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Fundal height measurement in itself is an inexpensive intervention which contributes to its widespread appeal and use.However, if all women undergo the procedure at each prenatal visit during the second and third trimesters however, additional costs may be incurred by the woman and her family including those related to unnecessary medical interventions and those resulting from neonatal care necessary for undiagnosed IUGR or macrosomia.
It was thought that the widespread introduction of fundal height measurement would improve the detection rate of fetal growth abnormalities but the results have varied widely from studies undertaken at different centers The ability to accurately predict pregnancy complication using fundal height measurement may be affected by a number of factors including the technique used, clinician skill, the number of clinicians involved, the maternal position, the status of the maternal bladder and the possibility of clinician bias.
There are studies which support the value of fundal height measurement ( Mathews, 1997 ) and some which have suggested improvements to ensure uniformity, ease of interpretation and an improvement in predictive value ( Gardosi, 1999 ).
Evidence based practice indicates that the care is based on findings from clinical studies that were designed to measure the effectiveness of specific therapeutic methods, especially systematic reviews that consider the strength and quality of evidence supporting or refuting a particular practice and lead to a consensus regarding guidelines ( Rook, J 1999 ).
While it is an appealing intervention given the fact that it is readily available, easy to perform and relatively non-invasive, the reliability and validity of fundal height measurement have been questioned.
If undiagnosed, and 65% of cases of intrauterine growth restriction ( IUGR ) are not identified prenatally ( Mc Farlin, 1994 ), the impact on the woman and her family may be significant if long term health problems ensue.
The American College of Nurse Midwives' philosophy of midwifery states that ".practice of nurse midwifery encourages continuity of care; emphasizes safe, competent clinical management..." and therefore midwives must ensure that any component of the care they administer is both valid and reliable.Clinicians have not always been able to detect growth problems prenatally resulting in the potential for perinatal morbidity and mortality.Early diagnosis allows care to be planned accordingly in order to reduce perinatal compromise.If a fundal height measurement deviates from the norm the midwife may become involved in sanctioning additional interventions such as ultrasound.In some clinical settings a diagnosis of IUGR or macrosomia may even necessitate transfer of a woman's care to an obstetrician or perinatologist.The predictive value has been studied by several investigators who found limited evidence to support its use ( Lindhard, 1990 ) and others who found problems related to interexaminer reliability and clinician bias.( Engstrom, 1994 ) It is the aim of this study to consider the literature and to determine the validity and reliability of this commonly performed intervention.