Comparison of fetal growth assessment by conventional method and by
using Intergrowth 21 st chart for detection of small for gestational age
foetuses: A prospective observational study among Indian population
Abstract
Objectives: Primary objective was to compare screening accuracy
of fetal growth assessment by conventional fundal height assessment by
palpation with plotting of symphysio-fundal height (SFH) measurement on
21 st Intergrowth charts for detecting small for
gestational age (SGA) foetuses. Secondary objective was to find an
agreement between these two methods. Design: Prospective
observational analytic study Setting: Lady Hardinge Medical
College and associated hospitals, Delhi, India Population: Five
hundred low risk pregnant women with singleton pregnancy, with reliable
dates at ≥28 weeks from Antenatal Clinic of Lady Hardinge
Medical College and associated hospitals from November 2019 to October
2021. Outcome measures: Assessment of fundal height in weeks by
palpation and a lag of ≥3 weeks, suggested SGA fetus. SFH
measured in centimetres and plotted on Intergrowth 21
st foetal growth charts. SFH of less than 10
th centile suggested SGA. Birthweight of new-born was
plotted on Intergrowth 21 st Estimated Foetal Weight
Chart. Birthweight of less than 10 th centile was
classified as SGA. Results: Thirteen percent women delivered
new-borns with birthweight below 10 th centile. Fundal
height palpation had 98.6 % specificity and 69.9% sensitivity compared
to 99.5% specificity and 83.3% sensitivity by SFH measurement for
detecting SGA neonates. Conclusions: SFH measurement plotted on
Intergrowth 21 st chart is more sensitive and specific
for detecting SGA neonates compared to conventional fundal height
palpation. Agreement between the methods measured by Cohen’s Kappa
Statistic was 0.804, indicating substantial agreement between the
methods. SFH measurement is a more accurate and practical tool, for use
in low resource settings.