Clinical examination is most commonly by symphysis-fundal height (SFH) measurement, and SFH assessment
Fig. 19.4 Likelihood ratio for severe adverse outcome (vertical axis) relating to mean pulsatility index (horizontal axis). Smokers are represented by a thick black line (to left), non-smokers by a thin line. From Lees et al. (2001) Obstet Gynecol 98(3), 369-73.
has traditionally been performed from 24 weeks gestation onwards by measuring the distance from the mother's pubic symphysis to the uterine fundus, and successive measurements recorded in the woman's notes or on a chart. The SFH measurement after 24 weeks has been taken to be equal in centimetres to the week of gestation ± 2 cm to 36 weeks, and 3 cms from 36-42 weeks. The problems associated with SFH measurement are poor intra and inter observer reproducibility and those inherent to the technique. As itrelies on assessmentof the heightof the uterine fundus as a proxy measure of fetal growth, it can, therefore, take no account of confounding maternal factors such as height, weight and physical build, and uterine-fetal factors such as fibroids, poly or oligohydramnios, multiple pregnancy and fetal lie. Two large retrospective studies in the 1980s suggested that reduced SFH measurements correctly identified only 25-50% of fetuses whose birthweight was < 10th centile.
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