intervención cesárea fue marcadamente inferior en el grupo activa frente al grupo expectante ([12,7% vs 18,4%, p=0,3; OR 0,65 [IC 95% 0.3-1.41]). Los resultados perinatales no muestran diferencias significativas entre ambos grupos. Conclusiones. La finalización electiva en el semana 42, en gestaciones de bajo riesgo obstétrico con condiciones cervicales desfavorables, parece reducir la tasa de cesáreas sin comprometer los resultados perinatales (AU)

Objective. To compare elective termination versus expectant management in low-risk prolonged pregnancy. Material and method. We performed a controlled randomized clinical trial comparing the results of active and expectant approaches in the management of low-risk prolonged pregnancy in a sample of 200 women between February 2003 and June 2005 at the Maternity Ward of the Canary Islands University Hospital. Results. The study group consisted of 200 patients. There were 102 in the active management group and 98 in the expectant management group. No between-group epidemiologic differences were found. Labor was not induced in a significantly higher proportion of patients in the active than in the expectant group [51% vs 35.7%, p=0.02; OR 0.53 (95% CI 0.3-0.94)] i.e. the induction rate was significantly higher in the expectant group. The proportion of patients with meconium-stained amniotic fluid during labor was significantly lower in the active management group [15.7% vs 28.6% p=0.02; OR 0.47 (95% CI 0.23-0.93)]. No significant differences were found in the type of delivery, although the proportion of cesarean sections was noticeably lower in the active management than in the expectant management group [(12.7% vs 18.4%, p=0.3; OR 0.65 (95% CI 0.3-1.41)]. No significant differences were found in perinatal outcomes between the two groups. Conclusions. Elective termination of low-risk pregnancies with unfavorable cervical findings at week 42 seems to reduce the rate of cesarean section without impairing perinatal outcome (AU)

Feasibility study of a Latest Date of Delivery (LDD) system of managing pregnancy.

BACKGROUND: This study aimed to establish the acceptability of a Latest Date of Delivery (LDD) system of managing pregnancy. An LDD is the date at 42 weeks on which labour will be induced if a woman has not delivered by then. This study examined whether women under conventional expected date of delivery (EDD) management would find an LDD system acceptable in principle, and whether they would prefer it to the EDD system. An additional objective was to examine changes in state anxiety in late pregnancy, post-term, and after delivery. METHODS: This was a preliminary survey of women's attitudes towards an LDD system. Sixty-two women under normal pregnancy management completed questionnaires about the acceptability of an LDD system at 36 weeks gestation. In addition, questionnaires measuring state anxiety were completed at 36, 38, 40, and 41 weeks. RESULTS: The majority of women evaluated an LDD system positively, with 64% of women saying they would agree to an LDD and only 11.3% saying they would not. Forty percent of women said they would prefer an LDD to an EDD system and 36% said they were not sure. Women who had not delivered by 41 weeks had significantly more anxiety than those who had delivered. CONCLUSIONS: The LDD system appears to be acceptable to women and, for 40% of women, preferable to the EDD. Anxiety appears to increase as women go post-term, but problems of attrition mean the results regarding anxiety should be treated cautiously. Potential difficulties with implementing an LDD system are discussed.

[Prolonged pregnancy and perinatal distress]. / Grossesse prolongée et souffrance périnatale.

212 out of 2806 women who delivered in the Haguenau Maternity had a period of amenorrhoea markedly longer than 42 weeks, when the menstrual cycle was 28 +/- 8 days. 39 of the 212 pregnancies, which means 18 per cent of the infants, showed signs of postmaturity and in these there was an excess of fetal distress. Those children who were born after pregnancies which were theoretically "prolonged" but did not show signs of postmaturity did not suffer neonatal distress any more than those children born at term. Having scans of uterine growth makes one come to the conclusion that these are not really prolonged pregnancies.