From the moment a pregnant woman registers until the very end of her term, doctors pay increased attention to the woman’s uterus. All the most important events of this “film” about the development of a fetus into a full-fledged child take place here.
In the first trimester, the size of the uterus matters, by which, in fact, pregnancy and the estimated timing are determined. And starting from 13-14 weeks, the height of the uterine fundus is taken into account. Because now this organ is not just enlarged - it extends beyond the pelvis, and with each passing week it gets further (or higher).
By this indicator, you can judge a lot of things: the duration and course of pregnancy, the expected date of birth, the condition of the fetus, the pace of its development. VMR is measured at every visit to the gynecologist. Usually, using a measuring tape or a device specially designed for this purpose - a basin gauge.
The height of the uterine fundus is the distance from the upper edge of the pubic symphysis (symphysis pubis) to the highest point of the uterus. The measurement is carried out with an empty bladder. To do this, a woman should lie on the couch on her back and straighten her legs. All indicators of VMR, together with abdominal circumference, are recorded in a card to track dynamics.
The following table of VDM indicators helps to judge the norm or deviations.
Table of correspondence between the height of the uterine fundus and the period of pregnancy
Gestational age/week | VDM/cm | Gestational age/week | VDM/cm |
8-9 | 26-27 | 25-28 |
|
10-11 | 10-11 | 28-29 | 26-31 |
12-13 | 10-11 | 30-31 | 29-32 |
14-15 | 12-13 | 32-33 | 31-33 |
16-17 | 14-19 | 34-35 | 32-33 |
18-19 | 16-21 | 36-37 | 32-37 |
20-21 | 18-24 | 38-39 | 35-38 |
22-23 | 21-25 | 40-41 | 34-35 |
24-25 | 23-27 |
However, when assessing AMD, one should take into account the individual characteristics of each female body (which is why AMD in different women at the same period can fluctuate by 2-4 cm in both directions) and other factors influencing the increase or decrease in the height of the uterine fundus:
- fruit size;
- fetal position;
- quantity amniotic fluid;
- number of embryos.
So, in case of multiple pregnancy, carrying a large child, the fundus of the uterus will be higher. Indicators below normal may be observed with delayed fetal development, with oblique or transverse presentation.
When assessing the course of pregnancy, the AFM is compared with the abdominal circumference and the size of the fetus.
It is considered a deviation when the height of the uterine fundus does not correspond to the gestational age by 3 cm or more. But premature conclusions should not be drawn. Often there are harmless reasons for this, for example, an error in determining the duration of pregnancy.
However, concerns about the failure of the WYD to meet the deadline may be well founded. Thus, underestimated indicators sometimes indicate, for example, placental insufficiency, and overestimated ones indicate the development of intrauterine infection, which provokes a sharp increase in amniotic fluid. The reasons may be different.
If the obstetrician-gynecologist has recorded the pathological value of the VDM, the pregnant woman is prescribed additional tests: ultrasound examination (ultrasound), cardiotocography (CTG), Doppler measurements and others. And only after this the final conclusion is made.
Especially for- Elena Kichak
Assessing the height of the uterine fundus by week of pregnancy has serious diagnostic significance. In addition to calculating the gestational age, gynecologists predict the condition of the fetus each week and suggest possible deviations from its normal development.
The length of the uterus is no more than 8 centimeters in a woman of reproductive age. Of these, the cervix occupies about 2.5 cm. Height - 4 cm. The uterus increases during pregnancy and by the 40th week of pregnancy it has a similar length - 40 cm. Before pregnancy, the weight of the organ is 50 grams. In the third trimester - about 4 kilograms.
Fundal height of the uterus by week - how to determine
- On early stages through the vagina we feel the size of the uterus.
- 12th week - the uterus reaches the pubic symphysis.
- From the 13th week it extends beyond the pelvic area and can be felt through the abdominal wall.
- With the pregnant woman lying down, the distance between the pubic symphysis and the highest point of the uterus (fundus) is measured with a measuring tape.
- The results are recorded in a notebook to track their dynamics.
- Approximate dimensions of the height of the uterine fundus by week in centimeters: 8-9 weeks - 8-9; 16-17 weeks – 14-19; 38-39 weeks – 35-38.
- The fundal height (FHR) approximately corresponds to the gestational age in weeks.
