Fetal growth restriction is associated with stillbirth, neonatal death and perinatal morbidity. The Perinatal Institute is running a regional initiative aimed at improving the antenatal detection of fetal growth restriction. The strategy follows the East Midlands pilot, and the RCOG Green Top Guideline 31 (PDF) which recommends serial fundal height measurement using customised growth charts.

The project, funded by the WM Strategic Commissioning Group, was developed following wide ranging discussion with stakeholders, road shows and local training workshops. GROW software is now in use in 18 maternity units in the West Midlands and in total over 80 units in the NHS. Recently, a rolling programme of accreditation training workshops has been commenced.

		Details of future dates can be viewed here
		A summary update (Jan 2009) of the WM initiative to improve the detection of fetal growth restriction can be viewed here
		Details of CoGS, the Birmingham Community Growth Scanning pilot, incl the recently released Interim Report can be viewed here

Reference documents and links:

		Protocol template. Following many requests, the Perinatal Institute has developed a draft protocol for fetal growth assessment. It is based on available evidence and wide consultation. The protocol can be used as a template for individual trusts to adapt for their own use. To download, please click here in PDF format or Word format.
		Recommendations on fundal height measurements and referrals for investigation, click here
		A summary of the evidence, and referenced articles on customised charts and adjustable standards (2005), click here
		A brief review of the "Differentiation between normal and abnormal fetal growth" (2002), click here
		"Audit of fundal height measurement plotted on customised growth charts", published in MIDIRS, September 2006 pages 341-345.
		Detailed information about customised charts, including background, concepts, coefficients and published references, click here.
		For information about fundal height screening for Best Practice, click here (2009)
		A summary of the 2004 West Midlands Audit of Referrals for Growth scans can be found here
		PI's response to the NICE consultation (antenatal care guidelines) can be viewed here.