Estimation Of Gestational Early Pregnancy

Question: Discuss About The Estimation Of Gestational Early Pregnancy? Answer: Introduction Papageorghiou, A. T., et al. “International standards for early fetal size and pregnancy dating based on ultrasound measurement of crown–rump length in the first trimester of pregnancy.” Ultrasound in Obstetrics & Gynecology 44.6 (2014): 641-648. Assessment of gestational age (GA) during pregnancy is necessary to effectively observe fetal growth patterns, anatomy and predict the date of delivery of the newborn. The GA calculation for fetus is mostly done by ultrasound measurement of fetal crown-rump length (CRL) at or above 14 weeks of gestation[1]. One research study focused on developing the first international standards for early fetal size and CRL measurement by optimizing study design and using prescriptive approach in the procedure. Research in this area was necessary due to methodological limitations found in past approach used for CRL measurement. The project was named as the INTERGROWTH-21ST Project and population based recruitment method selected women with singleton pregnancy between 9 + 0 and 13 + 6 weeks of gestation. The GA for the participants was calculated by means of last menstrual period and lack of hormonal medication in the past 2 months. Secondly, CRL was measures under strict protocols such as strict training and standardization for CRL measurement. The follow up with the participants until delivery and hospital discharge gave idea about GA estimation by means of CRL data. The result showed uniform increase in CRL with GA[2]. The strength of the study is its sample as it selected participants from eight geographically diverse countries, thus making the outcome generalizable for all population group. This increases the chance for the project to become a universal project for GA measurement. Secondly, another reason for the success of the project was that the researcher paid strict emphasis on quality control process and keeping unified protocols in all phase starting from recruitment to hospital discharge. This approach favored creating international standard for measuring fetal growth. The outcome of the INTERGROWTH-21ST Project has also been evaluated by another study which showed that reliable estimates can be obtained from the project[3]. Napolitano, R., et al. “Pregnancy dating by fetal crown–rump length: a systematic review of charts.” BJOG: An International Journal of Obstetrics & Gynaecology 121.5 (2014): 556-565. Another study focused on evaluating the methodological quality of studies reporting about GA estimation by CRL and the systematic review of observational studies was done using the MOOSE (Meta-analyses of Observation studies in Epidemiology) group checklist. The articles published between 1948- 20111 were retrieved from three electronic databases namely MEDLINE, EMBASE and CINAHL. The criteria for selecting article were that it should report about GA estimation from first trimester CRL measurement using ultrasound. About 1142 relevant citations were found and four of them had lowest risk of boas. Based on 29 set criteria, the articles were scores as having low or high risk of bias. Some studies used cross sectional research design and some used longitudinal research design. Five articles used mix of both methods. The result varies across setting and several limitations such as lack of description about population were found. The ultrasound aspects was well-described in most of the research articles, however there were also studies that failed to provide the equation for GA and CRL[4]. The conclusion from the evaluation of above article is that great heterogeneity has been found in studies regarding use of CRL for GA estimation. The most significant limitation was the approach taken to selected samples for the study. Consideration of the sample was important to effectively create reference equations for sample size. Secondly, in some studies, women with low risk of complication were not taken. However, this should be considered because certain conditions like hypertension, smoking and any disease can affect early fetal growth in the first trimester of pregnancy[5]. Hence, there is a need for innovative methodological design to reduce the variability in results obtained for GA estimation. Future studies need to focus in developing a design that can be universally accepted for GA estimation. References: Bouwland-Both, Marieke I., et al. “Prenatal parental tobacco smoking, gene specific DNA methylation, and newborns size: the Generation R study.” Clinical epigenetics 7.1 (2015): 83. Holman, Michelle A., et al. “444: Effect of fresh versus frozen embryo transfer on fetal growth parameters.” American Journal of Obstetrics & Gynecology 218.1 (2018): S268-S269. Napolitano, R., et al. “Pregnancy dating by fetal crown–rump length: a systematic review of charts.” BJOG: An International Journal of Obstetrics & Gynaecology 121.5 (2014): 556-565. Ohuma, Eric O., et al. “Estimation of gestational age in early pregnancy from crown-rump length when gestational age range is truncated: the case study of the INTERGROWTH-21 st Project.” BMC medical research methodology 13.1 (2013): 151. Papageorghiou, A. T., et al. “International standards for early fetal size and pregnancy dating based on ultrasound measurement of crown–rump length in the first trimester of pregnancy.” Ultrasound in Obstetrics & Gynecology 44.6 (2014): 641-648.

Estimation Of Gestational Early Pregnancy

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