Fundal height: A useful screening tool for fetal growth?

Objective. To determine the utility of fundal height in screening for small-for-gestational-age (SGA) and large-forgestational- age (LGA) neonates at term. Study design. This was a retrospective cohort study of 3627 women at University of California, San Francisco from 2002 to 2006 with term, singleton pregnancies specifically examining the 448 who had third trimester ultrasounds for size unequal to dates by fundal height. x² analyses determined the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of fundal height as a screening tool for abnormal intrauterine growth. Results. The sensitivity of fundal height was 16.6% for detecting actual birthweight (BWt) > 90th percentile (p < 0.001) and 17.3% for < 10th percentile (p < 0.001). Specificity ranged from 92.4 to 95.4%. Significant differences existed among subgroups by maternal weight, parity, age, and ethnicity. Sensitivity was lower for SGA among overweight/ obese women but higher among multiparous women. Additionally, women ≥35 years showed higher sensitivity for extreme LGA, and several notable differences were found by ethnicity such as higher sensitivity for extreme LGA among Caucasian women. Conclusion. The sensitivity of fundal height for detecting abnormal intrauterine growth was less than 35% for all subgroups, although specificity was more ideal at >90%. Other modalities should be considered to screen for growth abnormalities.