Symphysis-fundal Height Measurement Research Articles

Investigation and Care of a Small-for-Gestational-Age Fetus and a Growth Restricted Fetus (Green-top Guideline No. 31).

Key recommendations All women should be assessed at booking (by 14 weeks) for risk factors for fetal growth restriction (FGR) to identify those who require increased surveillance using an agreed pathway [Grade GPP]. Findings at the midtrimester anomaly scan should be incorporated into the fetal growth risk assessment and the risk assessment updated throughout pregnancy. [Grade GPP] Reduce smoking in pregnancy by identifying women who smoke with the assistance of carbon monoxide (CO) testing and ensuring in‐house treatment from a trained tobacco dependence advisor is offered to all pregnant women who smoke, using an opt‐out referral process. [Grade GPP] Women at risk of pre‐eclampsia and/or placental dysfunction should take aspirin 150 mg once daily at night from 12+0–36+0 weeks of pregnancy to reduce their chance of small‐for‐gestational‐age (SGA) and FGR. [Grade A] Uterine artery Dopplers should be carried out between 18+0 and 23+6 weeks for women at high risk of fetal growth disorders [Grade B]. In a woman with normal uterine artery Doppler and normal fetal biometry at the midtrimester scan, serial ultrasound scans for fetal biometry can commence at 32 weeks. Women with an abnormal uterine artery Doppler (mean pulsatility index > 95th centile) should commence ultrasound scans at 24+0–28+6 weeks based on individual history. [Grade B] Women who are at low risk of FGR should have serial measurement of symphysis fundal height (SFH) at each antenatal appointment after 24+0 weeks of pregnancy (no more frequently than every 2 weeks). The first measurement should be carried out by 28+6 weeks. [Grade C] Women in the moderate risk category are at risk of late onset FGR so require serial ultrasound scan assessment of fetal growth commencing at 32+0 weeks. For the majority of women, a scan interval of four weeks until birth is appropriate. [Grade B] Maternity providers should ensure that they clearly identify the reference charts to plot SFH, individual biometry and estimated fetal weight (EFW) measurements to calculate centiles. For individual biometry measurements the method used for measurement should be the same as those used in the development of the individual biometry and fetal growth chart [Grade GPP]. For EFW the Hadlock three parameter model should be used. [Grade C] Maternity providers should ensure that they have guidance that promotes the use of standard planes of acquisition and calliper placement when performing ultrasound scanning for fetal growth assessment. Quality control of images and measurements should be undertaken. [Grade C] Ultrasound biometry should be carried out every 2 weeks in fetuses identified to be SGA [Grade C]. Umbilical artery Doppler is the primary surveillance tool and should be carried out at the point of diagnosis of SGA and during follow‐up as a minimum every 2 weeks. [Grade B] In fetuses with an EFW between the 3rd and 10th centile, other features must be present for birth to be recommended prior to 39+0 weeks, either maternal (maternal medical conditions or concerns regarding fetal movements) or fetal compromise (a diagnosis of FGR based on Doppler assessment, fetal growth velocity or a concern on cardiotocography [CTG]) [Grade C]. For fetuses with an EFW or abdominal circumference less than the 10th centile where FGR has been excluded, birth or the initiation of induction of labour should be considered at 39+0 weeks after discussion with the woman and her partner/family/support network. Birth should occur by 39+6 weeks. [Grade B] Pregnancies with early FGR (prior to 32+0 weeks) should be monitored and managed with input from tertiary level units with the highest level neonatal care. Care should be multidisciplinary by neonatology and obstetricians with fetal medicine expertise, particularly when extremely preterm (before 28 weeks) [Grade GPP]. Fetal biometry in FGR should be repeated every 2 weeks [Grade B]. Assessment of fetal wellbeing can include multiple modalities but must include computerised CTG and/or ductus venous. [Grade B] In pregnancies with late FGR, birth should be initiated from 37+0 weeks to be completed by 37+6 weeks [Grade A]. Decisions for birth should be based on fetal wellbeing assessments or maternal indication. [Grade GPP]

Antenatal Care: A Comparative Review of Guidelines.

Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes. The aim of this study was to review and compare the most recently published guidelines on antenatal care. A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted. There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage. Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.

ROLE OF THE CLINICAL RESEARCH MIDWIFE

Welcome to our new series highlighting career pathways for midwives. Clinical Research Midwives support, deliver or lead research in the clinical setting to improve the care and health outcomes of women, birthing people and their families. This article will specifically focus on the Clinical Research Midwives who deliver research in the clinical setting. The role is varied and may involve identifying potential participants that meet the study eligibility requirements and providing information about research as well as an array of clinical skills and experience to deliver their local portfolio of research. Midwives are ideally placed to facilitate discussions with potential participants, particularly when approaching women and birthing people during labour, and gaining informed consent, as well as taking/collecting clinical specimens and/ or recording clinical assessment data, such as blood pressure recordings or symphysis-fundal height measurements. In addition, Clinical Research Midwives collect outcome data specific to the study.

Comparison of Estimation Fetal Weight (EFW) using the Niswander Method and the Risanto Formula on Birth Weight

Fetal growth monitoring can be observed by measuring the Symphysis-Fundal Height (SFH). To determine fetal growth, the SFH measurement is calculated into the Estimation Fetal Weight (EFW) formula. EFW formulas using SFH measurements include the Niswander method and the Risanto formula. This study aims to compare the results of the calculation of the EFW formula which is closest to the birth weight of the baby. This study is a comparative descriptive study with a cross-sectional design, which measures the SFH and weighs the baby's birth weight directly. The population of this research is pregnant women who will give birth at RSUD Soewondo Kendal. A total of 176 samples were taken using a consecutive sampling technique. The results of the independent t-test showed that the Risanto formula had no difference in the birth weight of the baby, while the Niswander method had a significant difference in the actual birth weight of the baby.

Measurement of symphysis fundal height for gestational age estimation in low-to-middle-income countries: A systematic review and meta-analysis.

In low- and middle-income countries (LMIC), measurement of symphysis fundal height (SFH) is often the only available method of estimating gestational age (GA) in pregnancy. This systematic review aims to summarize methods of SFH measurement and assess the accuracy of SFH for the purpose of GA estimation. We searched PubMed, EMBASE, Cochrane, Web of Science, POPLINE, and WHO Global Health Libraries from January 1980 through November 2021. For SFH accuracy, we pooled the variance of the mean difference between GA confirmed by ultrasound versus SFH. Of 1,003 studies identified, 37 studies were included. Nineteen different SFH measurement techniques and 13 SFH-to-GA conversion methods were identified. In pooled analysis of five studies (n = 5838 pregnancies), 71% (95% CI: 66-77%) of pregnancies dated by SFH were within ±14 days of ultrasound confirmed dating. Using the 1 cm SFH = 1wk assumption, SFH underestimated GA compared with ultrasound-confirmed GA (mean bias: -14.0 days) with poor accuracy (95% limits of agreement [LOA]: ±42.8 days; n = 3 studies, 2447 pregnancies). Statistical modeling of three serial SFH measurements performed better, but accuracy was still poor (95% LOA ±33 days; n = 4 studies, 4391 pregnancies). In conclusion, there is wide variation in SFH measurement and SFH-to-GA conversion techniques. SFH is inaccurate for estimating GA and should not be used for GA dating. Increasing access to quality ultrasonography early in pregnancy should be prioritized to improve gestational age assessment in LMIC.

