Symphysis-fundal height, gestational age and its value for identification of foetuses at risk in rural Tanzania: A qualitative follow-up study

Andrea Solnes Miltenburg, Sandra van Pelt, Richard Forget Kiritta, Tarek Meguid, Johanne Sundby

Abstract

Preterm birth and abnormal foetal growth increase the risk of perinatal morbidity and mortality. Timely identification of foetuses at risk is critical to improving maternal and neonatal outcomes. The objective of this study was to increase understanding of the quality of foetal growth monitoring during antenatal care in Tanzania. Between 2015 and 2017, 13 women were followed throughout their pregnancy, childbirth and postpartum period. Participants were recruited using a staggered approach at selected health facilities. Data collection included direct observations of 25 of 48 antenatal care consultations, review of the women’s antenatal cards, 88 in-depth interviews and participant observation at the health facilities. Six women had facility births and seven had home births. There was one stillbirth, one preterm birth and two term infants died between the age of 3-6 months. Of the 9 newborns with a known birthweight, 3 were possibly growth-restricted. During 12 ANC visits (25%) Symphysis-Fundal Height (SFH) was not recorded and during 22 visits (46%) the recorded Gestational Age (GA) was incorrect. Despite regular assessment of SFH, three possible growth-restricted infants remained undetected. There is a need to improve nurse-midwives ability to determine a reliable GA and improve critical reflection on SFH measurement. (Afr J Reprod Health 2021; 25[5]: 140-149).

Full Text:

PDF

References

Blencowe H, Cousens S, Jassir FB, Say L, Chou D,

Mathers C, Hogan D, Shiekh S, Qureshi ZU, You D, Lawn JE and FRCPCH for The Lancet Stillbirth Epidemiology Investigator Group. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: A systematic analysis. Lancet Glob Heal 2016; 4: e98–108.

United Nations Inter-agency Group for Child Mortality

Estimation. Levels & Trends in Child Mortality, UNICEF, New York, 2018.

Lawn JE, Blencowe H, Oza S, You D, Lee ACC, Waiswa

P, Lalli M, Bhutta ZQ, Barros AJD, Christian P, Mathers C and Cousens SN for The Lancet Every Newborn Study Group. Every newborn: Progress, priorities, and potential beyond survival. Lancet 2014; 384: 189–205.

Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R,

Ibiebele I, Gardosi J, Day LT and Stanton C for The Lancet’s Stillbirths Series steering committee. Stillbirths: Where? When? Why? How to make the data count? Lancet 2011; 377: 1448–63.

Sania A, Spiegelman D, Rich-Edwards J, Hertzmark E,

Mwiru RS, Kisenge R and Fawzi WW. The contribution of preterm birth and intrauterine growth restriction to childhood undernutrition in Tanzania. Matern Child Nutr 2015; 11: 618–30.

WHO. WHO recommendations on antenatal care for a

positive pregnancy experience. Geneva, 2016.

Robert Peter J, Ho JJ, Valliapan J, Sivasangari S.

Symphysial fundal height (SFH) measurement in pregnancy for detecting abnormal fetal growth. Cochrane Database Syst Rev 2015; 2015. DOI:10.1002/14651858.CD008136.pub3.

Kearns A, Hurst T, Caglia J, Langer A. FANC Tanzania,

Focused Antenatal Care. Women and Health Initiative. Maternal Health Task Force. Harvard School of Public Health. 2014

Pay ASD, Wiik J, Backe B, Jacobsson B, Strandell A and

Klovning A. Symphysis-fundus height measurement to predict small-for-gestational-age status at birth: A systematic review. BMC Pregnancy Childbirth 2015;15:1–9.

Sarker M, Schmid G, Larsson E, Kirenga S, De Allergi M,

Neuhann F, MbundaT, Lekule I and Muller Ol. Quality of antenatal care in rural southern Tanzania: a reality check. BMC Res Notes 2010;3:209.

Solnes Miltenburg A, Eem L Van Der, Nyanza EC, van

Pelt S, Ndaki P, Basinda N and Sundby J. Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study. Plos One 2017;12(12): e0188279.

Wanyonyi SZ, Mutiso SK. Monitoring fetal growth in

settings with limited ultrasound access. Best Pract Res Clin Obstet Gynaecol 2018;49:29–36.

MCHIP. Maternal and Newborn Quality of Care Surveys:

Antenatal care. Wachington DC, 2014.

Papageorghiou AT, Ohuma EO, Gravett MG, HirstJ, da

Silveira M F, Lambert A, Carvalho M, Jaffer YA, Altman DG, Noble JA, Bertino E, Purwar M, Pang R, Ismail LC, Victora C, Bhutta ZA, Kennedy SH and Villar J on behalf of the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21(st) Project: Prospective cohort study in eight countries. BMJ 2016;355:1–7.

Villar J, Ismail LC, Victora CG, Ohuma EO, Bertino E,

Altman DG, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Gravett MG, Purwar M, Frederick IO, Noble AJ, Pang R, Barros FC, Chumlea C, Bhutta ZA, Kennedy SH and International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for newborn weight, length, and head circumference by gestational age and sex: The Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet 2014;384:857–68.

Maxwell J. Validity. How might you be wrong? In:

Maxwell J, ed. Qualitative Research Design: An interactive approach, 3rd edn. London, Thousand Oaks, New Delhi, Singapore: Sage Publications, 2013:121–38.

Hermida J, Nicholas DD and Blumenfeld SN.

Comparative validity of three methods for assessment of the quality of primary health care. Int J Qual Heal Care 1999;11:429–33.

Pembe AB, Carlstedt A, Urassa DP, Lindmark G, Nyström

L and Darj E. Effectiveness of maternal referral system in a rural setting: a case study from Rufiji district, Tanzania. BMC Health Serv Res 2010;10:326.

Kim ET, Singh K, Moran A, Armbruster D and Kozuki N.

Obstetric ultrasound use in low and middle income countries: A narrative review. Reprod Health 2018;15:1–26.

Goldenberg RL, Nathan RO, Swanson D, Saleem S, Mirza

W, Esamai F, Muyodi D, Garces AL, Figueroa L, Chomba E, Chiwala M, Mwenechanya M, Tshefu A, Lokangako A, Bolamba VL, Moore JL, Franklin H, Swanson J, Liechty EA, Bose CL, Krebs NF, Michael Hambidge K, Carlo WA, Kanaiza N, Naqvi F, Pineda IS, López-Gomez W, Hamsumonde D, Harrison MS, Koso-Thomas M, Miodovnik M, Wallace DD and McClure EM. Routine antenatal ultrasound in low- and middle-income countries: first look – a cluster randomised trial. BJOG 2018;125(12):1591–1599.

Justus Hofmeyr G, Haws RA, Bergström S, Lee AC,

Okong P, Darmstadt GL, Mullany LC, Oo EK and Lawn JE. Obstetric care in low-resource settings: What, who, and how to overcome challenges to scale up? Int J Gynecol Obstet 2009;107(suppl1):S21–45.

Oluoch DA, Mwangome N, Kemp B, Seale AC, Koech A,

Papageorghiou AT, Berkley JA, Kennedy SH and Jones CO. ‘You cannot know if it’s a baby or not a baby’: Uptake, provision and perceptions of antenatal care and routine antenatal ultrasound scanning in rural Kenya. BMC Pregnancy Childbirth 2015;15: 1–11.

Refbacks

  • There are currently no refbacks.