IS MEASURING POSTNATAL SYMPHYSIS-FUNDAL DISTANCE WORTHWHILE

Objective: to assess levels of intraobserver and inter-observer variab ility in the measurement of postnatal symphysis-fundal distance and es tablish whether the measurement is sufficiently precise for it to be o f use in clinical practice, Setting: a consultant obstetric maternity unit in the south of England which caters for approximately 6000 deliv eries per annum. Methods: in the intra-observer study 15 midwives took repeated readings of symphysis-fundal distance on 30 postnatal women, In the inter-observer study 13 midwives took readings of symphysis-fu ndal distances on 24 postnatal women, Repeatability coefficients (the variability to be expected in the change between two measurements) wer e calculated, Findings: the repeatability coefficient, that is the max imum difference that is likely to occur, 95% of the time, for the diff erence between two measurements obtained by the same midwife on the sa me woman is 2.94 cm (intra-observer study), Where measurements are obt ained by different midwives on the same mother the repeatability coeff icient is 5.01 cm (inter-observer study), In everyday clinical practic e variability is likely to be greater than that found in this study. I mplications for practice: the daily measurement of the postnatal symph ysis-fundal distance with a tape measure cannot be obtained with enoug h precision to be useful in making clinical judgements and therefore s hould be discontinued, Further research is required to assess the valu e of routine palpation of the uterine fundus to assess involution duri ng the postnatal period.