If at a certain period the height of the uterine fundus exceeds normal values, then the doctor may suspect a multiple pregnancy, and if less, low fetal growth rates, oligohydramnios, oblique or transverse position.
A one-time determination of the height of the uterine fundus is not very informative.
It should be noted that the size of the IRR at different stages of pregnancy is the statistical average. It differs in large and short women, who have anatomical different sizes queens
Fundal height of the uterus during pregnancy by week
IN 8-9 weeks the uterus is the size of a goose egg. Until this time, it cannot be felt through the abdominal wall, as it is located in the pelvic area. Only from 3 months - located above the pubis. The placental system begins to actively function, and corpus luteum gradually disappears. The embryo begins to move and blood vessels form.
10-13 weeks. The length of the uterus is 11 cm. Toxicosis intensifies due to the cleansing of the mother’s body, which is rebuilt to normalize the trophism of the fetus.
14-16 weeks. The embryo completes the process of creating organs. The uterus increases to 14 cm.
16 weeks– the fundus of the uterus is located in the middle of the distance between the navel and the pubis.
17-18 weeks. The placental system has been formed. The fetus has a fully developed cerebellum, limbs, and immune system. The length of the uterus is 18-19 cm.
WITH 20th week The size of the uterine fundus begins to approximately correspond to the duration of pregnancy. So, at the 21st week, the distance between the pubis and the fundus of the uterus is approximately 21 cm. Subsequently, it increases weekly by 1 cm. The fundus of the uterus is projected at this stage below the navel by 2 fingers.
22-24 weeks. The embryo develops muscles and bones. Its weight is about 600 grams. At week 24, the pulmonary system begins to form. The uterus increases to 23 cm. In the 24th week, the fundus of the uterus is located in the navel with a height of 24 centimeters.
28 weeks The height of the uterine fundus is 28 cm. The uterine fundus is located 2 cm above the navel (two folded fingers).
29-30 weeks. In the third trimester, the uterus is about 31 cm. In a pregnant woman, the blood pressure because of large sizes fetus
32 weeks– the location of the uterus is in the middle of the distance between the xiphoid process of the sternum and the navel (9th month), and is 32 centimeters.
36 weeks- on the line that connects both costal arches.
38 weeks. After the 38th week, the uterus begins to descend. The bottom of the organ puts pressure on the stomach and diaphragm. The mother digests food slowly and develops heartburn. The child's weight is 2100-2250 grams.
On 40th week VDM – 32 cm. The bottom is again located between the ribs and the navel. The pregnancy is considered full term. The baby is actively growing, and the mother’s body is preparing for childbirth. When the baby descends into the pelvis, labor begins.
Fundal height of the uterus by week, what affects it:
- Fruit size
- Anatomical features of the woman’s body,
- Fetal position
- Number of embryos
- The severity of amniotic fluid.
If the fundus of the uterus during pregnancy is below normal
- Low water,
- Wide pelvis in large women
- Erroneous values when determining the timing of pregnancy,
- Delayed fetal development.
Assessment of the size of the uterine fundus during pregnancy should include a whole series of measurements.
If the fundus of the uterus is higher than normal during pregnancy
- Narrow pelvis
- Large fruit
- Polyhydramnios,
- Multiple pregnancy
- Incorrect position.
Simultaneously with the height of the uterine fundus, gynecologists calculate the amount of amniotic fluid, which affects the development of the fetus. This indicator depends on the individual developmental characteristics of the woman and the overall thickness of the subcutaneous heat. At the end of pregnancy, both indicators allow you to calculate the weight of the fetus using the formula: IRR - abdominal volume. The normal value is approximately 3420 grams.
Abdominal circumference: norm and deviations, their causes
Abdominal circumference during pregnancy is required to be measured by gynecologists for expectant mothers who come to see them. And future mothers themselves also like to measure their tummy, make sure that it is growing, which means that their baby is developing and gaining weight.
The abdominal circumference increases individually over the weeks, but in most cases there is always at least a slight increase. On average, from week 12 the volume increases by 1 centimeter per week. And doctors make sure that he grows, without taking into account individual sizes. After all, one woman may initially have a large volume due to excess weight. And the other one may be completely skinny. Of course, a lot also depends on weight gain during pregnancy, since fat deposits are also deposited on the abdominal wall.
