Fetal Growth Chart
Important For Determining Fetal Growth

Fetal growth chart for growth assessment of fetus helps predicting short and long term outcomes in a newborn baby.

The appropriateness of intrauterine growth estimation of fetuses has its limitations. The methods available for checking fetal size before delivery provide only an estimated fetal weight.

Fetal growth is a dynamic process. Its estimation requires serial evaluations of fetal size, each at 3 weeks interval : Shorter intervals could lead to some faulty interpretations. Moreover, it works on the assumption that growth is a uniform continuous process rather than sporadic.

These factors confuse the prediction of the expected outcome for neonates. Results of the various parameters evaluated for the fetal growth have to be correlated clinically.

The fetal growth charts are best as clinician's tools to judge the overall picture of an estimated fetal weight.

Methods of fetal length and weight assessment

Fetal growth charts

Fetal growth percentile charts need data on optimal intrauterine growth, which is seen only in pregnancies that are not affected by any maternal or fetal pathology.

Moreover, the fetus should not be exposed to any agent that can pathologically affect its intrauterine growth and development.

Limitations faced to collect data for appropriate intrauterine growth estimation of fetuses

  • Well babies with the optimal intrauterine growth are never born premature.Therefore, the neccessary data to prepare fetal growth charts has to be accumulated by an alternative method.

  • Data collection for intrauterine growth charts is done from birth weight of the babies born at different gestational age and is approximated with ultrasound evaluations done prenatally.

  • Fetuses do not grow at the same rate and implications of percentile vary with the existing growth restricting factors in the source population.

  • There are many normal determinants of fetal development, and so the estimation of percentile position at the extremes of distribution graph gets imprecise.

Uterine fundal height

The fundal height of uterus, when measured in centimeters, coincides with weeks of gestation between 18 and 30 weeks. If the measurement is more than 2-3 cm from the expected height, inappropriate fetal growth may be expected.

Factors that affect clinical measurement of the uterus or estimation of fetal weight:

  • Mother's weight and height
  • Uterus thickness
  • Size of the placenta
  • Amniotic fluid content of the uterus

Ultrasound examination

Prenatal ultrasound evaluations provide reliable measurements, which are used to estimate approximate fetal weight for the gestational age.
The common ultrasound measurements of fetus done during prenatal visits:

  • Head circumference
  • Bi-parietal diameter, distance between the sides of fetus's head.
  • Abdomen girth
  • Upper thigh bone

Please note that even the best ultrasound measurements can not be as reliable as actually weighing and measuring a baby after birth.

When is the outcome of fetal development a cause of concern?

Guarded Outcome is feared if a low percentile position on fetal growth chart is accompanied by:

  • Compromised maternal health status: Attributable to chronic diseases in the mother or her lifestyle related toxins, which jeopardize optimal fetal development; tobacco smoking, coffee consumption or alcohol abuse.

  • Poor fetal growth noticed between two consecutive prenatal checkups.

  • Asymmetric growth recorded clinically and on ultrasound.

  • Non reassuring fetal testing (NST, BPP, CST).

  • Oligohydramnios - sub optimal volume of amniotic fluid.
  • Elevated umbilical artery (S/D) ratio:
    Doppler systolic/diastolic ratio greater than 3.0, after 30 gestational weeks, indicates an increased risk for low birth weight.
    This compares umbilical artery’s systolic with the diastolic flow of blood; and identifies the existing resistance to blood flow in the placental vascular system.

Causes of large for date babies

  • Obesity in the mother
  • Diabetes in the mother - Gestational/Type2 Diabetes
  • Post term baby
  • Multipara mother
  • Large size due to genetic, racial or ethnic disposition.
  • Previous pregnancy with a large baby

Common causes of small for date babies

To download the percentile fetal growth chart click here.

The fetal growth chart is actually for the premature infants, but it also gives an approximate estimate of intrauterine growth of the unborn baby.

Fetal growth charts can also be used to monitor the percentile growth curve of developing fetuses.

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