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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is important to know gestational age in order to identify high-risk babies, especially in developing countries and malarious areas in which malnutrition and malaria in pregnancy often cause fetal growth retardation and/or pre-term delivery. The risk of low birth weight attributable to malaria in first pregnancies in malarious areas has been estimated to be as high as 40%. While gestational age is usually estimated from the last menstrual period (LMP), that method may yield inaccurate results due to errors in dates due to cycle variation and irregular menses. Manual assessment from uterine height is also inaccurate. A study was conducted to evaluate postnatal clinical assessment of gestational age by nurses in Malawi, a developing country, using a modified Ballard method, scoring for 6 external criteria only. Results were compared with other methods of gestational age assessment. No reliable gestational age could be obtained from LMP or fundal height approaches. However, at low gestational ages, the Ballard external criteria (BE) approach tended to give lower gestational ages than the Dubowitz score method. At an average gestational age of more than 251 days, BE gave higher values than did the Dubowitz method. Both BE and the Dubowitz method identified 48% of low-birth-weight babies as growth-retarded (gestational age of 37 weeks or longer). No significant difference in gestational age assessment of newborns between nurses was observed. The Ballard method, scoring for external criteria alone, compared favorably with the Dubowitz method and can be reliably and routinely used by nurses.
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PMID:Gestational age assessment by nurses in a developing country using the Ballard method, external criteria only. 957 93

Estimating gestational age in resource-limited settings is prone to considerable inaccuracy because crown-rump length measured by ultrasound before 14 weeks gestation, the recommended method for estimating gestational age, is often unavailable. Judgements regarding provision of appropriate obstetric and neonatal care are dependent on accurate estimation of gestational age. We determined the accuracy of the Dubowitz Gestational Age Assessment, a population-specific symphysis-fundal height formula, and ultrasound biometry performed between 16 and 40 weeks gestation in estimating gestational age using pre-existing data from antenatal clinics of the Shoklo Malaria Research Unit on the Thai-Myanmar border, where malaria is endemic. Two cohorts of women who gave birth to live singletons were analysed: 1) 250 women who attended antenatal care between July 2001 and May 2006 and had both ultrasound crown-rump length (reference) and a Dubowitz Gestational Age Assessment; 2) 975 women attending antenatal care between April 2007 and October 2010 who had ultrasound crown-rump length, symphysis-fundal measurements, and an additional study ultrasound (biparietal diameter and head circumference) randomly scheduled between 16 and 40 weeks gestation. Mean difference in estimated newborn gestational age between methods and 95% limits of agreement (LOA) were determined from linear mixed-effects models. The Dubowitz method and the symphysis-fundal height formula performed well in term newborns, but overestimated gestational age of preterms by 2.57 weeks (95% LOA: 0.49, 4.65) and 3.94 weeks (95% LOA: 2.50, 5.38), respectively. Biparietal diameter overestimated gestational age by 0.83 weeks (95% LOA: -0.93, 2.58). Head circumference underestimated gestational age by 0.39 weeks (95% LOA: -2.60, 1.82), especially if measured after 24 weeks gestation. The results of this study can be used to quantify biases associated with alternative methods for estimating gestational age in the absence of ultrasound crown-rump length to inform critical clinical judgements in this population, and as a point of reference elsewhere.
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PMID:Estimating Gestational Age in Late Presenters to Antenatal Care in a Resource-Limited Setting on the Thai-Myanmar Border. 2611 95