Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh

BMJ Open. 2020 Mar 12;10(3):e034942. doi: 10.1136/bmjopen-2019-034942.


Objective: To improve the accuracy of the prediction of gestational age (GA) before birth with the standardised measurement of symphysis-fundal height (SFH), estimation of uterine volume, and statistical modelling including maternal anthropometrics and other factors.

Design: Prospective pregnancy cohort study.

Setting: Rural communities in Sylhet, Bangladesh.

Participants: 1516 women with singleton pregnancies with early pregnancy ultrasound dating (<20 weeks); 1486 completed follow-up.

Methods: SFH and abdominal girth were measured at subsequent antenatal care (ANC) visits by community health workers at 24 to 28, 32 to 36, and/or >37 weeks gestation. An estimated uterine volume (EUV) was calculated from these measures. Data on pregnancy characteristics and other maternal anthropometrics were also collected.

Primary outcome measure: GA at subsequent ANC visits, as defined by early ultrasound dating.

Results: 1486 (98%) women had at least one subsequent ANC visit, 1102 (74%) women had two subsequent ANC visits, and 748 (50%) had three visits. Using the common clinical practice of approximating the GA (in weeks) with the SFH measurement (cm), SFH systematically underestimated GA in late pregnancy (mean difference -4.4 weeks, 95% limits of agreement -12.5 to 3.7). For the classification of GA <28 weeks, SFH <26 cm had 85% sensitivity and 81% specificity; and for GA <34 weeks, SFH <29 cm had 83% sensitivity and 71% specificity. EUV had similar diagnostic accuracy. Despite rigorous statistical modelling of SFH, accounting for repeated longitudinal measurements and additional predictors, the best model without including a known last menstrual period predicted 95% of pregnancy dates within ±7.4 weeks of early ultrasound dating.

Conclusions: We were unable to predict GA with a high degree of accuracy before birth using maternal anthropometric measures and other available maternal characteristics. Efforts to improve GA dating in low- and middle-income countries before birth should focus on increasing coverage and training of ultrasonography.

Trial registration number: NCT01572532.

Keywords: estimated uterine volume; gestational age; preterm birth; symphysis fundal height; uterine fundal height.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anthropometry / methods*
  • Bangladesh
  • Diagnostic Techniques, Obstetrical and Gynecological*
  • Female
  • Gestational Age*
  • Humans
  • Pregnancy
  • Prospective Studies
  • Sensitivity and Specificity
  • Ultrasonography, Prenatal
  • Uterus / physiology*
  • Young Adult

Associated data