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Published on: February 2, 2017
Prediction of low birthweight and small for gestational age from symphysis-fundal height mainly in developing
1Department of Medicine and Public Health, Mizawa Hospital, , Hamamatsu, Japan.
Insights
Symphysis-fundal height measurement is not a reliable primary screening method for predicting low birthweight or small for gestational age. Its diagnostic accuracy is moderate, with insufficient sensitivity and specificity for effective early detection.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Diagnostic Accuracy Studies
Background:
- Accurate and simple screening methods are crucial for early detection of low birthweight (LBW) and small for gestational age (SGA).
- Developing countries particularly require effective tools for identifying these conditions in newborns.
- Current screening methods may not meet the sensitivity and simplicity requirements for widespread use.
Purpose of the Study:
- To evaluate the predictive accuracy of symphysis-fundal height (SFH) for identifying LBW and SGA.
- To determine if SFH is a suitable tool for primary screening in obstetric care.
- To synthesize evidence from existing studies through a meta-analysis.
Main Methods:
- A comprehensive meta-analysis was conducted using studies published up to January 2012.
- Searches were performed on PubMed (MEDLINE) and other databases without date limitations.
- Inclusion criteria focused on moderate-to-high-quality diagnostic accuracy studies (QUADAS score ≥8) reporting true/false positive/negative results.
Main Results:
- The meta-analysis included 46 studies, primarily hospital-based, assessing SFH for LBW (12 studies) or SGA (34 studies).
- Sensitivity for predicting LBW (0.72) and SGA (0.58) was insufficient; specificity for LBW (0.73) was also inadequate.
- While specificity for SGA (0.87) was relatively high, overall diagnostic accuracy was moderate, with limited informational value.
Conclusions:
- Symphysis-fundal height measurement is not recommended as a primary screening tool for LBW or SGA.
- The study suggests that SFH screening may be overly optimistic due to the prevalence of hospital-based studies.
- Further research may be needed to explore alternative or improved screening strategies for LBW and SGA.
Background:
A highly sensitive and simple screening procedure is required for early detection of low birthweight and small for gestational age, especially in developing countries.
Methods:
A meta-analysis was performed to evaluate use of symphysis-fundal height for prediction of low birthweight and small for gestational age. PubMed (MEDLINE) and other databases were used with no limitation on the date of publication (January 2012). The inclusion criteria were moderate-to-high-quality studies, that is, Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) score ≥8, published in English, which provided true and false, positive and negative results for prediction. 2×2 tables were constructed and diagnostic meta-analysis was performed.
Results:
46 studies, which were conducted mostly in hospitals, evaluated the prediction of low birthweight (n=12) or small for gestational age (n=34). Only specificity to predict small for gestational age (0.87) was relatively high. Sensitivity to predict low birthweight (0.72) or small for gestational age (0.58) and specificity to predict low birthweight (0.73) were not sufficiently high. Regardless of predicting low birthweight or small for gestational age, the diagnostic accuracy was moderate (0.7≤ area under the curve≤0.9) and informational value was small (but sometimes important; positive and negative likelihood ratios of 2-5 and 0.5-0.2, respectively).
Conclusions:
The present meta-analysis suggested that symphysis-fundal height is unsuitable for primary screening of low birthweight or small for gestational age. The results may be overly optimistic due to the inclusion of hospital-based versus community-based studies.
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