- The low risk pathway requires 2-3 weekly clinical assessment, with standardised fundal height measurement (SFH) from 26-28 weeks until delivery, according to unit policy, using a standardised technique 21. Measurements should be plotted on the customised GROW chart.
- If suboptimal growth is suspected (first fundal height measurement <10th centile or slow growth), direct referral for growth scan and Doppler is recommended.
- If resources permit, a scan EFW should be repeated in 3 weeks’ time to ascertain the growth rate, as a single scan cannot provide reassurance about the growth trajectory of the fetus
- Where SFH is unreliable because of high BMI (35+) or large or multiple fibroids, growth monitoring by serial ultrasound scan is indicated 22. Where resources allow, this should be done 3 weekly starting from 28 weeks as an EFW at this gestational age serves as an important baseline for assessment of fetal growth in the third trimester.
3. Royal College of Obstetricians and Gynaecologists The Investigation and management of the Small-for-Gestational Age Fetus: Green-top Guideline No. 31: 2nd Edition. RCOG 2013 https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_31.pdf
21. Morse K, Williams A, Gardosi J. Fetal growth screening by fundal height measurement
Best Practice & Research Clinical Obstetrics and Gynaecology 2009; 23 809–818 https://doi.org/10.1016/j.bpobgyn.2009.09.004