Symphysis-fundal Height Measurement Research Articles

Symphysis-fundus height measurement to predict small-for-gestational-age status at birth: a systematic review.

BackgroundFetal growth restriction is among the most common and complex problems in modern obstetrics. Symphysis-fundus (SF) height measurement is a non-invasive test that may help determine which women are at risk. This study is a systematic review of the literature on the accuracy of SF height measurement for the prediction of small-for-gestational-age (SGA) status at birth in unselected and low-risk pregnancies.MethodsThe Medline, Embase, Cinahl, SweMed, and Cochrane Library databases were searched with no limitation on publication date (through September 2014), which returned 722 citations. Two reviewers then developed a short list of 51 publications of possible relevance and assessed them using the following inclusion criteria: cohort study of test accuracy performed in a routine prenatal care setting; SF height measurement for all participants; classification of SGA, defined as birth weight (BW) < 10th, 5th, or 3rd percentile or ≥ one or two standard deviations below the mean; study conducted in Northern, Western, or Central Europe; USA; Canada; Australia; or New Zealand; and sufficient data for 2 × 2 table construction. Quality of the included studies was assessed in duplicate using criteria suggested by the Cochrane Collaboration. Review Manager 5.3 software was used to analyze the data, including plotting of summary receiver operating curve spaces.ResultsEight studies were included in the final dataset and seven were included in summary analyses. The sensitivity of SF height measurement for SGA (BW < 10th percentile) prediction ranged from 0.27 to 0.76 and specificity ranged from 0.79 to 0.92. Positive and negative likelihood ratios ranged from 1.91 to 9.09 and from 0.29 to 0.83, respectively.ConclusionsSF height can serve as a clinical indicator along with other clinical findings, information about medical conditions, and previous obstetric history. However, SF height has high false-negative rates for SGA. Clinicians must understand the limitations of this test.The protocol has been registered in the international prospective register of systematic reviews, PROSPERO (Registration No. CRD42014008928, http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42014008928).Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0461-z) contains supplementary material, which is available to authorized users.

Factors associated with false diagnosis of fetal growth restriction

The aim of this study was to analize and describe some characteristics related to a false diagnosis of intrauterine growth restriction (IUGR). We retrospectively included 48 pregnant women referred to our service with a suspected diagnosis of IUGR that was not confirmed after birth and we compared them to another group with confirmed IUGR. We then analyzed the characteristics of the false-positive results. The results of the study were divided into continuous and categorical variables for analysis. The χ2test or Fisher exact test was applied to compare proportions. The level of significance was set at p<0.05 for all tests. In our sample, pregnant women with a false diagnosis of IUGR had the following characteristics: they were referred earlier (mean gestational age of 32.8 weeks); were submitted to 2 to 6 ultrasound examinations before been registered in our service; in 25% of cases ultrasound examination was performed before 12 weeks; in 66.7% of cases the symphysis-fundal height measurement was normal; in 52.1% of cases they had at least 1 sonographic exam above the 10th percentile; on average, the last ultrasound examination (performed on average at 36 weeks) was above the 18th percentile; the women were submitted to a mean number of 5 ultrasound examinations and to a mean number of 4.6 vitality exams. The false diagnosis of IUGR involves high hospital costs and higher demand for specialists. The symphysis-fundal height measurement must be valued, and the diagnosis of IUGR must be confirmed with ultrasonography in the last weeks of pregnancy before any obstetric management is taken.

A new population‐based reference curve for symphysis–fundus height

To present a new gestational-age-specific percentile curve for symphysis-fundus (SF) height and to determine the effects of maternal and fetal covariates. A population-based register study. Antenatal clinics in Västra Götaland County, Sweden, between 2005 and 2010. A total of 42 018 women with ultrasound-dated singleton pregnancies who delivered at Sahlgrenska University Hospital. Measurement of SF height. A non-linear regression of SF height on day of pregnancy was used to construct a reference chart for the median and other percentiles of SF height. The new reference curve for SF height showed almost linear growth until term. The median value was considerably larger at each gestational age compared with the curves for SF height used in Norway and Denmark. Compared with the curve currently used in Sweden, higher median values were observed only at gestational ages >34 weeks, accompanied by an upward shift in all percentiles. The only notably influential covariates were maternal pre-pregnancy weight and height. The new reference curve for SF height shows a pattern that is different from the Scandinavian reference curves of older origin, reflecting changes in the pregnant population, as well as methodological differences. The new curve can be adjusted for maternal and fetal covariates to suit individual pregnancies.

