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|Year : 1995 | Volume
| Issue : 4 | Page : 93-4
Symphysis fundal height curve--a simple method for foetal growth assessment.
L Rai, L Kurien, P Kumar
Department of Obstetrics and Gynaecology, KMC Hospital, Manipal DK, Karnataka.,
Department of Obstetrics and Gynaecology, KMC Hospital, Manipal DK, Karnataka.
In this prospective study, symphisis fundal height (SFH) was measured in centimeters at different weeks of gestation from 20th week onwards in 100 healthy women with uncomplicated pregnancies. A curve was plotted based on the mean SFH measurements with standard deviation. Readings were also arranged on the basis of 10th, 50th and 90th percentiles. Percentile curve was similar to the curve based on mean with standard deviation. The rate of growth was 1 cm per week between 20-32 weeks. Thereafter, there was a slight fall in the rate of growth. SFH measurement is a simple method of foetal growth assessment which can be utilized even by paramedical workers to screen for small for gestational age babies. It is better to have a standard curve derived from the population as there is regional variation.
Keywords: Adult, Embryo and Fetal Development, Female, Fetal Growth Retardation, diagnosis,epidemiology,Fetus, anatomy &histology,Gestational Age, Human, India, epidemiology,Pregnancy, Prospective Studies, Reference Values,
|How to cite this article:|
Rai L, Kurien L, Kumar P. Symphysis fundal height curve--a simple method for foetal growth assessment. J Postgrad Med 1995;41:93
Foetal growth assessment is an important part of antenatal care. Clinical palpation of fundal height in relation to anatomical landmarks such as umbilicus and xiphisternum, serial measurement of symphysis - fundal height (SFH) in cent-meters and serial sonography are the three available methods for foetal growth assessment. Palpation is subjective and has not been very useful as distance between anatomical landmarks vary. Serial sonography though accurate, is not practical as a screening method for growth assessment in a developing country. Equipment is expensive and its operation requires special skill. Many workers have found SFH measurement to be more scientific, objective, reproducible and reliable to assess foetal growth,,. SFH reflects the crown rump length of the foetus. However, SFH varies in women belonging to different population or race. Hence SFH curves should be generated locally from the population and ideally every institution should have its own standard curve.
In this study, we prospectively evaluated SFH at different periods of gestation to generate SFH curve for our population on the west coast of India.
Healthy women with uncomplicated singleton pregnancies were selected at random for this study. Only women with regular menstrual cycles and those who were sure of their last menstrual period were chosen. Gestational age was then confirmed by ultrasound. Normogram was constructed from the readings of only those women who delivered babies weighing between 2.5 to 3.5 kgs. One hundred women fulfilled these criteria and the graph was plotted based on their readings. The SFH was measured in cent-meters from the upper border of the symphysis pubis to the topmost part of the uterine fund-us with the patient lying supine with extended legs. Measurements were taken at 20, 24, 26, 28, 32, 36, 38 and 40 weeks. At least five readings were obtained per patient. Graph was plotted by computer with a total of 523 readings.
The age of women who enrolled for this study varied between 19-39 years with 52% being primi-gravidas. Mean weight of the babies was 2.9 kgs. Maternal height ranged from 140 to 167 cms with the mean of 152 cms. [Table - 1] shows mean SFH measurements at various gestational weeks.
Difference between mean and the SD were uniform in all weeks of gestation. The mean SFH increased from 18.9 cms at 20 weeks to 34.4 cms at 36 weeks. From 36 weeks to 40 weeks the increase was only 2.86 cms. Mean SFH curve with +1 and -1 SD was plotted as depicted in [Figure:1].
The measurements obtained were also arranged on the basis of 10, 50th and 90th percentiles. The readings were plotted graphically as in [Figure:2] Increase in SFH measurement expressed as percentiles is similar to that of mean with standard deviation.
The rate of growth of SFH was approximately 2.1 cm per week from 29 weeks to 32 weeks and thereafter it was 7-8 mm per week till 40 weeks.
West in popularised the gravidogram system in Sweden using graphic comparisons between changes in SFH, abdominal girth and maternal weight. He observed a wide variation in maternal weight and abdominal girth and hence these parameters were not very useful in prediction of foetal growth. SFH curve was steeper with a smaller biological variation and was a better predictor of foetal growth. Belizan et al plotted SFH curve based on percentile values. We found that curve based on mean with SD values is similar to the percentile curve and either of them could be used.
The pattern of the curve obtained in our study is similar to that of Indira et al from Pondicherry. situated on the east coast of India. However, their mean values are slightly less compared to our readings. In their study the mean SFH increased from 14.9 cms at 20 weeks to 33.2 cms at 39 weeks. This is about 3-4 cms less compared to our mean values at the same period of gestation. . This regional variation has been noted by other workers. Hence, it is better to have a standard curve derived from the local population for accurate interpretation. Grover et al found maximum increase in SFH from 20 - 32 weeks and thereafter the increase was only 7 mm per week as against 1 cm earlier. This has been our observation too.
SFH curve is not useful in extremely obese women. It cannot be used for assessment of foetal growth in the presence of hydramnios and twins. It has been found to be sensitive and reliable in screening for small for gestational age babies,,. Diagnosis of SGA is made if SFH measurement is below - 1 SD from mean or below the 10th percentile. Similarly large for gestational age is diagnosed if SFH measurement is more than 1 SD above mean or above the 90th percentile. This curve can be used even by the paramedical workers in the diagnosis of altered foetal growth and cases thus screened can then be referred to centres equipped with ultrasound for confirmation of diagnosis and management. Thus, inclusion of SFH curve in the routine antenatal file would be a useful addition to detect deviation from the normal pattern of foetal growth.
| :: References|| |
Westin B. Gravidogram and foetal growth. Acta Obstet Gynecol, Scand 197; 56: 273 - 82. |
|2.||Belizan JIM, Villar.J, Nardin JC. Malamud J, De Vicuna LS. Diagnosis of intrauterine growth retardation by a simple clinical method: measurement of uterine height. Am J Obstet Gynecol 1978; 131:643-6. |
|3.||Grover V, Usha R. Kalra S, Sachdeva S. Altered foetal growth: antenatal diagnosis by symphysis-fundal height in India and comparison with western charts. Int J Gynecol Obstet 1991; 35:231-4. |
|4.||Indira R, Ournachigui Asha, Narayan KA, Rajaram R Ramatingam G. Symphysis fundal height measurement - a reliable parameter for assessment of foetal growth. Int J Gynecol Obstet 1990; 33:1-5. |
|5.||Swain S, Agarwal A, Bhatia BD, Reddy DCS, Pandey S, LK Pandey. Fundal height measurement: a simple method of antenatal screening of term low birth weight J Obst Gynecol of India 1993; 43(1):28-32.
[Table - 1]