Migori County Referral Hospital_Gestational Age Data_Nov15-April16

Background: Preterm birth is the leading cause of neonatal mortality
worldwide and specifically in Kenya. Preterm birth is defined by
gestational age (GA) less than 37 weeks, but GA estimates are questionable
in the absence of the gold standard of early ultrasound. In Migori County,
where the majority of women seek care at government facilities and do not
receive ultrasound dating, the accuracy of the GA estimates, and therefore
the preterm birth rates, is unknown. Methods: We conducted a retrospective
chart review of 455 preterm births from Migori County Referral Hospital, a
level-four government hospital in Western Kenya. Preterm birth was defined
in this context as all babies less than 2500g and babies greater than
2500g with a last menstrual period (LMP) calculated GA of less than 37
weeks. GA estimates from both the maternity register and the individual
inpatient chart were evaluated for data quality, agreement between
measurements, and accuracy when compared to the INTERGROWTH-21st
International Newborn Birthweight Standards as a benchmark. Results:
 Data completeness ranged from 35.3% for recorded GA in the
inpatient chart to 97.8% for birth weight in the maternity register. LMP
and recorded GA agreed in 16.8% of cases in the maternity register and
19.2% of cases in the inpatient chart, while symphysis fundal height
agreed in 37.1% and 50.5% of cases, respectively. Of the four GA measures
evaluated, the maternity register recorded GA was accurate in 69.4% of
cases, maternity register LMP-calculated GA in 57.9% of cases, the
inpatient recorded GA in 68.8% of cases, and the inpatient LMP-calculated
GA in 56.0% of cases. Preterm birth rates calculated from the four GA
measures ranged from 7.5% to 18.8%. Conclusion: Non-ultrasound methods of
estimating GA result in a wide range of results, with up to five different
estimates per woman. With such conflicting data, clinical decision making
is compromised and preterm birth facility estimates are likely inaccurate.
Widespread access to early ultrasound, new technologies, and/or new
methods of thinking about GA are urgently needed to improve clinical care
for the mother-infant dyad, and to better understand the preterm birth
burden in low-resource settings.