PRACTICE
practice updates
top 10 points for midwives: assessment and promotion of fetal wellbeing in pregnancy
(GAP) education has been undertaken prior to using them). 6 / In some situations, fundal height measurement may be unreliable, e.g. BMI 35+, large fibroids or polyhydramnios. It is not appropriate to use fundal height measurement to assess uterine growth in multiple pregnancies.
JACQUI ANDERSON
7 / An ultrasound scan referral is
MIDWIFERY ADVISOR
recommended for wāhine when potential growth issues are identified on a growth chart: slow or static growth; growth crossing centile
Following the ratification of the College’s
of the first trimester (12 – 13+6) can be offered
lines or a single fundal height below the 10th
practice guidance document Assessment and
to wāhine to estimate gestation. Evidence
centile; slow or static growth if fundal height is
promotion of fetal wellbeing during pregnancy
does not support early first trimester scan for
not increasing consistently as expected.
in 2021, a selection of the relevant practice
dating purposes only.
points are highlighted below. 1 / Where any risk factors or concerns for
3 / Fundal height and abdominal palpation assessment of fetal growth is most consistent
fetal growth are identified, recommend:
when undertaken by the same practitioner,
•
where possible.
Referral for consultation (as per Referral Guidelines)
•
Increased assessments and monitoring of fetal growth including ultrasound growth scans
•
For wāhine at increased risk of FGR and/or pre-eclampsia, consider commencing low dose aspirin (100-150mg nocte) prior to 16 weeks gestation.
4 / From 26-28 weeks gestation measure fundal height, but not more frequently than every 2-3 weeks, and record in centimetres, preferably on the wahine’s customised growth chart. 5 / When using a customised fetal growth chart to plot fundal height, practitioners are required to be conversant with their conditions (for example a condition for the
2 / If LMP or time of conception is unknown or
use of the Perinatal Institute GROW© charts is
uncertain, an ultrasound scan towards the end
that the Growth Assessment Programme
8 / Provide wāhine with information on what to expect in relation to fetal movements as pregnancy progresses, including the presence of a diurnal pattern and development of longer quiet periods of fetal activity during the day near term. 9 / For all wāhine reporting decreased fetal movements, offer a full assessment including identifying the presence or absence of a fetal heart rate and a period of CTG monitoring. 10 / Growth issues may be indicated by USS when there is a discrepancy between the head circumference and the abdominal circumference centiles and/or the measurements cross centiles.
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ISSUE 103 DECEMBER 2021 | 17
