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Clinical guidelines for measuring fundal height in pregnant women using a tape measure. The procedure aims to determine the gestation and growth of the fetus, identify multiple pregnancies and complications, and ensure accurate measurements. Background information on the importance of fundal height measurement, the procedure for taking the measurement, and additional considerations for optimal results.
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King Edward Memorial Hospital
DPMS Ref: 5269
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 1 of 2
Date Issued: November 2001 1.6.3 Measuring Fundal Height with a Tape Measure Date Revised: September 2012 Section B Review Date: September 2015 Clinical Guidelines Authorised by: OGCCU King Edward Memorial Hospital Review Team: OGCCU Perth Western Australia
Key words: fundal height measurement
To determine the gestation and growth of the fetus. To identify multiple pregnancies and complications of pregnancy e.g. amniotic fluid disorders, hydatidiform mole, and fetal growth disturbances.
Measuring fundal height has been shown to be more accurate for detecting a small-for-gestation fetus than performing palpation alone.^1 Symphysis-fundal height (SFH) measurement refers to the distance measured in centimetres on the longitudinal axis of the abdomen from the top of the fundus to the upper border of the symphysis pubis. A measurement discrepancy of more than 2cm can be suggestive of a fetus that is small/large for gestational age, multiple pregnancy, or an inaccurate estimated due date.^2 Other causes include molar pregnancies, polyhydramnios/oligohydramnios, an oblique or transverse lie.^1 Between 20 to 34 weeks gestation the height of the uterus correlates closely with measurements in centimetres, however obesity has been shown to distort the accuracy of these measurements^3. Also towards the end of pregnancy measurements become less accurate due to the descent of the fetal presenting part into the maternal pelvis.^2
1 Obtain maternal consent.
2 Encourage the woman to empty her bladder if she has not done so in the last 30 minutes.
It has been demonstrated the fundal height can be 3 cm higher at 17-20 weeks gestation if the woman has a full bladder.^3
3 Position the woman in a supine position with her legs extended.
While not the preferred position for most women, a supine position has been found to yield least variation in measurements.^4
Consider placing a wedge under the right buttock if the gravid uterus is of a size likely to compromise maternal and/or fetal circulation.
An enlarged uterus can compress the inferior vena cava and the lower aorta leading to maternal supine hypotension and reduced utero-placental blood flow which can cause fetal compromise.^5
Date Issued: November 2001 1.6.3 Measuring Fundal Height with a Tape Measure
4 Ensure hands are clean and warm. Warm hands minimise maternal discomfort and potential for inducing contraction of the uterus.^5
5 Place the zero mark of the tape measure at the uppermost border of the symphysis pubis.
A tape measure that is placed downwards against the woman’s abdomen will reduce risk of making a biased assessment.^2 ,^6
6 Run the tape measure along the midline of the woman’s abdomen to the uppermost border of the uterine fundus.
To locate the fundus the hand is moved down the abdomen below the xiphisternum until the curved upper border of the fundus is felt.^5
7 The distance is measured from the top of the symphysis pubis to the depression in front of the pad of the middle finger.
8 Document the distance in centimetres and compare with the calculated gestation.
If there is a >2cm discrepancy the midwife should discuss this with the obstetric team registrar or above.
Date Revised: September 2012 Section B Review Date: September 2015 Clinical Guidelines Written by:/Authorised by: OGCCU King Edward Memorial Hospital Review Team: OGCCU Perth Western Australia
DPMS Ref: 5269
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 2 of 2