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Prior Knowledge of Obstetric Gestational Age and Possible Bias of Ballard Score

From the Departments of Obstetrics, Gynecology & Reproductive Sciences and Pediatrics, University of Texas Houston Medical School, Houston, Texas.

Address reprint requests to: Manju Monga, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Houston Medical School, 6431 Fannin, 3.268, Houston, TX 77030, E-mail: mmonga{at}obg.med.uth.tmc.edu

Objective: To determine whether prior knowledge of obstetric estimate of gestational age creates a bias in assignment of gestational age by the Ballard assessment score.

Methods: The Ballard assessment score was done on 82 infants weighing less than 2500 g by two examiners, one who had prior knowledge of best obstetric gestational age estimate and the other who was masked to that information. Obstetric gestational age was correlated with masked and unmasked score. Statistical analysis used Spearman rank correlation test, plotting the measurement means against the measurement differences, ², Wilcoxon signed-rank test, analysis of variance, and Student t test. Significance was assumed at P < .05.

Results: There was high reliability (r = 0.84–0.86) between obstetric gestational age estimates (33.3 ± 3.0 weeks) and the gestational age derived from masked (34.3 ± 3.0 weeks) and unmasked (34.0 ± 3.0 weeks) Ballard scores. The mean difference between unmasked scores and gestational age was 1.38 ± 1.15 weeks and that between masked scores and obstetric gestational age was 1.40 ± 1.15 weeks, a nonsignificant difference. There was no significant difference in the number of cases with 100% agreement between masked and unmasked scores and obstetric gestational age or in the number of cases in which the score (masked or unmasked) differed by more than 2 weeks from obstetric gestational age. This study had over 99% power to detect a 1-week difference between the accuracy of masked and unmasked scores.

Conclusion: Prior knowledge of obstetric gestational age did not bias the Ballard assessment score.

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