The RCOG Green-Top Guideline for the Investigation and Management of the Small-for-Gestational- Age Fetus is available here: RCOG Green Top Guideline 31

The guideline reviews the available evidence and recommends

  • the use of standardised fundal height measurement
  • use of customised growth charts to plot fundal height and estimated fetal weight
  • reviews risk factors for fetal growth restriction and makes recommendations for surveillance by serial scans
  • outlines management protocols for the SGA fetus in early and late pregnancy

NHS England have since issued recommendations for risk assessment in the Saving Babies Lives Care Bundle which includes a simplified fetal growth surveillance algorithm (page 19)  

NHS England Saving Babies’ Lives Care Bundle Element 2 Progress in GAP units - Report Dec 2017

Information about Birmingham City University's focussed courses for third trimester fetal growth scanning by midwives is available here: Third Trimester Focussed Course
Presentations from Lorraine Walsh and David Cole at the
Masterclass for ultrasonographers

Obstetric Ultrasound for Evaluation of Fetal Growth

Doppler Ultrasound in Fetal Growth Assessment
Fetal biometry review (FMMR, 2002): Ultrasound biometry and fetal growth restriction
EFW Audit Tool

The accuracy of ultrasound estimated fetal weight (EFW) can be determined after adjusting for the interval between date of scan and date of delivery. We have produced an audit tool in the form of a programmed Excel spreadsheet which allows calculation of scan error using birthweight as the gold standard. The application assumes that there was normal growth during the interval between the scan measurement and weight at birth - i.e. it is not designed to be used in pregnancies where abnormal growth was suspected.

EFW_error.xls is free and available by writing to the GAP team at