Growth Assessment Programme (GAP) New Zealand
As part of a national strategy to reduce neonatal encephalopathy, the Accident Compensation Commission (ACC) have commissioned the Perinatal Institute (PI) to offer the comprehensive GAP programme to all District Health Boards (DHBs). Content of the programme has been adapted for New Zealand following advice from the New Zealand College of Midwives (NZCOM) and Professor Lesley McCowan, an international expert in SGA.
The following details the GAP programme and PI Terms of Service:

Terms of service 

Recent Publications      
• Customized growth charts: rationale, validation and clinical benefits          
• Fetal growth surveillance – Current guidelines, practices and challenges  
• Customised vs INTERGROWTH-21st standards                                        
• Neonatal morbidity and small and large size for gestation: a comparison of birthweight centiles  

GAP is based on the following key elements:
  1. Evidence based guidelines and risk assessment algorithms
  2. Education and accreditation of all staff involved in clinical care
  3. Implementation of customised GROW chart and audit tool
  4. Rolling audit and benchmarking of performance
Further information - see MIDIRS article:

GAP Education - dates of forthcoming workshops are listed here.

Fundal Height Measurement - click here for video demonstration. (Enter password “measureright”).

Lecture - click here to view a presentation by Prof Jason Gardosi on Preventing Stillbirth: A National Campaign on 1/7/2016 (24 minutes)

• Most 'unexplained' stillbirths were growth restricted   • Customised charts and appropriate protocols should be used  
• Most stillbirths with IUGR are avoidable   • Standardised FH measurement and referral improves detection    
• A/N detection improves outcome and reduces SB   • In high risk pregnancy, serial scans improve detection  


Education in GAP is provided in two ways:

• A 3-hour workshop which covers risk assessment for SGA and appropriate care planning, standardised fundal height measurement, use of gestation related optimal growth (GROW) charts, referral for growth scanning, interpretation of scan findings and management once SGA is suspected/diagnosed. The programme is multidisciplinary, and encourages discussion between midwives, obstetricians and sonographers.

• An e-learning module is available and GAP users are encouraged to complete e-learning on an annual update. The login and password for e-learning is provided by the PI on request via email. Please provide details of name, clinical role, midwifery or medical council number and affiliated DHB to

New Zealand GAP lead educators - Joyce Cowan and Clare Barrett lead GAP workshops and work with a team of champions who are funded to work in their respective DHBs to provide support and cascade education following implementation of the programme.

New Zealand GAP leads - Joyce Cowan & Clare Barrett

    2013 Patient Safety Award for Clinical Leadership, for implementing West Midlands stillbirth prevention programme
    2014 Patient Safety Award for national roll-out of the GAP - Education and Training Programme
    2015 Patient Safety Award for improving safety in pregnancy by computer aided monitoring of fetal growth
    2015 BMJ Award for Clinical Leadership, for implementing national stillbirth prevention programme
    2016 Queens Award for Enterprise - Innovation for reducing stillbirth rates in England
    2018 Princess Royal Training Award for its comprehensive Education and Training Programme