Serial plotting on customised fundal height charts results in doubling of the antenatal detection of small for gestational age fetuses in nulliparous women

Background: The antenatal detection of fetal growth restriction is a focus point of antenatal care. If detected fetal demise may be prevented and perinatal complications could be managed more appropriately. Aims: To investigate whether introducing serial plotting on customised fundal height charts can increase the detection rate of small for gestational age (SGA) fetuses in low risk nulliparous women attending antenatal clinics in a public teaching hospital in Adelaide, South Australia. Methods: An observational study was employed to compare SGA detection rates, utilising data from an historical Control group compared to data collected after the study intervention. In the Control group the fundal height (FH) was measured for every antenatal visit and documented in the notes, but not plotted on a chart. The study intervention used serial FH plotting on customised charts, with a dedicated clinical practice guideline and regular audits to increase clinician awareness of the intervention. Results: The antenatal detection rate of SGA was 31/125 (24.8%) in the Control group and 44/87 (50.6%) in the Intervention group (P < 0.001; OR 3.10; 95% CI 1.73-5.57). Conclusions: Serial plotting of the FH on customised charts supported by a clinical practice guideline resulted in a doubling of the antenatal detection of SGA in nulliparous pregnant women at low risk for SGA.