Apparently my fundal height is measuring small - could it be baby's position?

[Zephram]

I saw my midwife on Wednesday and I have been stressing about this ever since. She said my fundal height is measuring small and she plotted this on a graph she made with my stats and said it was below 5th percentile and has sent me off for a scan to check baby is growing okay. Problem is they can't fit me in for the scan until Wednesday next week, so I have 4 more days to stress about it.

I've not experienced this before as my first LO was generally a cm or so ahead on fundal height (no individualized graph then as it was a different midwife and 3 years ago). They never worried about that. So I was 27 weeks and 5 days when I saw her, she first said I was 24cm for fundal height and I made her remeasure and she said 26cm, which according to this individualized graph is below 5th percentile for my personal stats. I'm totally confused as I thought a cm or 2 off was no biggie?

Baby was measuring right on track at my 20 week ultrasound and though in the back of my mind this whole time I have absolutely known my tummy is smaller than with my first LO - I even mentioned it to a few people - I feel like it might be the way he's lying in there. From feeling my stomach on the outside and from where his kicks are, I feel he is lying posterior and curled across the bottom of my uterus - transverse - which would be a reason for a smaller fundal height.

But another part of me isn't sure and is freaking out something is wrong.

Anyone have experience?

 

[Kazy]

This is my fourth baby and with my first two measured over by a few every time. My third was right on and this one is under a cm or two every appointment. I'm.pretty sure that's normal. My Dr didn't even start fundal height until about 24 weeks so I'm not sure about 20 weeks. The us tech said at 20 weeks baby measured small and my due date was probably wrong. But I had 3-4 early us so I know dates are correct. I think my baby is oblique position and that may be why fundal height is off. Anyway, all that to say I don't think a few cm either way should make a difference. I know my.Dr said it doesn't.

 

[Catiren]

last friday i had measured slightly smaller although my entire pregnancy ive measured perfect. the doctor sent me for an ultrasound to be safe. my 33 wks i measured on time but my 34 wks appointment showed different dates. at first i worried ALOT then i realized the baby dropped since last week and its very noticeable... this played a huge part in why i was measuring smaller

 

[mod19]

I've measured small the whole pregnancy. Apparently she's just a little thing, but is growing on her curve, and my amniotic fluid is low. Since finding out about the fluid issue I feel better about my bump not being nearly as big as other women that I see. I'm being monitored closely and drinking plenty of fluids, baby is moving good and is always practicing breathing every week when they scan me to check on her. It also could definitely be how baby is laying or how you're carrying him.

 

[Insomniash]

First of all, fundal height is well known for being unreliable. As you said position can be a factor along with many other things.

Secondly, her math is seemingly off. Didn't seem plausible to me so I looked up fundal height charts, and basically according to a standardized chart it works as follows. At 26 cms if she rounded down your gestation to 27 weeks you would be perfectly on the 50th percentile. If she rounded you up to 28 weeks you would have been around 37.5% which is still acceptable. So you are correct when you say a cm isn't anything to be concerned about. The only way you could measure on the 5th percentile is if she was using the first measurement. If she was using the original measurement of 24 cms 27 weeks would put you at around 17.5% and 28 weeks would represent 5%. But since you weren't quite 28 weeks at the time it is in fact a bit higher than that.

Anyhow, don't panic. I bet the ultrasound will show that everything is perfectly on track.

 

[lau86]

My fundal height has always been low, my midwife just put it down to babies position and that I'm tall?! My babies weren't big but they were fine.

 

[superbecks]

I'm not sure which area you are from for the person who mentioned about standardised growth charts and the midwifes maths being off but in the UK we used customised growth charts taking into account previous birth weight, mothers weight etc. so the midwife probably has plotted it correctly.

Yes fundal height measurements are subjective. But I would much rather a vigilant midwife send you for a scan to be doubly sure and everything be ok than her ignore it and then find baby was small and it not have been monitored. Before the customised growth charts (which were introduced only in some areas to reduce stillbirths) measuring larger or smaller by 2cm was fine.

 

[Insomniash]

I'm not sure which area you are from for the person who mentioned about standardised growth charts and the midwifes maths being off but in the UK we used customised growth charts taking into account previous birth weight, mothers weight etc. so the midwife probably has plotted it correctly.

Yes fundal height measurements are subjective. But I would much rather a vigilant midwife send you for a scan to be doubly sure and everything be ok than her ignore it and then find baby was small and it not have been monitored. Before the customised growth charts (which were introduced only in some areas to reduce stillbirths) measuring larger or smaller by 2cm was fine.

Ah I see, I stand corrected if that is the case. They don't really bother with that here they just use a standard guideline and track your progress appointment to appointment.

 

[superbecks]

I'm not sure which area you are from for the person who mentioned about standardised growth charts and the midwifes maths being off but in the UK we used customised growth charts taking into account previous birth weight, mothers weight etc. so the midwife probably has plotted it correctly.

Yes fundal height measurements are subjective. But I would much rather a vigilant midwife send you for a scan to be doubly sure and everything be ok than her ignore it and then find baby was small and it not have been monitored. Before the customised growth charts (which were introduced only in some areas to reduce stillbirths) measuring larger or smaller by 2cm was fine.

Ah I see, I stand corrected if that is the case. They don't really bother with that here they just use a standard guideline and track your progress appointment to appointment.

They used to do it here too and still do in a lot of areas. But there was a trial done,I think where they were undertaken and was shown to identify intrauterine growth restricted babies and by correctly monitoring them and doing dopplers etc and inducing when needed it reduced the risk of stillbirth. They are really good, it shows when growth becomes static and by plotting them onto the graph it's easier to see than just being written down in the notes. A lot of the time the scans are normal from the fundal height as the op says it's difficult due to position etc, but a lot of the time it does identify issues with growth too. Fundal height is really subjective though so I wouldn't worry until you have had your scan if you can help it x

 

[Zephram]

Thanks ladies.

Yup, as superbecks says the chart is customized to my stats. I'm in New Zealand and as I mentioned earlier I didn't have this kind of chart in my last pregnancy, though that was a different midwife. My current midwife only finished her training about 3 years ago max, I think, so it could be a fairly new thing.

From what I saw she had used my height, weight and my first baby's weight. I'm tall, so I think there may be an assumption that I should have a bigger baby, therefore a 26cm fundal height at that stage of pregnancy truly is on the rather small size.

I'm finding it very confusing though as she showed me where my first LO fit on the graph - he was 3.9kg at 41+2 when born - and apparently he was only 40th percentile on this customized graph, when all along I thought he was on the larger size. It's weird... I mean he's 2.5 now and he is a 91st for height on the standardized growth charts, so obviously not a small kid.

 

[Zephram]

I wanted to come back and update this. I had my scan and, first of all, I was right that baby is transverse. He is lying straight across my tummy, which is contributing to the small fundal height. I'm trying for a VBAC, so this kid has 11 weeks to turn!

As a separate issue, I do have slightly low fluid and his abdominal circumference is measuring a bit small, also contributing to the smaller fundal height. I totally freaked out after being told this at the scan, but I spoke to my midwife and she said that although the measurements are a little on the small side, it's nothing to worry too much about at the moment. We will probably check he is growing okay with another scan soon.

So, in my case, my midwife was right to peg the lower fundal height as a possible cause for concern, there is a small issue, though it's not a major one at this stage.