Many expectant mothers are interested in when the belly of pregnant women begins to grow, by what date should they buy new, looser clothes? Not earlier than 12 weeks. Moreover, until 16-18 weeks, basically the tummy that expectant mothers notice in themselves is not an enlarged uterus, but simply an intestine swollen from gases. Usually in the morning after going to the toilet, your tummy is almost invisible. But in the evening it grows. And then women love to take pictures of themselves in profile in the mirror and show off their belly.
If you want to find out what the normal abdominal circumference is by week of pregnancy, you can see it in the table. But it’s absolutely clear that you shouldn’t worry if you don’t fit into some norms. As we wrote earlier, growth dynamics are more important than specific numbers. If they interest you, then you can estimate that the circumference of your tummy by the end of pregnancy will be approximately 100-110 cm.
The height of the uterine fundus and abdominal circumference are measured by the doctor at each visit to his pregnant patient. And these data are recorded in the outpatient card of the expectant mother. Based on the data obtained, charts and graphs are constructed, and if a woman falls outside their limits, an ultrasound is usually prescribed.
Why can the abdominal circumference be less than normal? Possible reasons some.
1. Low water. It is reliably diagnosed by ultrasound, which determines the amniotic fluid index. Moderate oligohydramnios, as a rule, has no cause. Usually seen towards the end of pregnancy. True oligohydramnios occurs with certain fetal malformations, most often associated with the urinary system. Less commonly, oligohydramnios is associated with partial discharge of amniotic fluid.
2. Incorrect measurement. They must be performed by the same doctor. It happens that a nurse or another doctor measures the stomach, and the results are completely different.
3. Malnutrition. Not all expectant mothers gain weight well. Someone is trying to follow a diet or is malnourished for some other reason, for example, due to toxicosis. If there is no weight gain, or the expectant mother is losing weight, doctors prescribe or even give out special milk formulas for pregnant women as additional nutrition for free.
4. Fetal hypotrophy. This is a pathology in which the fetus is smaller than it should be at a given stage of pregnancy. Accordingly, the tummy is smaller than normal. Stops growing as it should. The size of the fetus is determined by ultrasound. If there really is hypertrophy, then the data from studying the fetal blood flow are very important to see if there are any abnormalities there. And if everything is more or less good, the doctor prescribes an ultrasound over time. In the case when the fetus has stopped or almost stopped growing, the woman is allowed to give birth. This way the baby will have a better chance of being born healthy.
But abdominal circumference is greater than normal for other reasons.
1. Polyhydramnios. This is when the index amniotic fluid turns out to be higher than normal. The causes of this pathology are diabetes mellitus in the mother, fetal malformations, and various infections.
2. Large fruit. Starting around the second half of pregnancy, children develop very individually. If a mother’s tummy quickly gains volume, then it may well be that she has a large baby growing inside her. A doctor can determine the approximate weight of the fetus during an ultrasound examination. If this is indeed the case, then the woman is advised to reconsider her diet and remove as much fast carbohydrates, and also get tested for diabetes.
3. Rapid weight gain, obesity. A woman is advised to monitor her diet and regularly have fasting days.
4. Multiple pregnancy. For this reason, we think everything is clear.
5. Fetal position. Sometimes the baby can lie across the uterus, and then the mother’s tummy acquires additional volume. And after changing position, the volume becomes smaller.
How to correctly measure your tummy? Doctors do not recommend doing this, as there is a high probability of error. At the very least, you don’t need to take the measurement results you obtained yourself very seriously.
Table of abdominal circumference by week of pregnancy (WF) and uterine fundal height (UFH):
| Week of pregnancy | VDM, cm | Coolant, cm |
|---|---|---|
| 12 | 2-6 | - |
| 16 | 10-18 | - |
| 20 | 18-24 | 70-75 |
| 22 | 20-26 | 72-78 |
| 24 | 22-27 | 75-80 |
| 26 | 24-28 | 77-82 |
| 28 | 26-32 | 80-85 |
| 30 | 28-33 | 82-87 |
| 32 | 30-33 | 85-90 |
| 34 | 32-35 | 87-92 |
| 36 | 33-38 | 90-95 |
| 38 | 36-40 | 92-98 |
| 40 | 34-38 | 95-100 |
These measurements should be carried out by a doctor. In this case, the expectant mother should lie on her back on a hard surface. Measurements are taken with a centimeter tape from the pubic bone to the so-called fundus of the uterus - this will be the size of its standing. The stomach is also measured while lying down. Both of these values are important for the doctor. But the most accurate of them is still the height of the fundus of the uterus. It should be approximately the same for all pregnant women.
