The overlap between miscarriage and extreme preterm birth in a limited-resource setting on the Thailand-Myanmar border: a population cohort study
Bibliographic record
Abstract
Background : Countries vary on the demarcation gestational age that distinguishes miscarriage and extreme preterm birth (PTB). This study provides a synopsis of the outcome of pregnancy between 22 to <28 weeks’ gestation from a low resource setting. Methods : A retrospective record review of a refugee and migrant population on the Thailand-Myanmar border with outcome between 22 to <28 weeks’ gestation, was conducted. Outcomes were classified as miscarriage: non-viability prior to 22 week’s gestation with expulsion of products between 22 to < 28 weeks’ gestation; or extreme PTB when the fetus was viable at ≥22 weeks and delivered between 22 to < 28 weeks’ gestation. Termination of pregnancy and gestational trophoblastic disease were excluded. Results : From 1995-2015, outcomes occurred between 22 to <28 weeks’ gestation in 0.9% (472/49,931) of pregnancies and 3.8% (18/472) met the exclusion criteria. Most included pregnancies (n=454) had ultrasound done 72.5% (n=329). Overall 43.6% (n=197) were miscarriage and 56.4% (n=257) extreme PTB. Miscarriage (late expulsion) between 22 to <28 weeks was observed with non-viability occurring at an estimated median gestation of 16 weeks. For cases with available data (n=252, 5 missing) the proportion of stillborn was 47.6% (n=120), liveborn 52.4% (n=132); and congenital abnormality 10.5% (24/228, 29 missing). Neonatal death was high 98.5% (128/131, 1 missing). Introduction of ultrasound was associated with a 2-times higher odds of classification of outcome as birth rather than miscarriage. Conclusion : In this low resource setting <1% of pregnancy outcomes occur in the 22 to <28 weeks’ gestation window; nearly half were miscarriage; and neonatal mortality approached 100%. In the scale-up to preventable newborns deaths, at least initially, greater benefits will be obtained by focusing on the greater number of viable newborns with a gestation of 28 weeks or more.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".