Accuracy of Johnson-Toshack, Niswander and Risanto formulas to predict the estimated fetal weight based on symphysis-fundal height measurement

Estimated fetal weight has a very important for planning whether the vaginal delivery is possible or not. There are various methods to determine the estimated fetal weight, ranging from conventional such using symphysis-fundal height and abdominal circumference measurements to more modern method such as using ultrasound examination. The estimated fetal weight can be calculated using several formulas such as the Johnson-Toshack, Niswander and Risanto formulas. The aim of this study was to compare the estimated fetal weight using the Johnson-Toshack, Niswander and Risanto formulas using simple symphysis-fundal height measurements. In this retrospective cross-sectional study, we assessed the medical records of 44 patients at Arifin Achmad Hospital of Indonesia from November 2020 to August 2021. The performance of the formulas was assessed using independent t-test. Our data suggested there was no significant difference between estimated fetal weight using Johnson formula (p=1.000), Risanto formula (p=1.000) and Niswander formulas compared to actual fetal birth weight (p=0.156). In conclusion, Johnson-Toshack, Niswander and Risanto formula could be used by medical personnel to calculate the estimated fetal weight in order to plan the delivery methods. This is crucial in particular in areas with limited resources such as ultrasound to calculate fetal weight in Indonesia.

Second and third trimester estimation of gestational age using ultrasound or maternal symphysis-fundal height measurements: A systematic review.

Tweetable abstractMany vulnerable women seek antenatal care late in pregnancy. How should gestational age be determined? We examine all available studies estimating GA >20 weeks. Ultrasound is much better than fundal height, and using cerebellar measurement appears to be the most accurate. Linked article: This article is commented on by Philip J. Steer, pp. 1459 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471‐0528.17127.

Measurement of symphysis fundal height for gestational age estimation in low-to-middle-income countries: A systematic review and meta-analysis

Measurement of symphysis fundal height for gestational age estimation in low-to-middle-income countries: A systematic review and meta-analysis

Symphysis-fundal height, gestational age and its value for identification of foetuses at risk in rural Tanzania: A qualitative follow-up study.

Preterm birth and abnormal foetal growth increase the risk of perinatal morbidity and mortality. Timely identification of foetuses at risk is critical to improving maternal and neonatal outcomes. The objective of this study was to increase understanding of the quality of foetal growth monitoring during antenatal care in Tanzania. Between 2015 and 2017, 13 women were followed throughout their pregnancy, childbirth and postpartum period. Participants were recruited using a staggered approach at selected health facilities. Data collection included direct observations of 25 of 48 antenatal care consultations, review of the women's antenatal cards, 88 in-depth interviews and participant observation at the health facilities. Six women had facility births and seven had home births. There was one stillbirth, one preterm birth and two term infants died between the age of 3-6 months. Of the 9 newborns with a known birthweight, 3 were possibly growth-restricted. During 12 ANC visits (25%) Symphysis-Fundal Height (SFH) was not recorded and during 22 visits (46%) the recorded Gestational Age (GA) was incorrect. Despite regular assessment of SFH, three possible growth-restricted infants remained undetected. There is a need to improve nurse-midwives ability to determine a reliable GA and improve critical reflection on SFH measurement.

Screening for Small for Gestational Age Fetus: Are we Succeeding? an Audit of Performance at a Regional Hospital

Background: Fetal growth restriction affects perinatal morbidity and mortality and in practice. symphysis fundal height measurement only identifies 17.3-24.8% of Small for Gestational Age (SGA) fetuses. Plotting on a growth chart and observation of trends has been reported to increase detection rate. Failure to diagnose such fetuses is a recurrent issue at the hospital. Aims: To determine rate of detection of SGA fetuses during the antenatal period and to determine effect of maternal factors on the detection rate. Materials and Methods: This was a retrospective chart review of all babies born at Ipswich General Hospital from 2016 to 2018 in singleton pregnancies with birthweight below the tenth percentile and born ≥28 weeks gestation confirmed by first trimester dating ultrasound. Results: Over 3 years, 760 singleton SGA infants were born. 86.4% had at least 3 antenatal visits after 20 weeks gestation. Although at some stage in pregnancy 52.5% had a symphysis fundal height (SFH) measurement ≥3cm less than gestational age, in only 273 (36%) this resulted in a request for an ultrasound scan to confirm SGA fetus. This happened 53.1% of women who had a scan. Statistical analysis showed the only factor to affect SFH measurement and ultrasound diagnosis of SGA was maternal BMI while maternal age, parity and smoking status had no significant effect. Conclusion: The rate of detection of SGA is low but may be improved with the introduction of a new program of education and plotting of SFH on charts to assess trend. Keywords: Small for gestational age; Symphysis-Fundal height; Antenatal care; Ultrasound

