Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Screening for fetal growth disorders by clinical exam in the era of obesity

Journal of Perinatology volume 33, pages 352–357 (2013)Cite this article

Subjects

Abstract

Objective:

To evaluate the performance of clinical estimation of fetal weight as a screening test for fetal growth disorders and then to estimate the effect of maternal body mass index (BMI) on its screening efficiency.

Study Design:

This was a retrospective cohort study of patients referred for third trimester ultrasound for the indication of ‘size unequal to dates’. Patients with medical co-morbidities that may alter their a priori risk for fetal growth disorders were excluded. The incidence of fetal growth disorders as well as amniotic fluid disturbances was determined for each group and then compared across maternal BMI categories of <25 kg m−2, 25–30 kg m−2, ⩾30 kg m−2 and ⩾40 kg m−2. To evaluate the accuracy of clinical estimation of fetal weight in predicting fetal growth disorders, the sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, as well as number needed to scan (NNS) was calculated and compared across BMI categories.

Result:

Of 51 366 patients, 1623 were referred for the indication of size>dates and 1543 for the indication of size<dates. The incidence of fetal growth disorders in each referral group was low and was not significantly different across BMI categories. The sensitivity and specificity were 9.7 and 96.6% for predicting neonatal birth weight (BW)>90th percentile and 13.5 and 96.7% for predicting BW<10th percentile. The NNS to detect one neonate with a BW<10th percentile ranged from 5 to 19, whereas the NNS to detect one neonate with a BW>90th percentile ranged from 6 to 13 across BMI categories.

Conclusion:

Overall, clinical estimation of fetal weight yields a low detection rate of fetal growth abnormalities; however, its screening efficiency is not adversely impacted by maternal BMI.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Lockwood CJ, Weiner S . Assessment of fetal growth. Clin Perinatol 1986; 13: 3–35.

    Article  CAS  Google Scholar 

  2. Rondo PH, Maia Filho NL, Valverde KK . Symphysis-fundal height and size at birth. Int J Gynaecol Obstet 2003; 81: 53–54.

    Article  CAS  Google Scholar 

  3. Hargreaves K, Cameron M, Edwards H, Gray R, Deane K . Is the use of symphysis-fundal height measurement and ultrasound examination effective in detecting small or large fetuses? J Obstet Gynaecol 2011; 31: 380–383.

    Article  CAS  Google Scholar 

  4. Quaranta P, Currell R, Redman CW, Robinson JS . Prediction of small-for-dates infants by measurement of symphysial-fundal height. Br J Obstet Gynaecol 1981; 88: 115–119.

    Article  CAS  Google Scholar 

  5. Persson B, Stangenberg M, Lunell NO, Brodin U, Holmberg NG, Vaclavinkova V . Prediction of size of infants at birth by measurement of symphysis fundus height. Br J Obstet Gynaecol 1986; 93: 206–211.

    Article  CAS  Google Scholar 

  6. Calvert JP, Crean EE, Newcombe RG, Pearson JF . Antenatal screening by measurement of symphysis-fundus height. Br Med J 1982; 285: 846–849.

    Article  CAS  Google Scholar 

  7. Sparks TN, Cheng YW, Mclaughlin B, Esakoff TF, Caughey AB . Fundal height: a useful screening tool for fetal growth? J Matern Fetal Neonatal Med 2011; 24: 708–712.

    Article  Google Scholar 

  8. Lindhard A, Nielsen PV, Mouritsen LA, Zachariassen A, Sorensen HU, Roseno H . The implications of introducing the symphseal-fundal height-measurement. A prospective randomized controlled trial. Br J Obstet Gynaecol 1990; 97: 675–680.

    Article  CAS  Google Scholar 

  9. Neilson JP . Symphysis-fundal height measurement in pregnancy. Cochrane Database Syst Rev 2009 Issue 1: CD000944.

  10. Gardosi J, Francis A . Controlled trial of fundal height measurement plotted on customized antenatal growth charts. Br J Obstet Gynaecol 1999; 106: 309–317.

    Article  CAS  Google Scholar 

  11. Wikstrom I, Bergstrom R, Bakketeig L, Jacobsen G, Lindmark G . Prediction of high birthweight from maternal characteristics, symphysis fundal height and ultrasound biometry. Gynecol Obstet Invest 1993; 35: 27–33.

    Article  CAS  Google Scholar 

  12. Mongelli M, Gardosi J . Symphysis-fundus height and pregnancy characteristics in ultrasound-dated pregnancies. Obstet Gynecol 1999; 94: 591–594.

    CAS  PubMed  Google Scholar 

  13. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan MA . United States national reference for fetal growth. Obstet Gynecol 1996; 87: 163–168.

    Article  CAS  Google Scholar 

  14. McIntire DD, Bloom SL, Casey BM, Levino KJ . Birth weight in relation to morbidity and mortality among newborn infants. N Eng J Med 1999; 340: 1234–1238.

    Article  CAS  Google Scholar 

  15. Morrison I, Olsen J . Weight-specific stillbirths and associated causes of death: an analysis of 765 stillbirths. Am J Obstet Gynecol 1985; 152: 975–980.

    Article  CAS  Google Scholar 

  16. Intrauterine growth restriction. ACOG Practice Bulletin No. 12. American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists: Washington DC,, 2000.

  17. Spellacy WN, Miller S, Winegar A, Peterson PQ . Macrosomia—maternal characteristics and infant complications. Obstet Gynecol 1985; 66: 158–161.

    CAS  PubMed  Google Scholar 

  18. Fetal macrosomia. ACOG Practice Bulletin No. 22. American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists: Washington DC,, 2000.

  19. Stevens-Simon C, McAnamey ER, Coulter MP . How accurately do pregnant adolescents estimate their weight prior to pregnancy? J Adolesc Health Care 1986; 7: 250–254.

    Article  CAS  Google Scholar 

  20. Dekkers JC, van Wier MF, Hendriksen IJ, Twisk JW, van Mechelen W . Accuracy of self-reported body weight, height and waist circumference in a Dutch overweight working population. BMC Med Res Methodol 2008; 8: 69.

    Article  Google Scholar 

  21. Jelks A, Cifuentes R, Ross MG . Clinician bias in fundal height measurement. Obstet Gynecol 2007; 110: 892–899.

    Article  Google Scholar 

Download references

Acknowledgements

Dr Goetzinger is supported by a training grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (5 T32 HD055172) and from a NIH/NCRR/NCATS Washington University ICTS grant (UL1 RR024992). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR, NIH or NCATS.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, MO, USA

    K R Goetzinger, M G Tuuli, A O Odibo, K A Roehl, G A Macones & A G Cahill

Authors
  1. K R Goetzinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M G Tuuli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A O Odibo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K A Roehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G A Macones
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A G Cahill
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K R Goetzinger.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goetzinger, K., Tuuli, M., Odibo, A. et al. Screening for fetal growth disorders by clinical exam in the era of obesity. J Perinatol 33, 352–357 (2013). https://doi.org/10.1038/jp.2012.130

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2012.130

Keywords

This article is cited by

Search

Advanced search

Quick links