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Fundal height dating

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After simulation, we restricted the data based on SFH by excluding actual and simulated values below 12 cm or above 38 cm (because gestational age assessment based on SFH is not undertaken clinically beyond these limits) and visually inspecting a plot of the data to assess that the truncation problem had been overcome.This process resulted in a total of 814 simulated data being included in the final dataset.The sensitivity of SFH measurement to detect small for gestational age fetuses has been assessed in three systematic reviews.5 6 7 Observational cohort studies show wide ranges of sensitivity from 17% to 93%.There is also marked study heterogeneity mainly due to the variety of methods used, including varying thresholds for defining small for gestational age and the use of multiple SFH charts.5 In fact, we believe that at least 21 different, locally derived SFH charts are currently being used in clinical practice worldwide.8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29To improve the care offered to women worldwide, we have developed international SFH standards, which were derived from the same eight urban populations of healthy, well nourished women in the INTERGROWTH-21 Project.Participants Healthy, well nourished pregnant women enrolled into the Fetal Growth Longitudinal Study component of the INTERGROWTH-21 Project at 9-14 weeks’ gestation, and followed up until birth.Main outcome measures 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.Objective To create international symphysis-fundal height standards derived from pregnancies of healthy women with good maternal and perinatal outcomes.

The median number of symphysis-fundal height measurements was 5.0 (range 1-7); 3976 (92.0%) women had four or more measurements.

To obtain an equation for the standard deviation, we modelled the resulting variance components from the multilevel model that accounts for the correlations between and within participants using fractional polynomials.

Goodness of fit was based on visual inspection of the overall model fit by comparing quantile-quantile (q-q) plots of the residuals, and the distribution of fitted Z scores across gestational ages.

Although it was not possible to blind the research staff to the gestational age at each visit, all SFH measurements were taken in a blinded fashion to reduce expected value bias by turning the tape measure so that no numbers were visible during the examination.

According to prespecified criteria, we excluded pregnancies complicated by fetal death or congenital abnormality, catastrophic or severe medical conditions (such as cancer or HIV); those with severe unanticipated conditions related to pregnancy that needed admission to hospital (such as eclampsia or severe pre-eclampsia); and those identified during the study who no longer fulfilled the entry criteria (such as women who started smoking during pregnancy or had an episode of malaria).