Controlled trial of fundal height measurement plotted on customised antenatal growth charts

Objective The purpose of this study was to evaluate the effect of a policy of standard antenatal care which included plotting fundal height measuremen ts on customised antenatal charts in the community. Design Prospective, non-randomised, controlled, population-based study. Population Two defined and separate referral areas from community to teachi ng hospital, with similar delivery rates and socioeconomic characteristics. A total of 1272 consecutively booked women with singleton pregnancies and dating ultrasound scans before 22 weeks of gestation. Intervention In the study area customised fundal height charts were issued to each mother at the routine hospital booking scan, on which regular funda l height measurements were to be plotted by community midwives. The charts adjusted limits according to maternal characteristics including height, wei ght, parity and ethnic group. Usual management in the control area included fundal height assessment by abdominal palpation and recording on a standar d co-operation card. Outcome measures Antenatal detection of small and large for gestational age babies; number of antenatal investigations for fetal growth in each group. Results The study group had a significantly higher antenatal detection rate of small for gestational age babies (48% vs 29%, odds ratio 2.2, 95% confi dence interval 1.1-4.5) and large for gestational age babies (46% vs 24%, O R 2.6, CI 1.3-5.5). There was no increase in the study group in the overall number of scans per pregnancy done in the ultrasound department (1.2 vs 1. 3, P = 0.14), but a slight decrease in repeat (two or more) third trimester scans (OR 0.8, CI 0.6-1.0, P = 0.08). Women in the study group had signifi cantly fewer referrals for investigation in a pregnancy assessment centre ( OR 0.7, CI 0.5-0.9; P = 0.01) and fewer admissions to the antenatal ward (O R 0.6, CI 0.4-0.7, P < 0.001). There were no differences in perinatal outco me. Conclusions Serial measurement of fundal height plotted on customised chart s leads to increased antenatal detection of small and large babies. This is accompanied by fewer investigations, which is likely to represent increase d confidence in the community to recognise normal fetal growth. With adjust ments for physiological variables, fundal height measurements appear to be a cost effective screening method which can result in substantial improveme nts in the antenatal assessment of fetal growth.