DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20221964

Symphysio-fundal height measurement as a tool in antenatal care: current understanding: narrative review

Dasari Papa

Abstract


Symphysio-fundal height (SFH) measurement during pregnancy was recognized as a simple clinical indicator for monitoring fetal growth since decades. However, its significance and validity are questioned in recent era of Sonography. This is a narrative review of the topic published. Conclusions of systematic reviews, meta-analysis as well as studies which compared SFH and ultrasound for fetal growth monitoring were included. The review revealed SFH has poor sensitivity as a tool for screening and diagnosing fetal growth restriction and inter-observer variations are high and hence fallacious. However multiple measurement model incorporating standard international guidelines may be useful in resource poor settings. Limitations of SFH include that it is not useful in hydramnios, multiple pregnancies and pregnancies with uterine or ovarian masses and fetuses in transverse lie. For screening and early diagnosis of growth restriction, estimation of gestational age and fetal weight estimation USG is the standard tool.


Keywords


Antenatal care, SFH measurement, Fetal growth, USG

Full Text:

PDF

References


Beazley JM, Underhill RA. Fallacy of the fundal height. BMJ. 1970;404-6.

Morse K, Willams A, Gardosi J. Fetal growth screening by fundal height measurement. Best Pract Res Clin Obstetr Gynaecol. 2009;23:809-18.

Lee ACC, Whelan R, Bably NN, Schaeffer LE, Rahman S, Ahmed S et al. Prediction of gestational age with symphysis-fundal height and estimated uterine volume in a pregnancy cohort in Sylhet, Bangladesh. BMJ Open. 2020;10(3):e034942.

White LJ, Lee SJ, Stepniewska K, Simpson JA, Dwell SL, Arunjerdja R et al. Estimation of gestational age from fundal height: a solution for resource-poor settings. J R Soc Interface. 2012;9(68):503-10.

Calvert JP, Crean EE, Newcombe RG, Pearson JF. Antenatal screening by measurement of symphysis-fundus height. Br Med J (Clin Res Ed). 1982;285(6345):846-9.

Rosenberg K, Grant JM, Tweedie I. Measurement of fundal height as a screening test for fetal growth retardation. Br J Obstet Gynaecol. 1982;89(6):447-50.

Rogers MS, Needham PG. Evaluation of fundal height measurement in antenatal care. Aust N Z J Obstet Gynaecol. 1985;25(2):87-90.

Lindhard A, Nielsen PV, Mouritsen LA, Zachariassen A, Sørensen HU, Rosenø H. The implications of introducing the symphyseal-fundal height-measurement. A prospective randomized controlled trial. Br J Obstet Gynaecol. 1990;97(8):675-80.

Pay ASD, Frøen JF, Staff AC, Jacobsson B, Gjessing HK. Symphysis-fundus measurement-the predictive value of a new reference curve. Tidsskr Nor Laegeforen. 2017;137(10):717-20.

Robert Peter J, Ho JJ, Valliapan J, Sivasangari S. Symphysial fundal height (SFH) measurement in pregnancy for detecting abnormal fetal growth. Cochrane Database Syst Rev. 2015;9:CD008136.

Royal College of Obstetricians and Gynaecologists. The investigation and management of the small-for-gestational age fetus. RCOG Green Top Guideline 2002. Available at: http://www.rcog.org.uk/files/rcog-corp/uploaded-files/GT31SmallGestationalAgeFetus.pdf. Accessed on 25 March, 2022.

National Institute for Health and Clinical Excellence. Antenatal care, routine care for the healthy pregnant woman. London: NICE. 2008. Available at: http://guidance.nice.org.uk/CG62. Accessed on 25 March, 2022.

Pay AS, Wiik J, Backe B, Jacobsson B, Strandell A, Klovning A. Symphysis-fundus height measurement to predict small-for-gestational-age status at birth: a systematic review. BMC Pregnancy Childbirth. 2015;10;15:22.

Papageorghiou AT, Ohuma EO, Gravett MG, Hirst J, da Silveira MF, Lambert A et al. International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: prospective cohort study in eight countries. BMJ. 2016;355:i5662.

Homer CS, Oats J, Middleton P, Ramson J, Diplock S. Updated clinical practice guidelines on pregnancy care. Med J Aust. 2018;209(9):409-12.

Mortazavi F, Akaberi A. Estimation of birth weight by measurement of fundal height and abdominal girth in parturients at term. East Mediterr Health J. 2010;16(5):553-7.

Chen ZG, Xu YT, Ji LL, Zhang XL, Chen XX, Liu R et al. The combination of symphysis-fundal height and abdominal circumference as a novel predictor of macrosomia in GDM and normal pregnancy. BMC Pregnancy Childbirth. 2020;20(1):461.

Onah HE, Ikeme AC, Nkwo PO. Correlation between intrapartum fundal height and birth weight. Afr J Reprod. Health. 2022;6:23-9.