The accuracy of symphysis fundal height measurement

Fetal growth anomalies are correlated with an increased risk of perinatal morbidity and mortality, including unexplained stillbirth. Identification of the small for gestational age (SGA) and large for gestational age (LGA) fetus, especially during an otherwise uncomplicated pregnancy requires effective antenatal screening methods, and involves input from midwives and obstetricians. Measuring fetal growth by serial symphysis fundal height (SFH) measurement using a tape measure and plotting the measurement on a customised growth chart, is the current recommended method. This article compares and presents the findings of recent research literature, and critiques elements of the methodology surrounding the main studies.

Is the use of symphysis-fundal height measurement and ultrasound examination effective in detecting small or large fetuses?

SummaryWe investigated the accuracy of using symphysis pubis-fundal height measurement and ultrasonically derived estimation of fetal weight for identifying small-for-gestational-age (SGA) and large-for-gestational-age (LGA) fetuses. A retrospective cohort study was performed using computerised records of all non-diabetic women referred for an ultrasound growth scan (US) with clinically suspected SGA or LGA singleton fetuses from 35 weeks’ gestation between October 2008 and March 2009 (n = 185). Birth weight data were also collected for all births over the study period (n = 3200). One-third (34%) of ultrasound estimated fetal weights were inaccurate by >10%. However, an inaccurate ultrasound estimation did not significantly increase the likelihood of spontaneous or induced onset of labour or delivery by caesarean section. Most (79%) growth scans were performed on well-grown fetuses. The majority (80%) of SGA and LGA babies in our cohort were not identified by clinicians during routine antenatal care. From 3,200 live births, there were a total of 59 infants weighing <2,500 g or >5,000 g. Of these, only 12 had been referred for an ultrasound growth scan, indicating that abdominal palpation and fundal height measurement has a 20% sensitivity in detecting SGA or LGA fetuses. Of the 12, four were detected using ultrasound, indicating a 33% detection rate. Although ultrasound has a slightly higher sensitivity, neither clinical examination using fundal height measurements nor 3rd trimester ultrasound examinations are effective at detecting SGA or LGA fetuses.

Identifying placental dysfunction in women with reduced fetal movements can be used to predict patients at increased risk of pregnancy complications

Maternal perception of fetal movements has historically been used to indicate fetal wellbeing, and has been used with varying success in recent years to identify those pregnancies at increased risk of stillbirth, and other placental pathologies. We present a hypothesis that links reduced fetal movements (RFM) to fetal growth restriction (FGR) and stillbirth through placental dysfunction, and suggests the possibility that this can allow development of a reliable method to identify those women experiencing RFM who are at increased risk of adverse outcome. Reduced fetal movement is thought to represent fetal compensation in a chronic hypoxic environment due to inadequacies in the placental supply of oxygen and nutrients. Placental analysis in FGR and in stillbirth has revealed a number of structural abnormalities and an imbalance in cell turnover, and in terms of function, FGR is also associated with reduced nutrient transport. Both FGR and stillbirth are linked to changes in maternal levels of placental hormones. However, no such studies have been performed in samples from pregnancies affected by RFM. Currently, there are no formal guidelines to direct the management of such women, although it is recommended they undergo measurement of symphysis-fundal height and cardiotocography, and possibly Doppler ultrasound and biophysical profiling. Novel tests could involve the measurement of placental-derived hormones in maternal serum. To address this hypothesis, macroscopic and microscopic analysis of placental samples from both normal pregnancies and those affected by RFM is needed to detect any changes in structure. Placental function could be evaluated by levels of placental hormones in maternal blood. If placental dysfunction can be linked to RFM, and a robust method of identifying those women with placental insufficiency can be developed; screening patients with RFM could lead to a reduction in perinatal morbidity and mortality.

