Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Aug 25;17(8):e0272718.
doi: 10.1371/journal.pone.0272718. eCollection 2022.

Measurement of symphysis fundal height for gestational age estimation in low-to-middle-income countries: A systematic review and meta-analysis

Rachel Whelan  1 , Lauren Schaeffer  1 , Ingrid Olson  1 , Lian V Folger  1   2 , Saima Alam  3 , Nayab Ajaz  4 , Karima Ladhani  5 , Bernard Rosner  6 , Blair J Wylie  7   8 , Anne C C Lee  1   8
Affiliations
Meta-Analysis

Measurement of symphysis fundal height for gestational age estimation in low-to-middle-income countries: A systematic review and meta-analysis

Rachel Whelan et al. PLoS One. .

Abstract

In low- and middle-income countries (LMIC), measurement of symphysis fundal height (SFH) is often the only available method of estimating gestational age (GA) in pregnancy. This systematic review aims to summarize methods of SFH measurement and assess the accuracy of SFH for the purpose of GA estimation. We searched PubMed, EMBASE, Cochrane, Web of Science, POPLINE, and WHO Global Health Libraries from January 1980 through November 2021. For SFH accuracy, we pooled the variance of the mean difference between GA confirmed by ultrasound versus SFH. Of 1,003 studies identified, 37 studies were included. Nineteen different SFH measurement techniques and 13 SFH-to-GA conversion methods were identified. In pooled analysis of five studies (n = 5838 pregnancies), 71% (95% CI: 66-77%) of pregnancies dated by SFH were within ±14 days of ultrasound confirmed dating. Using the 1 cm SFH = 1wk assumption, SFH underestimated GA compared with ultrasound-confirmed GA (mean bias: -14.0 days) with poor accuracy (95% limits of agreement [LOA]: ±42.8 days; n = 3 studies, 2447 pregnancies). Statistical modeling of three serial SFH measurements performed better, but accuracy was still poor (95% LOA ±33 days; n = 4 studies, 4391 pregnancies). In conclusion, there is wide variation in SFH measurement and SFH-to-GA conversion techniques. SFH is inaccurate for estimating GA and should not be used for GA dating. Increasing access to quality ultrasonography early in pregnancy should be prioritized to improve gestational age assessment in LMIC.

PubMed Disclaimer

Conflict of interest statement

This research was supported by a grant from the Bill and Melinda Gates Foundation (BMGF). ACL reported research grants from the Eunice Kennedy Shriver National Institute of Health and Child Development and the BMGF, and is a consultant to the World Health Organization. BW and BR reported research grants from the NIH. BW has served on the Board for the Society of Maternal-Fetal Medicine within the past three years. This does not alter our adherence to PLOS One policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA flow diagram for systematic literature review of symphysis fundal height for gestational age estimation.
See this image and copyright information in PMC

References

    1. Pugh SJ, Ortega‐Villa AM, Grobman W, Newman RB, Owen J, Wing DA, et al.. Estimating gestational age at birth from fundal height and additional anthropometrics: a prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. 2018;125(11):1397–404. doi: 10.1111/1471-0528.15179 - DOI - PMC - PubMed
    1. Papageorghiou AT, Ohuma EO, Gravett MG, Hirst J, da Silveira MF, Lambert A, et al.. International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: prospective cohort study in eight countries. BMJ (Clinical research ed). 2016;355. doi: 10.1136/bmj.i5662 - DOI - PMC - PubMed
    1. Scott K, Gupta S, Williams E, Arthur M, Somayajulu UV, Noguchi L. “I can guess the month… but beyond that, I can’t tell” an exploratory qualitative study of health care provider perspectives on gestational age estimation in Rajasthan, India. BMC pregnancy and childbirth. 2020;20(1):1–13. doi: 10.1186/s12884-020-03201-6 - DOI - PMC - PubMed
    1. Althabe F, Belizán JM, Buekens P, McClure EM, Koso-thomas M, Committee NsGNfWs, et al.. Antenatal corticosteroids to reduce preterm deaths in low-income settings. The Lancet Global health. 2014;2(8):e444. Epub 2014/07/23. doi: 10.1016/S2214-109X(14)70261-X ; PubMed Central PMCID: PMC4767156. - DOI - PMC - PubMed
    1. Fung R, Villar J, Dashti A, Ismail LC, Staines-Urias E, Ohuma EO, et al.. Achieving accurate estimates of fetal gestational age and personalised predictions of fetal growth based on data from an international prospective cohort study: a population-based machine learning study. Lancet Digit Health. 2020;2(7):e368–e75. Epub 2020/06/23. doi: 10.1016/S2589-7500(20)30131-X ; PubMed Central PMCID: PMC7323599. - DOI - PMC - PubMed

Publication types

LinkOut - more resources