Symphysis-fundal height (SFH) measurement

The UK has one of the worst stillbirth rates in the developed world and at least 40% of all stillbirths are related to fetal growth restriction. Growth restriction in the fetus is the single largest risk factor for stillbirth, and risk increases seven fold if growth restriction is undetected.1

SFH is a widely used method of monitoring fetal growth surveillance for low risk pregnancies in the third trimester. The cost effectiveness and non-invasive nature makes it a useful primary screening tool. Recommendations from the Perinatal Institute are that measurements are commenced between 26-28 weeks’ gestation.

Watch our mini video to empower you to take an accurate measurement and help more babies arrive safely:

Full training for clinicians is available as part of the Perinatal Institute’s Growth Assessment Programme (GAP).

Please visit their website for available training dates or for more information on fetal growth.

Guidance for clinicians

  • Explain the procedure to the mother, gain verbal consent, and wash hands.
  • The expectant mother should be in a semi-recumbent position (45-degree angle) on a firm surface, with an empty bladder and expose enough of the abdomen to allow a thorough two handed palpation.
  • Fundal height measurements should be undertaken using a non-elastic centimetre tape. The tape measure should be reversed to avoid the centimetre scale influencing the clinician.
    Following the palpation, the measurement should start from the variable point; the highest point of the uterus which is the fundus.
  • Fixing the tape measure at the fundus, it is run along the longitudinal axis of the uterus, (not correcting to the midline,) to the top of the symphysis pubis – the fixed point, and the more easily identified landmark.
  • Measure once, and plot immediately on a customised GROW chart in whole centimetres.
  • When using customised growth charts, do not allow for the descent of the head. The curves do not flatten towards term; uncompromised babies should continue growing until delivery. Measure in the same way, and if there is static/slow growth referral should be made for an ultrasound scan.
  • If a growth problem is identified, the measurement should not be repeated or checked by another clinician, instead there should be a direct referral for an ultrasound scan.
  • Ultrasound scan should be performed within 72 hours of referral.
  • Measurements should occur no more frequently than, every two weeks if a woman is already having serial growth scans until delivery (2-3 weekly from 26-28 weeks to birth) there is no need to perform SFH, unless scans are sporadic i.e. 28 and 34 weeks.
  • When measuring and plotting on a customised GROW chart, do not ‘allow’ for descent of the head by accepting slow or static growth; uncompromised babies continue growing until delivery.
  • Multiple pregnancies should be on a serial scanning pathway, SFH is an inaccurate and inappropriate tool for these women.
  • For women with a BMI >35, polyhydramnios, or multiple/ large fibroids a fundal height measurement is inaccurate, this cohort of women should be having serial scans to assess fetal growth.

References

  1. Gardosi J, Kady S, McGeown P et al.  Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ 2005;331:1113–17.
  2. Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: A population based study. BMJ 2013;346:F108
  3. Bailey SM, Sarmandal P, Grant JM. A comparison of three methods of assessing inter-observer variation applied to measurement of the symphysis-fundal height. BJOG 1989;96:1266-71