Symphysis-fundal height curve in the diagnosis of fetal growth deviations

Freire, Djacyr Magna Cabral; Cecatti, José Guilherme; Paiva, Cláudio Sérgio Medeiros

doi:10.1590/s0034-89102010005000044

Cited by 9 publications

(11 citation statements)

References 21 publications

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“…Another study reported that weekly self-administered symphysis-fundal measurements can be used to monitor fetal growth [24]. Similar results were found in an observation study from Brazil [25] where 753 low risk women were followed with periodic symphysis-fundal height measurement and the results were plotted to obtain a curve. Results showed a sensitivity of about 86 % for detection of SGA infants.…”

Section: Resultssupporting

confidence: 55%

Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths

et al. 2011

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BackgroundThere is a strong association between stillbirth and fetal growth restriction. Early detection and management of IUGR can lead to reduce related morbidity and mortality. In this paper we have reviewed effectiveness of fetal movement monitoring and Doppler velocimetry for the detection and surveillance of high risk pregnancies and the effect of this on prevention of stillbirths. We have also reviewed effect of maternal body mass index (BMI) screening, symphysial-fundal height measurement and targeted ultrasound in detection and triage of IUGR in the community.MethodsWe systematically reviewed all published literature to identify studies related to our interventions. We searched PubMed, Cochrane Library, and all World Health Organization Regional Databases and included publications in any language. Quality of available evidence was assessed using GRADE criteria. Recommendations were made for the Lives Saved Tool (LiST) based on rules developed by the Child Health Epidemiology Group. Given the paucity of evidence related to the effect of detection and management of IUGR on stillbirths, we undertook Delphi based evaluation from experts in the field.ResultsThere was insufficient evidence to recommend against or in favor of routine use of fetal movement monitoring for fetal well being. (1) Detection and triage of IUGR with the help of (1a) maternal BMI screening, (1b) symphysial-fundal height measurement and (1c) targeted ultrasound can be an effective method of reducing IUGR related perinatal morbidity and mortality. Pooled results from sixteen studies shows that Doppler velocimetry of umbilical and fetal arteries in ‘high risk’ pregnancies, coupled with the appropriate intervention, can reduce perinatal mortality by 29 % [RR 0.71, 95 % CI 0.52-0.98]. Pooled results for impact on stillbirth showed a reduction of 35 % [RR 0.65, 95 % CI 0.41-1.04]; however, the results did not reach the conventional limits of statistical significance. This intervention could be potentially recommended for high income settings or middle income countries with improving rates and standards of facility based care. Based on the Delphi, a combination of screening with maternal BMI, Symphysis fundal height and targeted ultrasound followed by the appropriate management could potentially reduce antepartum and intrapartum stillbirth by 20% respectively. This estimate is presently being recommended for inclusion in the LiST.ConclusionThere is insufficient evidence to recommend in favor or against fetal movement counting for routine use for testing fetal well being. Doppler velocimetry of umbilical and fetal arteries and appropriate intervention is associated with 29 % (95 % CI 2% to 48 %) reduction in perinatal mortality. Expert opinion suggests that detection and management of IUGR with the help of maternal BMI, symphysial-fundal height measurement and targeted ultrasound could be effective in reducing IUGR related stillbirths by 20%.

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Section: Resultssupporting

confidence: 55%

Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths

et al. 2011

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“…Nessa mesma casuística, Freire et al 20 encontraram uma sensibilidade de 51,6% da curva de AU em detectar PIG pelo peso fetal estimado por ultrassonografia (PFE) e sensibilidade de 85,7% para detectar PIG pelo peso neonatal, bem superior à sensibilidade da curva adotado pelo Ministério da Saúde (12,5 e 42,9%). Concluíram que esses resultados já são suficientes para recomendar seu uso na prática clínica do rastreamento pré-natal de desvios de crescimento fetal.…”

Section: Discussionunclassified

“…Esta é uma análise secundária do estudo originalmente realizado para validar a curva de referência de altura uterina por idade gestacional de Freire et al 18 em sua capacidade de predizer os desvios do crescimento fetal, e detalhes adicionais sobre o método empregado podem ser encontrados na publicação original 20 . Os dados referentes a 753 gestantes que foram acompanhadas durante o pré-natal em um hospital universitário e em uma maternidade pública da cidade de João Pessoa (PB) foram incluídos na presente análise.…”

Section: Métodosunclassified

A altura uterina é capaz de diagnosticar os desvios do volume de líquido amniótico?

Freire¹,

Cecatti²,

Paiva³

2013

Rev. Bras. Ginecol. Obstet.