Fundal height of the uterus - this term is familiar to any woman who has been pregnant and has undergone examinations. This parameter is measured in expectant mothers during regular examinations by an obstetrician-gynecologist. What does it mean, what are the norms for this measurement at various stages of pregnancy, and what to do if there are deviations?
Fundal height of the uterus - what is it?
Fundal height of the uterus (UFH) is one of the most important parameters determining proper development pregnancy. The uterus changes its size, adapting to the growing embryo, therefore, by how much the fundus of the uterus rises, one can judge the size of the child, which, in turn, provides information about the age of the embryo and possible pathologies in its development. 
Along with the growth of the embryo, the uterus also grows - its bottom rises higher and higher
In the early stages of pregnancy, this parameter cannot be measured - the uterus “hides” behind the pubic bone and its size is still too small to be felt. Usually the uterus rises above the pubic symphysis (and it becomes possible to find it by palpation) at a period of 16 weeks, sometimes a little earlier, but not earlier than 10–12 weeks.
Features of changes in the uterus (repeated or multiple pregnancies)
The most common physiological (that is, non-hazardous) reason for deviation of VDM from the norm is multiple pregnancy. Obviously, if there are two or more children in the uterus, its size will exceed the norms designed for pregnancy with one child. Usually, a multiple pregnancy is learned from the results of an ultrasound scan, much earlier than it becomes possible to measure the UMR parameter, but there are cases when, due to a certain position in the womb, only one baby is visible on an ultrasound scan, or, for example, a woman, for some reason, is not at all I did an ultrasound. In this case, a multiple pregnancy can be suspected by an excessively rapid increase in abdominal girth and uterine fundus height - of course, such a conclusion is not made based on this indicator alone, but is verified by additional examinations.
During multiple pregnancies, the uterus grows faster as children take up more space. Moreover, in case repeat pregnancies The uterus grows in size faster than it did the first time because it is no longer “virgin” and the abdominal muscles are not as actively inhibiting its growth. It’s not for nothing that women notice that the next time they carry a child, the belly usually becomes visible to others earlier than the previous time. The height of the uterine fundus can also rise somewhat faster than what happened with the first baby, and, accordingly, exceed the calculated norms. However, if the dynamics of growth in the GMR value at the same time maintains the correct pace, then there is no need to worry, this is normal.
Why is it important to monitor fundal height indicators?
The dynamics of changes in the AMR indicator allows us to judge the development of the child, possible pathologies of the fetus, high or low water, and inflammatory processes in the uterus. This is a non-invasive test that does not have any effect on the pregnant woman and/or fetus, it can be performed any number of times without any consequences, and when carried out correctly it gives important and accurate results.
Since measurements are made from the outside, the result is also influenced by the woman’s physical parameters - the presence/absence of excess weight, the shape of the pelvis, the thickness of fat deposits. In addition, the characteristics of the pregnancy itself also influence the position of the child in the expectant mother’s belly, the condition and attachment of the placenta, and the number of embryos. Therefore, some shifts in the positive or negative direction from the norm are usually not considered critical. The main importance is not so much the height of the uterine fundus itself, but rather its increase over the weeks of pregnancy.
How to measure the height of the uterine fundus
The height of the uterine fundus is measured very simply; all you need to do is have a regular tailor's tape with you. Various rulers will not be suitable for such measurements, because you will need to measure the length of the convex line. If desired, a woman can do this herself, but it is better if someone helps her, since measurements taken independently may not be accurate enough.
Video: measuring the height of the uterine fundus
So, to find out the UMR parameter, a pregnant woman should perform the following steps:
- empty bladder;
- give access to your pelvis - loosen the belts, if any, lower or unfasten your trousers; the body from the pelvis to the chest should not be compressed by anything;
- lie on your back with your legs extended;
- find the beginning of the symphysis pubis - the place where the pubic bone is felt;
- find the highest point of the uterus - to do this, palpate the abdomen along the midline from the pubic symphysis upward; where the dense part of the abdomen turns into the soft part, there is the desired fundus of the uterus;
- Use a measuring tape to measure the distance between these two points.
