|Grade of Evidence|
|Study design||Sample size and description||Research procedure||Measures used & their reliability & validity||Statistics reported|
(include type of statistic reported & p value/confidence intervals as indicated)
|Study results & midwifery perspective|
|B||Prospective.||3 abd measurement methods compared.584 sets of observations obtained from 250 subjects.||Fundal ht (FH)was compared with abd girth (AG) and abd length(ALR) measurements to assess reliability of each in prediction of SGA.||A uniform technique using a non elastic tape was used.|
FH=78% sensitivity AG=55% " ALR=33% " FH=88% specificity AG=75% " ALR=88% " Only FH appeared useful in prediction of SGA.
|Mean and 1&2 SD above and below were calculated for each measurement technique.||Fundal ht demonstrate-d greater reliability, sensitivity and specificity in prediction of SGA. No midwifery perspecive is presented.|
|B||Prospective.||119 women were statistically divided into 2 groups: normal wt and obese by BMI/IBW.|
All subjects received tape and US FHM to compare the reliability of each technique.
|U/S and a tape FHM(face down to eliminate bias) technique were carried out on pregnant women between 11 and 42 weeks gestation.||FHM was obtained using a uniform technique.U/S was used to locate the fundus and the 2 findings were compared. The comparison enabled researchers to support the hypothesis that a manual technique is as reliable and valid as the U/S method of location and measurement of the FH.Both the reliability & validity of FHM were improved by use of the customized individual growth chart.||Simple linear regression and analysis of covariance.|
|There was no significant difference between manual and U/S measurement of FH. The reliability and validity of the technique is supported.|
A midwifery perspective is not represented.
Obesity had no influence on either measurement.
|1272 participants were selected from 2 separate geographical areas to determine the reliability and validity of FHM & the use of a customized antenatal growth chart.The hypothesis was that the study technique would lead to an increased prenatal diagnosis of SGA.||A control group(n=605) received traditional PNC & the study group (n=667)underwent FHMs which were plotted on customized growth charts adjusted for variables including maternal ht, wt, parity & ethnicity.||By means of multiple regression coefficients derived from the population, the optimal fetal wt predicted at term was calculated by adjusting for maternal ht, wt, parity & ethnicity.||Odds ratio; confidence limits; P values according to standard formulae.|
SGA= OR=2.23 CI=1.12-4.45P=0.03.
|A significantly higher proportion of SGA & LGA infants were detected in the study group.A midwifery perpective is not represented.|
|Linhard,A. et al.|
|1639 participants randomized into a FHM group & a control group to determine the implications of introducing FHM into widespread clinical practice.||The study group (n=804)received FHM from 28 weeks gestation & the results were plotted. The control group (n=835) had the FH measured with a tape with no markings in a uniform position & the results were not analyzed until after delivery.||The hypothesis that FHM would lead to more accurate prediction of SGA infants meant that delivery outcomes were measured. Maternal characteristics were also considered ( age, wt, age, parity, smoking & alcohol)||X2-test ( limit of significance: P<0.05), confidence interval.||Reliability and validity of FHM NOT supported as there were no differences in outcomes between the 2 groups.Midwives were involved in data collection but a specific perspective was not presented.|
|22 women received FHM from 4 clinicians to determine the reliability of 3 different FHM techniques.|
( Very limited sample size.)
44 women received the 3 FHM techniques to determine which might more accurately predict birth weight.
45 women received FHM using the 3 techniques to consider the relationship between FHM & gestational age.
60 women received FHM using 3 techniques from 4providers to compare inter & intra-examiner reliability.
48 women underwent FHM in 4 different positions to determine the effect on the reliability/validity
( Total 192 measurements).
126 women had the uterine fundus identified by a clinician and then by U/S to determine clinicians' ability to locate the fundus.There were 8 clinicians involved.
240 subjects between 15-40 weeks had FHM obtained using marked & unmarked tape to assess the effect of clinician bias.
|No specific instructions were given to clinicians regarding the techniques.( 2 tape methods & 1 caliper method)|
The 3 FHM techniques were obtained 7 days prior to the EDD & compared in terms of correlation with birth weight.
All 3 techniques were obtained from women who delivered AGA infants.
Clinicians were instructed in a uniform technique and blank tapes were used to eliminate bias
Between 21-36 weeks gestation FHM were obtained in these maternal positions.
2)Trunk elevation/knees ext.
4)Trunk elevation/knees flexed.
The uppermost border of the fundus was marked by a clinician following palpation ( no instruction) & then U/S was used to identify it sonographically.
FHM were obtained using marked & unmarked tapes & a uniform technique. The client's record was reviewed prior to measurement.
|1) FHM tape technique that includes the upper curve of the fundus in the measurement.|
2)FHM tape technique that did not include the upper border.
3)A FHM technique utilizing a caliper.
As above.A tape technique demonstrated greater validity.
As above. Reliability proved greatest with the caliper method.
A uniform tape measurement technique was used by 4 different clinicians on each subject using blank tapes. Even a slight variation in maternal position can effect reliability & validity.
Validity was influenced by uterine wall thickness(error=greatest when the uterine wall was thin) Inter examiner error was not statistically significant.Validity was not influenced by parity. Reliability was influenced by fetal presentation.
Validity of FHM is influenced by clinician bias which is demonstrated by this research.
|Mean: Standard Deviation.|
Analysis of variance.
SD of net differences. % of differences less than & equal to 1cm & 2cm.
Mean absolute differences.
Mean; SD; t-value; P-value.
Analysis of variance.
Mean absolute differences.
|The caliper FHM technique demonstrated greater inter-examiner reliability. |
A higher correlation with birth wt occurred with FHM#1.
The 2 tape techniques showed a similar % of varience.The caliper method explained less.
The MAD was smallest for the caliper method. Inter-examiner differences were very apparent.
When there is trunk
elevation & knee flexion the differences between the supine position were clinically & statistically significant.
Error in identification of the uterine fundus can be influenced by maternal & fetal factors.
FHM reliability & validity is negatively affected by clinician bias.
Each of these articles by Engstrom presents the midwifery perspective and midwives were directly involved in each of the studies
|Study||Grade of Evidence||Study Design and Validity|
|Detecting fetal growth abnormalities.|
( 2001 )
|11-2||Case Reports.||None specific reported in detail.||Standardizing FHM & routinely serially plotting the measurement on a customized growth chart has been shown to improve the detection rate of fetal growth abnormalities.|
|Cochrane Data Base.|
Neilson, J. P.
( 2001 )
|1-C||Expert opinion.||Review of existing research.||There is insufficient data to assess whether the routine use of FHM during prenatal visits improves pregnancy outcomes.|