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Symphysis-fundus measurements in screening for small-for-dates infants: a community based study in Gloucestershire
Insights
Serial symphysis-fundus measurements can help predict low birth weight. This method offers improved accuracy over abdominal palpation for identifying small-for-dates infants in antenatal clinics.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Prenatal Care
Background:
- Accurate fetal growth monitoring is crucial for identifying potential complications.
- Traditional methods like abdominal palpation have limitations in precision.
- Symphysis-fundus (SF) measurement offers a standardized approach to track fetal growth.
Purpose of the Study:
- To evaluate the effectiveness of symphysis-fundus (SF) charts in predicting low birth weight.
- To assess the sensitivity and specificity of SF measurements in identifying small-for-dates infants.
- To compare the utility of SF measurements with abdominal palpation.
Main Methods:
- A 12-month prospective study involving 1139 symphysis-fundus charts from general practitioner and hospital antenatal clinics.
- Analysis of SF measurements to predict birthweight below the 10th and 5th centiles for gestational age.
- Evaluation of measurement variability between different healthcare providers.
Main Results:
- A sensitivity of 51% and specificity of 88% was observed for predicting birthweight below the 10th centile with one or more low SF measurements.
- With four or more measurements after 26 weeks, sensitivity increased to 65% for the 10th centile and 91% for the 5th centile.
- Sensitivity decreased with increasing maternal body mass index; mean measurement difference between providers was 1.5 cm.
Conclusions:
- Serial symphysis-fundus measurements are a valuable tool for predicting small-for-dates infants in community antenatal settings.
- SF measurement provides an improvement over abdominal palpation for identifying at-risk pregnancies.
- Referral for ultrasound is recommended when symphysis-fundus measurements indicate potential growth restriction.
Abstract:
Symphysis-fundus charts were introduced into 50 general practitioner antenatal clinics and the hospital antenatal clinics of two obstetricians in Gloucestershire in February 1985 for a 12-month period. Of the 1139 charts analysed, the sensitivity of one or more low fundal height measurements in predicting birthweight below the tenth centile for gestational age was 51% with a specificity of 88%. In the 319 charts with four or more measurements after 26 weeks gestation a sensitivity of 65% was recorded in predicting birthweight below the tenth centile, rising to 91% in the prediction of birthweight below the fifth centile; the specificity was correspondingly 81% and 80%. The sensitivity of the test varied inversely with maternal body mass index. The mean absolute difference in pairs of observations between general practitioners, midwives and an observer was 1.5 cm. Measurement of symphysis-fundus distance is not a precise diagnostic tool but it does provide an improvement on abdominal palpation in the prediction of small-for-dates infants. The findings of this study support the use of serial symphysis-fundus measurements in community antenatal clinics. Referral for ultrasound investigation is recommended when the measurement is low.