Correct procedure for measuring fundal height.

To promote best practice when measuring fundal height

To determine the gestation and growth of the fetus.

Fundal height: also known as the Symphyseal fundal (S-F) height measurement is the measured distance from the top of the uterine fundus to the top of the symphysis pubis in centimeters. It is used to indirectly measure fetal growth.

Serial measurement of SFH is recommended at each antenatal appointment starting from 24 weeks (Dept of Health 2018)

CTG - Cardio-toco graph

AFI - Amniotic Fluid Index

BOS - Birthing Outcome System

Between 24 weeks until term, the height of the uterus correlates closely with measurements in centimetres, however obesity and uterine fibroids has been shown to distort the accuracy of these measurements

KEY POINTS
- Symphyseal fundal height is to be performed at every scheduled antenatal visit after 24 weeks gestation.
- Symphyseal fundal height must always be documented in centimetres.

If there is a discrepancy in size and gestation of > 2cm, the midwife/doctor must discuss this with a Registrar or Consultant Obstetritian.

A discrepancy of more than 2 cms after 32 weeks gestation should be referred to the obstetric team for further investigation. A reduced fundal height is likely to require an assessment involving CTG, AFI, Doppler and growth ultrasound.

A reduced measurement may be due to one of the following reasons:

• Error in estimated date of delivery based on first day of last menstrual period
• Fetus potentially small for gestational age requiring Medical review
• Oligohydramnios
• Fetus positioned transverse

A larger measurement may be caused by:

• Twins, or other types of multiple birth
• Error in estimated date of delivery
• Fetus is healthy but physically large
• Gestational diabetes causing a larger baby
• Polyhydramnios
• Large for gestational age

Tape measure in centimetres

Preparation:

• Explain procedure and obtain womans consent
• Ensure the woman has emptied her bladder within the last 30 mins
• Assist woman to uncover abdomen
• Position the woman comfortably in a semi-recumbent position
• Adjust bed height for your comfort
• Perform hand hygiene
• Gather a non-elastic tape measure

SFH Measurement:

• Palpate and identify the top of the uterine fundus (which may not be midline)
• Turn tape measure so centimetre markings are facing away from you to reduce potential bias
• Secure the beginning of the tape measure at the top of the fundus with one hand
• Guide the tape downwards over the whole abdominal curvature to the top of the symphysis pubis with your other hand
• Measure the distance in between (only measure once)
• Confirm gestation
• Explain findings to woman and document in BOS and hand held record
• Plot Fundal height measurement on the fundal height centile graph
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