Dating gestational age by last menstrual period, symphysis-fundal height, and ultrasound in urban Pakistan

Objective To compare the accuracy of the reported date of the last menstrual period (LMP) with that of symphysis-fundal height (SFH) in the estimation of gestational age (GA), using an ultrasound (US) scan as reference. Methods Gestational age was concurrently assessed by the 3 methods in this prospective, population-based, pregnancy-outcome study conducted in Hyderabad, Pakistan, from June 18, 2003, through August 31, 2005, with 1128 women between 20 and 26 weeks of a singleton pregnancy. Results The mean GA was less by ultrasound than by SFH measurement or the reported LMP, and the mean differences with the US result were statistically significant ( P < 0.001 for both). At delivery, about 75% of the GA values estimated by SFH measurement were within 7 days and almost 91% were within 14 days of the estimation by ultrasound, compared with 65% and 82% for the GA estimated by the reported LMP. Moreover, using the US as reference, the SFH correctly classified 84% of the term, 68% of the preterm, and 86% of the post-term deliveries (weighted κ = 0.58) compared with the corresponding 79%, 61%, and 55% predicted by the reported LMP (weighted κ = 0.44). Conclusion The SFH measurement was found to be more accurate than the reported LMP as a tool to estimate GA and therefore date of delivery, but neither were as accurate as a US scan.

A simple clinical formula for predicting fetal weight in labour at term--derivation and validation.

To derive and validate a simple formula for birth weight based on symphysis-fundal height (SFH) measurement during labour, and to determine a useful SFH cut-off value for prediction of birth weight > or = 4000 g. In a derivation study, SFH was measured in women at term in the active phase of labour. A simplified formula for birth weight was derived from a regression equation. The best cut-off SFH measurement was obtained for prediction of birth weight > or = 4000 g. After this, a similar study was done to validate these findings. In the derivation study (N = 504), birth weight was predicted by the equation: birth weight in g = 301 + 78 (SFH in cm). This was transformed to the simplified formula: birth weight in g = 100 ([SFH in cm]-5). Using this formula for the data set, 68.1% of birth weight estimates were correct to within 10% of the birth weight. For prediction of birth weight > or = 4000 g, an SFH measurement of 40 cm had a sensitivity of 82% and a specificity of 80%. In the validation study (N = 294), the derived simplified formula gave 65.0% of estimates correct to within 10% of the birth weight. The predictive values of the 40 cm SFH cut-off were similar to those in the derivation study. The derived simplified formula was validated in the second study. The formula may be useful for intrapartum use in term pregnancies. A cut-off SFH measurement of 40 cm may identify labours at risk for cephalopelvic disproportion or shoulder dystocia.

Reference curves of symphysis-fundus height in twin pregnancies

Objective To generate reliable new reference ranges for symphysis-fundus height (SFH) in twin pregnancies using modern statistical methods and to evaluate whether small-for-gestational age (SGA) babies of women who had a SFH measurement after the 25th gestational week could be predicted by the SFH measurement in the reference curves and other maternal data. Study design In a retrospective cross-sectional study at the obstetric outpatient clinic, Zurich University Hospital, SFH was determined in 257 twin-pregnant women with accurately dateable twin pregnancies (Caucasians: N = 217, Asians: N = 15, Blacks: N = 10, and 15 others). Exclusion criteria were intrauterine fetal death, and known fetal and maternal diseases, which influence SFH. Pregnant women with twins were divided in three groups according to the birth weight of the babies. Group I: both babies were appropriate for gestational age (AGA), group II: one baby was AGA and one SGA, and group III: both babies were SGA. Results SFH measurements increased linearly with gestational age (GA). The following rule of thumb is suggested for the 50th centile of SFH (cm) = gestational week + 10% of gestational week. Age, height, weight and body mass index (BMI) before pregnancy, parity and ethnic group were insignificant determinants in SFH measurement. A prognostic score for identification of group III was created for a GA ≥ 25 weeks and BMI < 30 kg/m 2. Conclusions Measuring SFH is simple, inexpensive and non-invasive and may be of some use for identifying twin mothers with SGA twin pairs.

Symphysis-fundal height measurements and maternal weight gain are more accurate than ultrasound in predicting neonatal macrosomia in morbidly obese women asha

Fetal growth determination is difficult in morbidly obese women. Ultrasound examinations have limitations. We compared the accuracy of ultrasound with symphysis-fundal height (SFH) measurement to determine which of the two more accurately estimated the neonatal weight.

