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Adherence to Swedish national pregnancy dating guidelines and management of discrepancies between pregnancy dating methods: a survey study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.ORCID iD: 0000-0003-3603-7983
Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.ORCID iD: 0000-0002-6311-9506
Department of Medicine, Solna; Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.ORCID iD: 0000-0002-4935-7532
2019 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 16, article id 95Article in journal (Refereed) Published
Abstract [en]

Background. Swedish national guidelines for pregnancy dating were published in 2010. Follow-up is needed to assess adherence and to identify whether any clinical topics are not covered in the guidelines.

Methods. All units in Sweden that performed ultrasound-based pregnancy dating were asked to complete a web-based questionnaire comprising multiple-response questions and commentary fields. Information was collected regarding baseline information, current and previous clinical practice, and management of discrepancies between last-menstrual-period- and ultrasound-based methods for pregnancy dating.

Results. The response rate was 88% (38/43 units). Half of the units offered first-trimester ultrasound to all pregnant women. However, contrary to the guidelines, the crown–rump length was not used for ultrasound-based pregnancy dating in most units. Ultrasound-based pregnancy dating was performed only if the biparietal diameter was between 21 and 55 mm. The methods for management of discrepancies between methods for pregnancy dating varied widely.

Conclusions. The units reported high adherence to national guidelines, except for early pregnancy dating, for which many units followed unwritten or informal guidelines. The management of discrepancies between last-menstrual-period-based and ultrasound-based estimated day of delivery varied widely. These findings emphasize the need for regular updating of national written guidelines and efforts to improve their implementation in all units.

Place, publisher, year, edition, pages
2019. Vol. 16, article id 95
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-345956DOI: 10.1186/s12978-019-0760-3ISI: 000474617600001PubMedID: 31272510OAI: oai:DiVA.org:uu-345956DiVA, id: diva2:1189968
Projects
Discrepancy between pregnancy dating methods – correlates and outcomesAvailable from: 2018-03-13 Created: 2018-03-13 Last updated: 2019-08-21Bibliographically approved
In thesis
1. Discrepancy between pregnancy dating methods – correlates and outcomes
Open this publication in new window or tab >>Discrepancy between pregnancy dating methods – correlates and outcomes
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 59
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1444
Keywords
pregnancy, gestational age, ultrasound, last menstrual period
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-345957 (URN)978-91-513-0277-5 (ISBN)
Public defence
2018-05-04, Samlingssalen, Psykiatricentrum, ingång 29, Västmanlands sjukhus, Västerås, 13:15 (Swedish)
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Supervisors
Available from: 2018-04-11 Created: 2018-03-15 Last updated: 2018-04-24

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Kullinger, MeritGranfors, MichaelaSkalkidou, Alkistis

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