Symphysis-fundal height correlates with adverse delivery and neonatal outcomes in induced full-term and premature pregnancies

Background: Assessing outcomes of birth in induced patients (full-term and premature) in relation with symphysis-fundal height (SFH) measurement. Methods: A prospective enrollment of induced patients was performed at the Obstetrics and Gynecology Unit of Arcispedale Sant’Anna of Ferrara. Reasons for induction, Bishop’s score, body mass index, gestational age, parity, mode of induction, number of induction cycles, time of active labor phase, Cesarean section, operative vaginal birth, post-partum hemorrhage, arterial cord pH, neonatal intensive care admission, size at birth were recorded. Correspondence analysis was applied to analyze independent relationships. These relationships were converted into probabilities. Probabilities for outcomes variables were plotted along with values of SFH and trends were tested. Results: Significant trends of increasing probability of adverse birth and labor outcomes were observed for SFH from 34 cm or less to over 37 cm: two cycles of induction (best fit p = 0.002); three cycles of induction (best fit p = 0.002); Cesarean section (best fit p = 0.027); higher length of active phase of labor (best fit p = 0.002); operative vaginal birth (best fit p = 0.002); arterial blood pH below or equal to 7.15 (best fit p = 0.006); post-partum minor hemorrhage (best fit p = 0.002), post-partum major hemorrhage (best fit p = 0.006). Conclusion: In induced pregnancies, SFH over 34 cm increased the probability of both neonatal and labor adverse outcomes, independently of gestational age.

Symphysis-Fundal Height Curve in Pregnancies Complicated by Maternal Hyperglycemia: Comparison with Curves of Nondiabetic Pregnant Women.

Background Reference symphysis-fundal height (SFH) curves for pregnancies complicated by maternal hyperglycemia are not available. Objective To build an SFH curve according to gestational age for pregnant women with hyperglycemia-type 2 diabetes (T2DM), gestational diabetes mellitus (GDM), or mild gestational hyperglycemia (MGH) and compare it with three other curves in use in Brazil. Methods Prospective cohort study of 422 pregnant women with hyperglycemia attending the Perinatal Diabetes Research Center (PDRC) of Botucatu Medical School, São Paulo State University/UNESP. Between 13 and 41 weeks of pregnancy, 2470 SFH measurements were obtained (mean 5.85 per woman). For the assessment of glycemic control, 2074 glucose level measurements were taken and the glycemic mean (GM) at each gestational week was estimated. Results GM was adequate (<120 mg/dL) in 94.9% and inadequate (≥120 mg/dL) in 5.1% of the cases. The equation applied for SFH prediction was expressed as SFH = 1.082 + 0.966∗week (r2 = 84.6%). At visual analysis, P10 and P90 SFH measurements were higher in the study curve than in the three other curves. Statistical analysis confirmed that SFH median values in this study were higher than those in the reference curve of habitual risk pregnancies, especially after 19 weeks of pregnancy. Conclusion Taking into account that the maternal hyperglycemia was at strict control, our unedited results suggest that the current SFH curve can be a useful tool in prenatal care of T2DM, GDM, and MGH pregnant women.

Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh

ObjectiveTo improve the accuracy of the prediction of gestational age (GA) before birth with the standardised measurement of symphysis-fundal height (SFH), estimation of uterine volume, and statistical modelling including maternal...

Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants.

Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants.

Care of Women with Obesity in Pregnancy

Care of Women with Obesity in Pregnancy

Concordance of three alternative gestational age assessments for pregnant women from four African countries: A secondary analysis of the MIPPAD trial.

