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Pregnancy dating is frequently uncertain in low-resource settings due to late presentation for antenatal care, challenges of last menstrual period (LMP) recall, and unavailability of ultrasonography.

In high-income countries, postnatal clinical assessment of infant physical and neurologic maturity was commonly used to estimate GA before ultrasound was widely available.

For fetuses A literature review was conducted to identify existing postnatal clinical assessments and a range of potential individual neuromuscular and physical clinical signs to be included (Supplemental Table 5).

A study ultrasonographer (medical physician with ultrasound certification) was trained and standardized in early pregnancy biometry for pregnancy dating, and scans were performed in the field clinic by using a portable Nanomax Sonosite ultrasound machine (Fuji Sonosite, Inc, Bothell, WA).Simplified methods for GA assessment had poor diagnostic accuracy for identifying preterm births (community health worker prematurity scorecard [sensitivity/specificity: 70%/27%]; Capurro [5%/96%]; Eregie [75%/58%]; Bhagwat [18%/87%], foot length CONCLUSIONS: Newborn clinical assessment of GA is challenging at the community level in low-resource settings.Anthropometrics are also inaccurate surrogate markers for GA in settings with high rates of fetal growth restriction.In these settings, preterm infants are commonly unrecognized and/or fail to seek medical care.Accurate and feasible methods of determining gestational age (GA) are urgently needed in LMICs to facilitate the early recognition and referral of premature infants, and the delivery of potentially life-saving interventions.

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