Gardosi J, Francis A
Division of Obstetrics, Midwifery and Gynaecology, University Hospital, Queen's Medical Centre, Nottingham, UK.
Br J Obstet Gynaecol. 1999 Apr;106(4):309-17. doi: 10.1111/j.1471-0528.1999.tb08267.x.
The purpose of this study was to evaluate the effect of a policy of standard antenatal care which included plotting fundal height measurements on customised antenatal charts in the community.
Prospective, non-randomised, controlled, population-based study.
Two defined and separate referral areas from community to teaching hospital, with similar delivery rates and socioeconomic characteristics. A total of 1272 consecutively booked women with singleton pregnancies and dating ultrasound scans before 22 weeks of gestation.
In the study area customised fundal height charts were issued to each mother at the routine hospital booking scan, on which regular fundal height measurements were to be plotted by community midwives. The charts adjusted limits according to maternal characteristics including height, weight, parity and ethnic group. Usual management in the control area included fundal height assessment by abdominal palpation and recording on a standard co-operation card.
Antenatal detection of small and large for gestational age babies; number of antenatal investigations for fetal growth in each group.
The study group had a significantly higher antenatal detection rate of small for gestational age babies (48% vs 29%, odds ratio 2.2, 95% confidence interval 1.1-4.5) and large for gestational age babies (46% vs 24%, OR 2.6, CI 1.3-5.5). There was no increase in the study group in the overall number of scans per pregnancy done in the ultrasound department (1.2 vs 1.3, P = 0.14), but a slight decrease in repeat (two or more) third trimester scans (OR 0.8, CI 0.6-1.0, P = 0.08). Women in the study group had significantly fewer referrals for investigation in a pregnancy assessment centre (OR 0.7, CI 0.5-0.9; P = 0.01) and fewer admissions to the antenatal ward (OR 0.6, CI 0.4-0.7, P < 0.001). There were no differences in perinatal outcome.
Serial measurement of fundal height plotted on customised charts leads to increased antenatal detection of small and large babies. This is accompanied by fewer investigations, which is likely to represent increased confidence in the community to recognise normal fetal growth. With adjustments for physiological variables, fundal height measurements appear to be a cost effective screening method which can result in substantial improvements in the antenatal assessment of fetal growth.
本研究旨在评估一项标准产前护理政策的效果，该政策包括在社区将宫高测量值绘制在定制的产前图表上。
前瞻性、非随机、对照、基于人群的研究。
从社区到教学医院的两个明确且独立的转诊区域，分娩率和社会经济特征相似。共有1272名连续登记的单胎妊娠妇女，在妊娠22周前进行了超声孕周扫描。
在研究区域，在常规医院预约扫描时向每位母亲发放定制的宫高图表，社区助产士需在图表上定期绘制宫高测量值。图表根据母亲的特征（包括身高、体重、产次和种族）调整了限值。对照区域的常规管理包括通过腹部触诊评估宫高并记录在标准合作卡片上。
产前检测小于胎龄儿和大于胎龄儿；每组中针对胎儿生长的产前检查次数。
研究组小于胎龄儿的产前检测率显著更高（48%对29%，优势比2.2，95%置信区间1.1 - 4.5），大于胎龄儿的产前检测率也显著更高（46%对24%，优势比2.6，置信区间1.3 - 5.5）。研究组每次妊娠在超声科进行的扫描总数没有增加（1.2对1.3，P = 0.14），但晚期妊娠重复（两次或更多次）扫描略有减少（优势比0.8，置信区间0.6 - 1.0，P = 0.08）。研究组妇女在妊娠评估中心进行检查的转诊次数显著减少（优势比0.7，置信区间0.5 - 0.9；P = 0.01），产前病房住院次数也减少（优势比0.6，置信区间0.4 - 0.7，P < 0.
