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 To create international symphysis-fundal height standards derived from pregnancies of healthy women with good maternal and perinatal outcomes. Prospective longitudinal observational study. Eight geographically diverse urban regions in Brazil, China, India, Italy, Kenya, Oman, United Kingdom, and United States. Healthy, well nourished pregnant women enrolled into the Fetal Growth Longitudinal Study component of the INTERGROWTH-21st Project at 9-14 weeks' gestation, and followed up until birth. Symphysis-fundal height was measured every five weeks from 14 weeks' gestation until birth using standardised methods and dedicated research staff who were blinded to the symphysis-fundal height measurements by turning the tape measure so that numbers were not visible during examination. The best fitting curve was selected using second degree fractional polynomials and further modelled in a multilevel framework to account for the longitudinal design of the study. Of 13 108 women screened in the first trimester, 4607 (35.1%) met the study entry criteria. Of the eligible women, 4321 (93.8%) had pregnancies without major complications and delivered live singletons without congenital malformations. The median number of symphysis-fundal height measurements was 5.0 (range 1-7); 3976 (92.0%) women had four or more measurements. Symphysis-fundal height measurements increased almost linearly with gestational age; data were used to determine fitted 3rd, 50th, and 97th centile curves, which showed excellent agreement with observed values. This study presents international standards to measure symphysis-fundal height as a first level screening tool for fetal growth disturbances.

Original publication




Journal article


BMJ (Clinical research ed.)

Publication Date





Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK


International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st), Abdomen, Pubic Symphysis, Humans, Fetal Growth Retardation, Ultrasonography, Prenatal, Anthropometry, Longitudinal Studies, Prospective Studies, Fetal Development, Gestational Age, Pregnancy, Adult, Infant, Newborn, Female, Male