Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

Fundal Height Measurement in Pregnancy: Clinical Guideline, Lecture notes of Obstetrics

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.

Typology: Lecture notes

2021/2022

Uploaded on 09/12/2022

koss
koss 🇺🇸

4.8

(16)

243 documents

1 / 2

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
WOMEN AND NEWBORN HEALTH SERVICE
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
CLINICAL GUIDELINES
SECTION B : OBSTETRICS AND MIDWIFERY CARE
1 ANTEPARUM CARE
1.6 ANTEPARTUM PROCEDURES - MATERNAL
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
1.6.3 MEASURING FUNDAL HEIGHT WITH A TAPE MEASURE
AIMS
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.
BACKGROUND INFORMATION
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 measurements3. Also towards the end of pregnancy measurements become less accurate due
to the descent of the fetal presenting part into the maternal pelvis.2
PROCEDURE
ADDITIONAL INFORMATION
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
pf2

Partial preview of the text

Download Fundal Height Measurement in Pregnancy: Clinical Guideline and more Lecture notes Obstetrics in PDF only on Docsity!

WOMEN AND NEWBORN HEALTH SERVICE

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

CLINICAL GUIDELINES

SECTION^ B^ :^ O^ BSTETRICS AND^ MIDWIFERY^ C^ ARE

1 ANTEPARUM CARE

1.6 ANTEPARTUM PROCEDURES - M ATERNAL

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

1.6.3 MEASURING FUNDAL HEIGHT WITH A TAPE MEASURE

AIMS

 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.

BACKGROUND INFORMATION

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

PROCEDURE ADDITIONAL INFORMATION

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

PROCEDURE ADDITIONAL INFORMATION

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.

REFERENCES

  1. Grigg C. Working with with women in pregnancy. In: Pairman S, Pincombe J, Thorogood C, Tracy S, editors. Midwifery preparation for Practice. Sydney: Churchill Livingstone; 2010. p. 431-68.
  2. MIDIRS. Symphysis-fundal height measurement: Available from: http://www.midirs.org/development/studentmidwife.nsf/FC3E6E492F5CC7F780257743004543A6/$File/A bdominal.pdf.
  3. Cunningham FG, Hauth JC, Leveno KJ, et al, editors. Williams Obstetrics. New York: McGraw-Hill;
  4. Engstrom J. Techniques for measuring fundal height. Journal of Nurse Midwifery. 1993;38(1):5-14.
  5. Murray I, Hassall J. Change and adaptation in pregnancy. In: Fraser DF, Cooper MA, editors. Myles Textbook for Midwives. 15th ed. London: Churchill Livingstone; 2009. p. 189-225.
  6. Jelks A, Cifuentes R, Ross MG. Clinician Bias in Fundal Height Measurement. Obstetrics & Gynecology. 2007;110(4):892-99.

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