Pregnancy : Symphysis-Fundal Height (SFH) Measurement

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The UK has one of the worst stillbirth rates in the developed world and at least 1 third of stillbirths are related to fetal growth restriction. At least 10% of ALL babies born are growth restricted. Growth restriction in an unborn child is the single largest risk factor for stillbirth, especially when it goes unrecognised before birth.1

SFH is a widely used method of monitoring fetal growth usually measured from 28 weeks gestation. It is, however, not very accurate in detecting babies that are small2 with as little as 30%3,4 being reported. Furthermore, it has a high degree of variance between professionals5. However, its speed and cost effectiveness can still make it a useful screening tool to this day.

For this reason, it is important to measure as accurately as possible. It is also important to listen to mums regarding concerns about her baby’s movements and growth (especially if she is multiparous).

Watch our mini video to empower you to take an accurate measurement and help more babies arrive safely:

Measure once and plot immediately on a customised growth chart. If growth is not following a normal pattern, a referral should be made for an ultrasound scan which should take place within 72 working hours.

Full SFH training is available as part of The Perinatal Institute’s Growth Assessment Programme (GAP) for the ultimate detection of growth restricted babies. Please visit their website for more information.

Top Tips

All clinicians should use the same, standardised technique. This will decrease the degree of error and variation.
If a problem is identified, the test shouldn’t be repeated by another clinician as the inter-observer variation can be as large as 10cm depending on technique. Instead, there should be direct referral for an ultrasound scan.
Patients should have an empty bladder as a full bladder can add 2cm to the measurement.
Measurements should be taken every 2 – 3 weeks. If the mother is already having serial scans 2-3 weekly, there is no need to measure and plot fundal height measurements between her scans. However, if serial scanning is sporadic i.e. only at 28 and 34 weeks continue fundal height measurements and refer if any concerns around growth velocity.
When using customised growth charts, do not allow for the descent of the head. The curves do not flatten towards term; uncompromised babies should continue growing until delivery. Measure in the same way, and if there is static/slow growth referral should be made for an ultrasound scan.
Transverse lie – measure in the same way and record position. The baby’s position is irrelevant, measure from the highest point of the fundus to the symphysis pubis and plot the metric measurement. If you are concerned with the serial plots, referral should be made for an ultrasound scan.
Multiple pregnancies – do not measure fundal height. This cohort of women should be having serial scanning to assess individual growth
If a mother has an increased body mass index (BMI >35) fundal height measurements will not be accurate. This cohort of women should be having serial scanning to assess fetal growth.

In some rural areas of the world, in specific populations, SFH can be much more useful6. The Cochrane database reviews7 could only find one randomised controlled trial8.

Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: A population based study. BMJ 2013;346:F108.
Rosenberg K, Grant JM, Hepburn M. Antenatal detection of growth retardation: Actual practice in a large maternity hospital. BJOG 1982;89:12-15.
Hall M, Chng PK, MacGillivray I. Is routine antenatal care worthwhile? Lancet 1980;ii:78-80
Belizan JM, Villar J, Nardin JC, Malamud J, De Vicurna LS. Diagnosis of intrauterine growth retardation by a simple clinical method: measurement of fundal height. AmJOG 1978;131:643-6
Bailey SM, Sarmandal P, Grant JM. A comparison of three methods of assessing inter-observer variation applied to measurement of the symphysis-fundal height. BJOG 1989;96:1266-71
Challis K, Osman NB, Nystrom L, Nordahl G, Bergstrom S. Symphysis-fundal height growth chart of an obstetric cohort of 817 Mozambican women with ultrasound dated singleton pregnancies. Trop Med Int Health.2002 Aug;7(8):678-84
Robert PJ, Ho JJ, Vallipan J, Sivasangari S. Measuring the height of the uterus from the symphysis pubis (SFH) in pregnancy for detecting problems with fetal growth. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.:CD008136. DOI:10.1002/14651858.CD008136.pub2
Lindhard A, Nielsen PV, Mouritsen LA, Zachariassen ALA, Sorensen HU, Roseno H, The implications of introducing the symphyseal-fundal height measurement. A prospective randomized controlled trial. BJOG 1990;97:675-80

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