Estimation of fetal weight by symphysis–fundus height measurement

Estimation of fetal weight by symphysis–fundus height measurement

Estimation of fetal weight by symphysis–fundus height measurement

Estimation of fetal weight by symphysis–fundus height measurement

The impact of adjustment for parity and mid‐upper‐arm circumference on sensitivity of symphysis‐fundus height measurements to predict SGA foetuses in Mozambique

With a new symphysis-fundus height (SFH) growth chart, based on Mozambican women with ultrasound-dated singleton pregnancies, the aim was to examine the possibility to enhance sensitivity of predicting small for gestational age (SGA) newborns by attempts to adjust the chart for parity and for mid-upper-arm circumference (MUAC). Two antenatal clinics were chosen in the suburban area of Maputo City. A cohort of 904 consecutively recruited antenatal clients was followed until birth. Gestational age was determined by ultrasound at enrolment. The growth of the SFH was measured every 2-3 weeks. Women with multiple pregnancy or with gestational age >21 weeks at enrolment were excluded. Attempts were made to adjust SFH measurements for parity and MUAC by developing a mathematical model to increase sensitivity of the SFH method to predict a foetus being SGA. Parous women had on average 0.5-1 cm higher SFH readings than nulliparous women. Women with a body mass index (BMI) <19 and women with BMI >27 had approximately 1 cm lower and 1 cm higher readings, respectively, compared with women of normal BMI. There was a significant correlation between BMI and MUAC (r = 0.621; P < 0.001). The usefulness of SFH measurements to predict SGA newborns was analysed. The sensitivity was 49%, the specificity was 66%, the positive predictive value was 14% and the negative predictive value, 93%. By using the correlation between BMI and MUAC we tried to find a simple and useful method to improve the sensitivity of SFH to detect SGA foetuses. By reducing the SFH measurement by 1 cm for women with MUAC >29 and by 1 cm for multiparous women the sensitivity raised to 65% at the expense of reducing the specificity to 51%. Using a linear function of BMI, MUAC and parity to adjust the SFH measurement for each individual woman, it was possible to get a sensitivity of 70% with a corresponding specificity of 56%. By using BMI, MUAC and parity, it might be possible to improve the sensitivity of the SFH growth chart in predicting newborn being SGA but mostly at the expense of specificity.

Symphysis–fundal height and size at birth

Symphysis–fundal (SF) height prepregnancy weight weight at delivery height weight gain body mass index (BMI) and mid-upper arm circumference (MUAC) measurements have been associated with birth size. However the influence of some of these measurements on birth weight seems to be more important in populations with moderate-to-severe malnutrition. We therefore decided to: (1) assess the associations of maternal anthropometry with birth size of offspring in a population of well-nourished women; and (2) evaluate the usefulness of a single SF height measurement for prediction of a small for gestational age (SGA) neonates. (excerpt)

Symphysis-fundal height growth chart of an obstetric cohort of 817 Mozambican women with ultrasound-dated singleton pregnancies.

Our aim was to construct a new symphysis-fundus height (SFH) growth chart, based on Mozambican women with ultrasound-dated singleton pregnancy, who represent the largest obstetric cohort in a developing country followed for this purpose. Two antenatal clinics were chosen in the suburban area of Maputo City. A cohort of 904 consecutively recruited antenatal clients was followed until delivery. The growth of the SFH was measured every second to third week. Gestational age was determined by ultrasound at enrolment. Women with multiple pregnancy or with gestational age > 21 weeks at enrolment were excluded. The average number of antenatal SFH measurements per woman was 7.8 (SD 2.4). The drop out rate was 9.6%. Mean birthweight was 2909 g. Pre-term deliveries occurred in 15% and low birthweight deliveries (< 2500 g) in 16%. Using proper longitudinal methods, we constructed an FH growth chart and compared it with various previously published SFH charts, which showed the Mozambican chart to be 0-3 cm below the others. Nulliparous women were 0.5 cm below multiparous women. We did not find any difference in the SFH growth charts between women with or without overt morbidity. Women with a body mass index (BMI) < 19 and women with a BMI > 27 had approximately 1 cm lower and 1 cm higher readings, respectively, than women with normal BMI. The Mozambican SFH growth chart is an example of an elaborated growth chart for a well-defined population in a low-income country. It constitutes the basis for further studies to predict the small-for-gestational age newborn from anthropometrical data obtained by use of appropriate technology.

Symphysis fundus height measurements during labour: a prospective, descriptive study.

This study was conducted to determine the correlation between symphysis fundus height (SFH) measurements and infant weight. It was also to examine whether descent of the fetus or rupture of the membranes affects the relationship and to calculate a simple formula for estimation of fetal weight. A descriptive prospective study design was used. The setting was the teaching hospitals in Johannesburg. Results show that there is a good correlation between SF measurements and birthweight (r = 0.56) and also between the product of SF measurements and abdominal girth (r = 0.57). The correlation of abdominal girth alone and birthweight was less significant (r = 0.47). Rupture of the membranes has minimal effect on the measurements. The correlation of SF measurements with birthweight was highest when subtracting engagement of the head (in fifths above the pelvic brim) from the SF measurement (r = 0.64). In conclusion, fundal height among women with similar size fetuses varies widely. The formula created from the observations was not sufficiently accurate to be clinically useful. The primary value of SF measurements is to assess fetal growth over time by repeated measurements in individual pregnancies.

Symphysis Fundus Height Measurements during Labour: A Prospective, Descriptive Study

Symphysis Fundus Height Measurements during Labour: A Prospective, Descriptive Study

Symphysis-fundus height and pregnancy characteristics in ultrasound-dated pregnancies

Objective: To investigate the relation between maternal and pregnancy characteristics and symphysis-fundus height values at term in an obstetric population dated by sonography. Methods: Three hundred twenty-five women were recruited from the antenatal clinics of the Queen’s Medical Centre, Nottingham, United Kingdom for measurement of fundal height and for ultrasound scans. Symphysis-fundus height measurements were analyzed by multivariate regression analysis in relation to gestational age, maternal height and weight, ethnic group, and smoking. Results: Gestational age and maternal characteristics explained nearly half of the variability in symphysis-fundus height. Gestational age was the most important determinant, followed by maternal weight, parity, and sex of the infant. The other variables were not significantly correlated. Conclusion: Maternal characteristics had statistically significant effects on the expected symphysis-fundus height, which suggests that individually adjusted fundal height charts may improve the precision of clinical screening for fetal growth restriction.

Customised gravidogram and fetal growth chart in a South African population

Objective: To investigate whether gravidograms and fetal growth curves should be customized, i.e. tailor made for a specific ethnic group. Methods: a cross-sectional study of 800 pregnant Xhosa women attending antenatal care in the Eastern Cape Province (South Africa). The data measured was used to compare the correlation between the symphysis–fundus height measurement (SFHM) and the sonographic estimate of gestational age (SEGA), as well as the intra-uterine fetal growth curve with existing gravidograms and fetal growth charts. Results: There was a good correlation between the SFHM and the SEGA: r=0.91 ( P<0.0001). The correlation between the SFHM and the sonographic estimate of fetal weight (SEFW) yielded a correlation coefficient ( r) of 0.40 ( P<0.0001). The correlation between the SEFW and SEGA resulted in a r=0.97 ( P<0.0001). The customized gravidogram and fetal growth chart followed the general trend seen in their Caucasian equivalents. Conclusion: The comparison of our customized gravidogram and intra-uterine fetal growth curve with similar charts established in Caucasians does not show any significant difference.

Fetal growth velocity: a cautionary tale

One of the most important aims of antenatal care is to detect fetuses who are not growing adequately, because this is the best way of identifying pregnancies with placental failure requiring early delivery. In the UK, the commonest screening technique is by measurement of symphysis fundal height with a tape measure at every antenatal visit. 1 Pearce JM Campbell S A comparison of symphysis-fundal height and ultrasound as screening tests for light for gestational age infants. Br J Obstet Gynaecol. 1987; 940: 100-104 Crossref Scopus (73) Google Scholar When the height is less than expected for the duration of gestation, an ultrasound scan should be undertaken to measure the fetal abdominal and head circumferences, which are then plotted on standardised growth curves. If these values confirm that the fetus is small, the cause of the smallness should be sought by ultrasound scanning for anomalies and by examination of doppler waveforms of the umbilical artery. Classification of small fetuses according to these two investigations is important because the further management 2 Chard T Yoong A Macintosh M The myth of fetal growth retardation at term. Br J Obstet Gynaecol. 1993; 100: 1076-1081 Crossref PubMed Scopus (70) Google Scholar and outcome 3 Soothill PW Ajayi RA Campbell SC Ross EM Nicolaides KH Fetal oxygenation at cordocentesis, maternal smoking and childhood neurodevelopment. Eur J Obstet Gynecol Reprod Biol. 1995; 59: 21-24 Summary Full Text PDF PubMed Scopus (42) Google Scholar differ for different types of small fetus.