BackgroundAt times, ultrasound is not readily available in low resource countries in Africa for accurate determination of gestational age, so using alternative methods is pivotal during pregnancy. These assessments are used to aid the risk analysis for an infant and management strategies for premature delivery, if necessary. Currently, date of last menstrual period, fundal height measurements, and the New Ballard Score are commonly used in resource-limited settings. However, concordance of these measures is unknown for sub-Saharan Africa. We obtained data from an open-label randomized controlled trial, to assess the concordance of these alternative assessment methods. The purpose of our study was to determine the agreement between these alternative methods when used in sub-Saharan African populations.MethodsA total of 4,390 pregnant women from Benin, Gabon, Mozambique and Tanzania were included in our analysis. The assessment methods compared were: 1) reported last menstrual period, 2) symphysis-fundal height measurement, and 3) the New Ballard Score. The Bland-Altman method and intraclass correlation coefficient (ICC) were used to test the degree of agreement. Survival range gestational age, used as an inclusion criterion for further analysis, was from 22 to 44 weeks.FindingsPlots showed a lack of agreement between methods and the 95% limits of agreement too wide to be clinically useful. ICC = 0.25 indicated poor agreement. A post-hoc analysis, restricted from 32 to 42 weeks, was done to check for better agreement in this near-term population. The plots and ICC = 0.16 still confirmed poor agreement.ConclusionThe alternative assessments do not result in comparable outcomes and discrepancies are far beyond the clinically acceptable range. Last menstrual period should not be used as the only estimator of gestational age. In the absence of reliable early ultrasound, symphysis-fundal height measurements may be most useful during pregnancy for fetal risk assessment and the New Ballard Score after delivery as a confirmation of these estimations and for further neonatal management. However, promotion of portable ultrasound devices is required for accurate assessment of gestational age in sub-Sahara Africa.

International Standards for Symphysis-Fundal Height Based on Serial Measurements From the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: Prospective Cohort Study in Eight Countries

(Abstracted from BMJ 2016;355:i5662) Fetal growth assessment is important to identify fetuses with abnormal fetal growth that are at increased risk of perinatal morbidity and mortality. Serial measurement of symphysis-fundal height (SFH) is the recommended, inexpensive, and first-level screening tool in both low- and high-risk pregnancies.

International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: prospective cohort study in eight countries

Objective To create international symphysis-fundal height standards derived from pregnancies of healthy women with good maternal and perinatal outcomes.Design Prospective longitudinal observational study.Setting Eight geographically diverse urban regions in Brazil,...

New WHO antenatal care model—quality worth paying for?

The 2016 WHO guidelines on antenatal care 1 were published earlier this month and are widely welcomed because they are not only academically robust, but also relevant to end-users and patients. The guidelines cover antenatal care for normal pregnancies and have adopted a woman-centred, holistic approach to care. They cover nutritional interventions, maternal and fetal assessment, preventive measures, interventions for common physiological pregnancy symptoms, and health systems interventions to improve the use and quality of antenatal care. The guidelines address antenatal evidence-based practices that improve outcomes and detail how these practices should be delivered. In addition to standard antenatal medical advice, the 49 recommendations include guidance on psychological support, nutrition, and domestic violence screening. Each recommendation is backed up with an evidence review, generally based upon systematic reviews conducted by the Cochrane Collaboration. But even with the most rigorous analyses of the evidence, there are conflicting opinions as to how to deal with some of the results, and what to recommend when there is very limited evidence to support or reject common practice. The WHO antenatal care Guideline Development Group (GDG) is to be congratulated for putting into practice the old adage that “no evidence of benefit is not the same as evidence of no benefit”. So in symphysis-fundal height measurement, for example, where there is limited evidence for its benefit, they do not discard it but recommend that clinicians continue whatever is their current practice.

Symphysis fundal height measurement: appeals to ignorance incur an opportunity cost.

Symphysis fundal height measurement: appeals to ignorance incur an opportunity cost.