Antenatal detection of the SGA fetus can be significantly improved through training and protocols, including standardised measurement of fundal height and plotting on customised charts, together with appropriate referral pathways for investigation.
Because of the element of training and the composite nature of the intervention, RCTs are difficult. Instead, evaluation was undertaken in a controlled study of two similar cohorts 30; this showed an improvement in antenatal detection of SGA from 29% to 48% in the study group. At the same time, there were fewer false positive assessments of SGA.
Similarly improved detection rates were confirmed in other studies 31, 32
30. Gardosi J & Francis A Controlled trial of fundal height measurement plotted on customised antenatal growth charts British Journal of Obstetrics and Gynaecology 1999, V01106, pp. 309-317
31. Roex A, Nikpoor P, van Eerd E, Hodyl E, Dekker G Serial plotting on customised fundal height charts results in doubling of the antenatal detection of small for gestational age fetuses in nulliparous women Australian and New Zealand Journal of Obstetrics and Gynaecology 2012; 52: 78–82 DOI: 10.1111/j.1479-828X.2011.01408.x
32. Jayawardena L, Sheehan P. Introduction of a customised growth chart protocol increased detection of small for gestational age pregnancies in a tertiary Melbourne hospital. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2018;0(0). https://doi.org/10.1111/ajo.12902