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A comparison of women’s, providers’ and ultrasound assessments of pregnancy duration among termination of pregnancy clients in South Africa

  1. K Blanchard1,*,
  2. D Cooper2,
  3. K Dickson3,
  4. L Cullingworth2,
  5. N Mavimbela4,
  6. C Von Mollendorf5,
  7. LJ Van Bogaert6,
  8. B Winikoff7

Article first published online: 11 APR 2007

DOI: 10.1111/j.1471-0528.2007.01293.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 114, Issue 5, pages 569–575, May 2007

Additional Information

How to Cite

Blanchard, K., Cooper, D., Dickson, K., Cullingworth, L., Mavimbela, N., Von Mollendorf, C., Van Bogaert, L. and Winikoff, B. (2007), A comparison of women’s, providers’ and ultrasound assessments of pregnancy duration among termination of pregnancy clients in South Africa. BJOG: An International Journal of Obstetrics & Gynaecology, 114: 569–575. doi: 10.1111/j.1471-0528.2007.01293.x

Author Information

  1. 1

    Ibis Reproductive Health, Cambridge, MA, USA

  2. 2

    Women’s Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory 7925, Cape Town, South Africa

  3. 3

    World Health Organization, Geneva, Switzerland

  4. 4

    Population Council, Craighall Johannesburg, South Africa

  5. 5

    Reproductive Health and HIV Research Unit, Department of Obstetrics & Gynaecology, University of Witwaterstrand, Chris Hani Baragwanath Hospital, Soweto, Gauteng South Africa

  6. 6

    Philadelphia Hospital, Nelspruit, Mpumalanga, South Africa

  7. 7

    Gynuity Health Projects, New York, NY, USA

*K Blanchard, Ibis Reproductive Health, 17 Dunster Street, Suite 201, Cambridge, MA 02138, USA. Email kblanchard@ibisreproductivehealth.org

Publication History

  1. Issue published online: 11 APR 2007
  2. Article first published online: 11 APR 2007
  3. Accepted 10 January 2007.

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Keywords:

  • Medical abortion;
  • pregnancy duration;
  • ultrasound

Objective  To compare providers’ and women’s estimates of duration of pregnancy with ultrasound estimates for determining medical abortion eligibility.

Design  Cross-sectional study.

Setting  Public termination of pregnancy (TOP) services in three provinces.

Sample  A total of 673 women attending the above services for TOP.

Methods  Women participating in a medical abortion feasibility study in South Africa provided estimates of pregnancy duration and date of last menstrual period (LMP). Each woman also had clinical and ultrasound exams. We compared estimates using the four methods, calculating the proportion of women in the ‘caution zone’ (≤8 weeks gestation by woman or provider estimate and >8 weeks by ultrasound).

Main outcome measures  Mean gestational age by each method; difference between provider and LMP estimates and ultrasound estimates; and percentage of women in the ‘caution zone’.

Results  Women’s estimates of pregnancy duration were 19 days fewer than ultrasound estimates (95% CI =−27 to 63). Mean provider- and LMP-based estimates were two (95% CI =−30 to 35) and less than one day(s) (95% CI =−46 to 51) fewer than ultrasound estimates. Comparing provider and ultrasound estimates, 15% of women were in the ‘caution zone’; this fell to 12% if estimates of 9 weeks or fewer were considered acceptable.

Conclusions  Provider estimates of gestational age were sufficiently accurate for determining eligibility for medical abortion. LMP-based estimates were also accurate on average, but included more extreme differences from ultrasound estimates. Medical abortion could be provided in TOP facilities without ultrasound or with ultrasound on referral.

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