Gravidogram and Fetal Growth:Comparison with Biochemical Supervision

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Abstract
The gravidogram system was designed for the supervision of pregnancy by graphic comparisons between changes in maternal symphsis-fundus (SF) distance, girth, weight and blood pressure and known normal values. Increases of maternal weight, girth and SF-distance, in 100 uncomplicated term pregnancies (50 nulliparae and 50 multiparae) resulting in normal for dates infants (NFD = mean weight .+-. 1 SD for gestational week in question) were presented as means .+-.2 SD. SF-distance had the smallest coefficient of variation and was therefore selected as an indirect indicator of fetal growth. SF-curves for 50 large for dates (LFD) and 50 small for dates (SFD) infants were constructed. By the 20th wk of pregnancy the SF-growth curve for LFD-infants differed significantly from that of NFD-infants (P < 0.01). The SF-growth curve for SFD-infants differed significantly from that of NFD-infants by the 28th wk of gestation (P < 0.01). Antenatal screening was performed by SF-tape measurements (mean .+-. 1 SD) in a consecutive series of 428 women delivered between the 37th-42nd wk of pregnancy. When SF-growth charts were normal, 80-84% of infants were NFD. The number of infants detected in this way comprised 64% of all NFD-infants, which was close to statistical expectation. When SF-growth charts were above the normal (> mean +1 SD), 65% of all LFD-infants were correctly predicted. When SF-growth charts were below normal (< mean-1 SD), satic or declining, 75% of all SFD-infants were predicted. SF-growth charts were analyzed in 69 twin pregnancies, and the clinical diagnosis improved from the well known 50% level to 86%. If SF-values greater than the mean + 2 SD (NFD-singleton) were considered as suspicious of twin pregnancy, this suspicion was confirmed in all but 1 case (99%). Average time for suspicion of a twin pregnancy was 24 .+-. 4 (1 SD) gestational wk. Human placental lactogen (HPL) and urinary estriol (U-estriol) were determined 2-3 times/wk during the 3rd trimester in pregnancies resulting in LFD- and SFD-infants. SF-measurements were superior to HPL and U-estriol in detecting accelerated and retarded fetal growth. After the introduction of the gravidogram there was a prompt and persistent fall in the uncorrected perinatal mortality rate to 8.0/1000 total births. A normal SF-growth curve implies normal fetal growth, and the risk of intrauterine death from fetal growth retardation was practically nil. Biochemical and sonographic fetal supervision was limited to cases where the SF-growth chart deviated from normal.

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