2.3 Fundal height measurements: misconceptions

• The proposed ‘rule’ that weeks’ gestation should equal fundal height in cm is false, as the normal range varies with gestational age and with maternal characteristics  ³⁷ 
• The term ‘symphysio-fundal height’ (or ‘symphysis-fundus height), SFH, is a misnomer, as the measurement should start from the variable point (the uterine fundus) and lead to the fixed point (symphysis pubis), not the reverse. ²¹ However, as SFH is the commonly used abbreviation (and FH is also used as abbreviation for fetal heart), we keep SFH, but to denote ‘Standardised Fundal Height’ measurements. 
• Starting from the top will leave both hands free to first palpate the uterus and find the fundus,  and hold one end of the measuring tape there with one hand, while leading the tape with the free hand to the fixed point (top of symphysis). In reverse, i.e. fixing the tape first at the symphysis, makes it difficult to lead the tape up while trying to find the fundus with the other hand. 
• The main emphasis is to standardise the procedure to minimise variation between clinicians and ensure that all who use this tool – as any other – are fully trained.

37. Mongelli M, Gardosi J. Symphysis-Fundus Height and Pregnancy Characteristics in Ultrasound-Dated Pregnancies.
Obstet Gynecol. 1999;94(4):591–594.

21. Morse K, Williams A, Gardosi J. Fetal growth screening by fundal height measurement.
Best Practice & Research Clinical Obstetrics and Gynaecology 2009; 23:809–818