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ResumoOBJETIVO: Avaliar o desempenho de uma curva de altura uterina (AU) quanto à capacidade de rastrear desvios do volume de líquido amniótico, utilizando uma curva brasileira de índice de líquido amniótico (ILA) como padrão-ouro. MÉTODOS: O presente estudo representa um corte transversal no qual foram incluídas 753 gestantes em acompanhamento pré-natal na rede pública de João Pessoa (PB) no período de março a outubro de 2006 e que tiveram um exame de ultrassonografia (US) de rotina agendado para depois da 26ª semana de idade gestacional. Foram excluídos os casos com diagnóstico de gestação gemelar, óbito fetal intrauterino e malformações fetais maiores. Além de informações sociodemográficas, foram coletados também os valores da AU medida de forma padronizada, os valores do peso fetal estimado, do ILA e a idade gestacional pelo exame de US. A capacidade da curva de AU em predizer os desvios do volume de líquido amniótico foi avaliada tendo uma curva brasileira de ILA em função da idade gestacional como padrão-ouro. Para isso, foram estimados a sensibilidade, especificidade e valores preditivos positivo e negativo para diferentes pontos de corte. RESULTADOS: A medida da AU identificou 10,5% das mulheres como AU baixa e possivelmente associada ao oligoâmnio, e 25,2% como AU alta e possivelmente associada ao polidrâmnio. Utilizando uma curva brasileira de referência para ILA, a AU foi capaz de predizer pobremente a ocorrência de oligoâmnio (sensibilidade variando entre 37 a 28%) e de forma razoável a ocorrência de polidrâmnio (sensibilidade variando entre 88 a 69%). CONCLUSÃO: A medida da altura uterina mostrou um desempenho ruim para predizer oligoâmnio e um desempenho razoável para predizer polidrâmnio. Sua utilização para essa finalidade só se justifica, portanto, em situações nas quais o exame ultrassonográfico não esteja fácil e rotineiramente disponível, a fim de ajudar na priorização dos casos que deveriam ter esse exame realizado. Abstract PURPOSE:To evaluate the performance of a Brazilian reference curve of fundal height (FH) regarding its capacity of screening the deviations of volume of amniotic fluid using a Brazilian reference curve of amniotic fluid index (AFI) as gold standard. METHODS: This was a cross-sectional study evaluating 753 pregnant women receiving prenatal care at the public health services of João Pessoa (PB), from March to October 2006, who had a routine ultrasound exam scheduled for after 26 weeks of gestational age. Cases with diagnoses of twin pregnancy, intrauterine fetal death and major fetal malformations were excluded. Besides socio-demographic information, data regarding fundal height measured in a standard way, estimated fetal weight, AFI and gestational age at the time of the ultrasound exam were also collected. The capacity of the FH curve to predict deviations of the amniotic fluid volume was assessed using the Brazilian curve of AFI according to gestational age as the gold standard. For this purpose, sensitivity, specificity, positive and negative predictive values were est...

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“…In fact, we believe that at least 21 different, locally derived SFH charts are currently being used in clinical practice worldwide 89 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29…”

Section: Introductionmentioning

confidence: 99%

International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21^stProject: prospective cohort study in eight countries

Papageorghiou

Ohuma

Gravett

et al. 2016

BMJ

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Objective To create international symphysis-fundal height standards derived from pregnancies of healthy women with good maternal and perinatal outcomes.Design Prospective longitudinal observational study.Setting Eight geographically diverse urban regions in Brazil, China, India, Italy, Kenya, Oman, United Kingdom, and United States.Participants Healthy, well nourished pregnant women enrolled into the Fetal Growth Longitudinal Study component of the INTERGROWTH-21st Project at 9-14 weeks’ gestation, and followed up until birth.Main outcome measures Symphysis-fundal height was measured every five weeks from 14 weeks’ gestation until birth using standardised methods and dedicated research staff who were blinded to the symphysis-fundal height measurements by turning the tape measure so that numbers were not visible during examination. The best fitting curve was selected using second degree fractional polynomials and further modelled in a multilevel framework to account for the longitudinal design of the study.Results Of 13 108 women screened in the first trimester, 4607 (35.1%) met the study entry criteria. Of the eligible women, 4321 (93.8%) had pregnancies without major complications and delivered live singletons without congenital malformations. The median number of symphysis-fundal height measurements was 5.0 (range 1-7); 3976 (92.0%) women had four or more measurements. Symphysis-fundal height measurements increased almost linearly with gestational age; data were used to determine fitted 3rd, 50th, and 97th centile curves, which showed excellent agreement with observed values.Conclusions This study presents international standards to measure symphysis-fundal height as a first level screening tool for fetal growth disturbances.

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Symphysis-fundal height curve in the diagnosis of fetal growth deviations

Cited by 9 publications

References 21 publications

Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths

Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths

A altura uterina é capaz de diagnosticar os desvios do volume de líquido amniótico?

International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21^stProject: prospective cohort study in eight countries

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Symphysis-fundal height curve in the diagnosis of fetal growth deviations

Cited by 9 publications

References 21 publications

Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths

Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths

A altura uterina é capaz de diagnosticar os desvios do volume de líquido amniótico?

International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21stProject: prospective cohort study in eight countries

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International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21^stProject: prospective cohort study in eight countries