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
5.21 GROW-App Reports (8/16)
5.22 GROW-App Reports (9/16)
5.23 GROW-App Reports (10/16)
5.24 GROW-App Reports (11/16)
5.25 GROW-App Reports (12/16)
5.26 GROW-App Reports (13/16)
5.27 GROW-App Reports (14/16)
5.28 GROW-App Reports (15/16)
5.29 GROW-App Reports (16/16)
5.30 Additional data can be requested via perinatal.org.uk
5.31 Case note audit of missed SGA: SCORE
5.32 Case note audit of missed SGA
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3.3 First SFH below the 10th centile

GAP India: 2023-2024 Chapter 3 – Indications for Referral 3.3 First SFH below the 10th centile
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​A first SFH measurement below the 10th centile MAY be an indication of SGA and of potential concern as a single measurement cannot reassure that the growth rate is normal. Therefore it is an indication for an ultrasound scan to determine the EFW which should be plotted, with further management as set out in the GAP guidance. 17

The mother should be told that a fundal height measurement is an assessment of the uterus and its contents, while a scan will be able to estimate the baby’s weight.​

17. GAP Guidance. Perinatal Institute 2020. https://www.perinatal.org.uk/GAPguidance.pdf​

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