GAP India: 2023-2024

Module 1 - GAP Theory
Chapter 1 - Definitions
11 Topics
1.1 Contents
1.2 LBW, SGA, and FGR (1/3)
1.3 LBW, SGA, and FGR (2/3)
1.4 LBW, SGA, and FGR (3/3)
1.5 Fetal Growth Restriction (FGR) or Intrauterine Growth Restriction (IUGR)
1.6 The customised GROW chart 6
1.7 GROW
1.8 Causes of Fetal growth Restriction 3
1.9 Symmetrical and Asymmetrical FGR7
1.10 Early and late onset FGR (1/2)
1.11 Early and late onset FGR (2/2)
Chapter 2 - Fetal growth restriction and pregnancy outcome
5 Topics
2.1 Contents
2.2 FGR, perinatal morbidity and mortality
2.3 Stillbirth and FGR (1/3)
2.4 Stillbirth and FGR ctd (2/3)
2.5 Stillbirth and FGR ctd 16 (3/3)
Chapter 3 - Risk Assessment
14 Topics
3.1 Contents
3.2 Risk assessment and surveillance for fetal growth restriction (FGR)
3.3 Risk assessment in early pregnancy
3.4 GAP Care Pathway Phase I
3.5 GAP Care Pathway Phase II
3.6 Risk Assessment (1/3)
3.7 Risk Assessment (2/3)
3.8 Risk Assessment (3/3)
3.9 Fetal Growth Surveillance: Low risk
3.10 Fetal Growth Surveillance: assessing growth rate
3.11 Fetal Growth Surveillance (1/3)
3.12 Fetal Growth Surveillance (2/3)
3.13 Fetal Growth Surveillance (3/3)
3.14 Summary recommendations
Chapter 4 - Screening and Surveillance
6 Topics
4.1 Contents
4.2 Predictive tests
4.3 Surveillance in low risk pregnancies
4.4 Surveillance in increased risk pregnancies
4.5 Growth scans at term
4.6 Routine growth scans
Chapter 5 - Monitoring effect of implementation
9 Topics
5.1 Contents
5.2 Impact of training
5.3 Monitoring the effect of implementation
5.4 Antenatal detection of SGA
5.5 Effect on stillbirth rates
5.6 Stillbirths in England 2000-2019 (ONS)
5.7 Reduction of proportion of stillbirths that are SGA 35
5.8 Level of GAP implementation and effect on stillbirth rates
5.9 Key points – Module 1
Module 2 - GAP Practice
Chapter 1 - Generating and using customised growth charts
13 Topics
1.1 Abbreviations
1.2 Contents
1.3 How to generate a customised GROW chart
1.4 Generating a customised growth chart
1.5 Features of the chart
1.6 Generating a customised growth chart
1.7 Generating a customised growth chart
1.8 Features of the chart (1/2)
1.9 Features of the chart (2/2)
1.10 The Antenatal Chart
1.11 Plotting fundal height
1.12 Plotting estimated fetal weight (EFW)
1.13 Summary Points
Chapter 2 - Fetal growth surveillance in low-risk pregnancies
11 Topics
2.1 Contents
2.2 Fundal height measurements: Introduction
2.3 Fundal height measurements: misconceptions
2.4 Standardising fundal height measurements (1/5)
2.5 Standardising fundal height measurements (2/5)
2.6 Standardising fundal height measurements (3/5)
2.7 Standardising fundal height measurements (4/5)
2.8 Standardising fundal height measurements (5/5)
2.9 Additional Points
2.10 Serial standardised fundal height measurements
2.11 Fundal height measurement: contraindications 21:
Chapter 3 - Indications for Referral
8 Topics
3.1 Contents
3.2 Normal growth
3.3 First SFH below the 10th centile
3.4 Slow Growth (SFH)
3.5 First SFH plot above 90th centile
3.6 Serial plots above 90th centile
3.7 Accelerated or excessive growth
3.8 Summary Points
Chapter 4 - Fetal growth surveillance in increased risk pregnancies
8 Topics
4.1 Contents
4.2 Serial ultrasound biometry
4.3 GAP Care Pathway – Phase I: moderate and increased risk
4.4 Slow growth – EFW (1/2)
4.5 Slow growth – EFW (2/2)
4.6 Doppler
4.7 Risk assessment (1/2) (see also Module 1, Chapter 3)
4.8 Risk assessment (2/2)
Chapter 5 - Audit
32 Topics
5.1 Contents
5.2 Audit: Monitoring SGA/FGR and detection rates
5.3 Definitions for reporting
5.4 Data Collection Method
5.5 GROW-App (1/2)
5.6 GROW-App (2/2)
5.7 Retrieving the record
5.8 Confirm that retrieved chart is correct
5.9 Input the unit that was responsible for antenatal care
5.10 Birth details
5.11 Early pregnancy risk assessment
5.12 Birth weight centile (1/2)
5.13 Birth weight centile (2/2)
5.14 GROW-App Reports (1/16)
5.15 GROW-App Reports (2/16)
5.16 GROW-App Reports (3/16)
5.17 GROW-App Reports (4/16)
5.18 GROW-App Reports (5/16)
5.19 GROW-App Reports (6/16)
5.20 GROW-App Reports (7/16)
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1.3 LBW, SGA, and FGR (2/3)

GAP India: 2023-2024 Chapter 1 – Definitions 1.3 LBW, SGA, and FGR (2/3)
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Different limits are used in practice to define SGA, including 10th , 5th or 3rd centile, or  – more rarely – 1 or 2 standard deviations (SD). The lower the limit, the stronger the association with pathological outcome. However, low limits e.g. <3rd miss other cases (for example between the 3rd and 10th centile) that are also at significantly increased risk 1.

 For obstetric and midwifery screening / assessment and prospective management of pregnancy, the 10th centile is recommended to define SGA 2,3

1. Clausson B, Gardosi J, Francis A, Cnattingius S. Perinatal outcome in SGA births defined by customised versus population-based birthweight standards. 
Br J Obstet Gynaecol. 2001;108(8):830–834. https://doi.org/10.1111/j.1471-0528.2001.00205.x

2. Gardosi J. Intrauterine growth restriction: new standards for assessing adverse outcome.
Best Practice & Research Clinical Obstetrics and Gynaecology; 2009: 23; 741–749

3. Royal College of Obstetricians and Gynaecologists The Investigation and management of the Small-for-Gestational Age Fetus:
Green-top Guideline No. 31: 2nd Edition. RCOG 2013

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