uu.seUppsala universitets publikasjoner
Endre søk
RefereraExporteraLink to record
Permanent link

Direct link
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Discrepancy between pregnancy dating methods affects obstetric and neonatal outcomes: a population-based register cohort study
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa). Region Västmanland – Uppsala University, Center for Clinical Research, Hospital of Västmanland Västerås, Sweden.
Department of Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. (Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden)ORCID-id: 0000-0002-6311-9506
(Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Solna, Sweden)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.ORCID-id: 0000-0002-4935-7532
2018 (engelsk)Inngår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, artikkel-id 6936Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

To assess associations between discrepancy of pregnancy dating methods and adverse pregnancy, delivery, and neonatal outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for discrepancy categories among all singleton births from the Medical Birth Register (1995–2010) with estimated date of delivery (EDD) by last menstrual period (LMP) minus EDD by ultrasound (US) -20 to +20 days. Negative/positive discrepancy was a fetus smaller/larger than expected when dated by US (EDD postponed/changed to an earlier date). Large discrepancy was <10th or >90th percentile. Reference was median discrepancy ± 2 days. Odds for diabetes and preeclampsia were higher in pregnancies with negative discrepancy, and for most delivery outcomes in case of large positive discrepancy (+9 to +20 days): shoulder dystocia [OR 1.16 (95% CI 1.01–1.33)] and sphincter injuries [OR 1.13 (95% CI 1.09–1.17)]. Odds for adverse neonatal outcomes were higher in large negative discrepancy (–4 to –20 days): low Apgar score [OR 1.18 (95% CI 1.09–1.27)], asphyxia [OR 1.18 (95% CI 1.11–1.25)], fetal death [OR 1.47 (95% CI 1.32–1.64)], and neonatal death [OR 2.19 (95% CI 1.91–2.50)]. In conclusion, especially, large negative discrepancy was associated with increased risks of adverse perinatal outcomes. 

sted, utgiver, år, opplag, sider
2018. Vol. 8, artikkel-id 6936
HSV kategori
Identifikatorer
URN: urn:nbn:se:uu:diva-345955DOI: 10.1038/s41598-018-24894-yISI: 000431204500016PubMedID: 29720591OAI: oai:DiVA.org:uu-345955DiVA, id: diva2:1189967
Prosjekter
Discrepancy between pregnancy dating methods – correlates and outcomesTilgjengelig fra: 2018-03-13 Laget: 2018-03-13 Sist oppdatert: 2018-07-25bibliografisk kontrollert
Inngår i avhandling
1. Discrepancy between pregnancy dating methods – correlates and outcomes
Åpne denne publikasjonen i ny fane eller vindu >>Discrepancy between pregnancy dating methods – correlates and outcomes
2018 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

With the introduction of obstetric ultrasound there has been a shift from last menstrual period-based to ultrasound-based estimation of gestational age. The choice of the method and timing of pregnancy dating is important because it can affect dating precision and perinatal outcomes.

First, when comparing two large population-based cohorts from the Medical Birth Register, from before and after the introduction of ultrasound-based pregnancy dating, male infants on the edge of prematurity did not benefit from progress in medical care as much as female infants in terms of prematurity-related outcomes. This might reflect a bias introduced by the ultrasound-based pregnancy dating method, because of a tendency to overestimate gestational age in pregnancies with a male fetus.

Second, in a large population-based cross-sectional study, the associations of discrepancies between last menstrual period-based and ultrasound-based estimates with variables such as fetal sex and maternal height, indicated that ultrasound-based pregnancy dating introduced systematic errors presumably related to the method’s use of fetal size as a proxy for gestational age. The largest effect estimates were found for maternal obesity in cases of large negative discrepancies.

Third, in a large population-based cohort study, discrepancies between last menstrual period-based and ultrasound-based estimates were associated with several adverse pregnancy, delivery, and neonatal outcomes. Most importantly, a large negative discrepancy was associated with higher odds for neonatal and intrauterine fetal death, as well as for an infant being small for gestational age.

Fourth, in a survey study there was overall good adherence to national guidelines, except for early pregnancy dating. However, the management of discrepancies between methods for pregnancy dating varied widely in clinical practice, which may be due to the lack of national guidelines.

In summary, ultrasound-based dating can be biased by maternal or fetal characteristics. Discrepancies between methods for pregnancy dating may indicate a need for closer monitoring to optimize perinatal care during pregnancy and childbirth.

sted, utgiver, år, opplag, sider
Uppsala: Acta Universitatis Upsaliensis, 2018. s. 59
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1444
Emneord
pregnancy, gestational age, ultrasound, last menstrual period
HSV kategori
Forskningsprogram
Obstetrik och gynekologi
Identifikatorer
urn:nbn:se:uu:diva-345957 (URN)978-91-513-0277-5 (ISBN)
Disputas
2018-05-04, Samlingssalen, Psykiatricentrum, ingång 29, Västmanlands sjukhus, Västerås, 13:15 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2018-04-11 Laget: 2018-03-15 Sist oppdatert: 2018-04-24

Open Access i DiVA

fulltext(1002 kB)62 nedlastinger
Filinformasjon
Fil FULLTEXT01.pdfFilstørrelse 1002 kBChecksum SHA-512
f5ac02e223fe9045b133a9dd25520b72e7fb1145f2b9a6b360f748d4e4baae1410208721b3b9696d55a0cb976c27f4873fccc46e562f55810a0bbb71ba003764
Type fulltextMimetype application/pdf

Andre lenker

Forlagets fulltekstPubMed

Personposter BETA

Kullinger, MeritGranfors, MichaelaSkalkidou, Alkistis

Søk i DiVA

Av forfatter/redaktør
Kullinger, MeritGranfors, MichaelaSkalkidou, Alkistis
Av organisasjonen
I samme tidsskrift
Scientific Reports

Søk utenfor DiVA

GoogleGoogle Scholar
Totalt: 62 nedlastinger
Antall nedlastinger er summen av alle nedlastinger av alle fulltekster. Det kan for eksempel være tidligere versjoner som er ikke lenger tilgjengelige

doi
pubmed
urn-nbn

Altmetric

doi
pubmed
urn-nbn
Totalt: 135 treff
RefereraExporteraLink to record
Permanent link

Direct link
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf