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INTRAUTERINE GROWTH RESTRICTION |
Br J Obstet Gynaecol. 1999 Apr;106(4):309-17.
Controlled trial of fundal height measurement plotted on customised
antenatal growth charts.
Gardosi J, Francis A.
Division of Obstetrics, Midwifery and Gynaecology, University Hospital,
Queen's Medical Centre, Nottingham, UK.
Objectives:
The purpose of this study was to evaluate the effect of a policy
of standard antenatal care which included plotting fundal height
measurements on customised antenatal charts in the community.
Design:
Prospective, non-randomised, controlled, population-based study. POPULATION:
Two defined and separate referral areas from community to teaching hospital,
with similar delivery rates and socioeconomic characteristics. A total of
1272 consecutively booked women with singleton pregnancies and dating
ultrasound scans before 22 weeks of gestation.
Intervention:
In the study
area customised fundal height charts were issued to each mother at the
routine hospital booking scan, on which regular fundal height measurements
were to be plotted by community midwives. The charts adjusted limits
according to maternal characteristics including height, weight, parity and
ethnic group. Usual management in the control area included fundal height
assessment by abdominal palpation and recording on a standard co-operation
card. OUTCOME MEASURES: Antenatal detection of small and large for
gestational age babies; number of antenatal investigations for fetal growth
in each group.
Results:
The study group had a significantly higher antenatal
detection rate of small for gestational age babies (48% vs 29%, odds ratio
2.2, 95% confidence interval 1.1-4.5) and large for gestational age babies
(46% vs 24%, OR 2.6, CI 1.3-5.5). There was no increase in the study group
in the overall number of scans per pregnancy done in the ultrasound
department (1.2 vs 1.3, P = 0.14), but a slight decrease in repeat (two or
more) third trimester scans (OR 0.8, CI 0.6-1.0, P = 0.08). Women in the
study group had significantly fewer referrals for investigation in a
pregnancy assessment centre (OR 0.7, CI 0.5-0.9; P = 0.01) and fewer
admissions to the antenatal ward (OR 0.6, CI 0.4-0.7, P < 0.001). There were
no differences in perinatal outcome.
Conclusions:
Serial measurement of
fundal height plotted on customised charts leads to increased antenatal
detection of small and large babies. This is accompanied by fewer
investigations, which is likely to represent increased confidence in the
community to recognise normal fetal growth. With adjustments for
physiological variables, fundal height measurements appear to be a cost
effective screening method which can result in substantial improvements in
the antenatal assessment of fetal growth.