Using a centimeter tape, measure the distance between the lower point of the uterus (it is located in the area of the pubic symphysis) and the upper Standards for VDM indicators
The norm is considered to be the correspondence between the week of pregnancy and the height of the uterine fundus in centimeters, plus or minus 2–3 centimeters. That is, at the 16th week, for example, the VDM is from 13 to 19 centimeters, at the 30th week it is approximately 27–33. After the 38th week, the baby begins to prepare for childbirth, the stomach drops and the UMR readings decrease - this is normal.
Table: WYD by week of pregnancy
Deviations of the height of the uterine fundus from the norm
The deviation of the VDM value from the norm can be positive or negative.
Physiological reasons that the fundus of the uterus rises lower than it should be may be:
- incorrect determination of the period - if for some reason a woman missed the first ultrasound, at which the pregnancy period can be calculated with an accuracy of one day, then the doctor cannot always accurately determine how many weeks the pregnancy will last;
- wide pelvis - in this case the child is placed in a small uterus, so it does not need to grow up too quickly;
- small size of the fetus (if this is a normal option);
- genetic predisposition.
If the delay in the growth of AMD is caused by one of these reasons, then there is no need to worry - they are features, and not pathologies at all, and do not threaten the mother and child with anything dangerous. However, there is another list of factors that can cause lower VDM values:
- oligohydramnios - when there is insufficient amniotic fluid, the uterus does not grow at the proper speed;
- problems with the placenta - fetoplacental insufficiency, thin placenta, its premature aging;
- intrauterine growth retardation;
- infectious and inflammatory diseases;
- intrauterine death of a child.
In my first pregnancy, the UMR indicator was 3-4 centimeters behind the norm. It seems that the discrepancy is not very large, but still, whatever one may say, it is a deviation from the norm. However, the dynamics in this case corresponded to the norm, all other parameters were in order, the examinations also did not reveal any problems. As a result, after giving birth, it turned out that I had oligohydramnios, and very “little” at that - fortunately, this did not affect the child’s condition in any way. Apparently, this is precisely what turned out to be the reason for the reduced VMR.
Unnecessarily rapid growth height of the uterine fundus, which is not dangerous, is possible in the following situations:
- large fetus (if it is hereditary and not the result of pathology);
- excess body weight in a pregnant woman;
- narrow pelvis;
- placenta previa;
- multiple pregnancy.
Pathological reasons for exceeding the VDM value include:
- large fetus as a result of diabetes;
- hydatidiform mole;
- swelling of the placenta;
- polyhydramnios.
Excessive amniotic fluid accelerates the growth of the uterus If measures are not taken in a timely manner to eliminate the consequences of pathological causes of excess or lag of the GMR value from the norm, the results can be catastrophic - even the death of the pregnant woman. That is why, if the growth dynamics of the fetus slows down, you should undergo additional examinations as soon as possible to check the condition of the fetus and, if necessary, undergo a course of treatment. It is worth remembering that the main principle of treating deviations of the UMR from the norm during pregnancy is pathogenetic, that is, a low or high value of the height of the uterine fundus cannot be cured in itself; you need to find the cause of this deviation and work with it.
The height of the uterine fundus is a parameter whose importance is difficult to overestimate - it is easy to measure, and at the same time its value is an indicator of the condition of the fetus. The dynamics of VDM readings can warn in time about emerging problems and pathologies. It is important to remember that this indicator is only informative and not diagnostic; for a more accurate diagnosis, additional studies should be performed.
- this is the level at which the fundus of the uterus is located at a certain period pregnancy, and also after childbirth. The uterine fundus is the upper dome-shaped part of the uterus, which is located above the place where the body of the uterus connects to the fallopian tubes. The bottom of the uterus is tilted forward. It is the bottom of the pregnant uterus that can be felt with your hands, since this part of the uterus “rises” during the process of growth, moving from the pelvis to the abdominal cavity towards the diaphragm ( muscular plate that separates the chest cavity from the abdominal cavity).
How to measure the height of the uterine fundus?
You can measure the height of the uterine fundus after one week of pregnancy. Until this time, the uterus is located inside the small pelvis, that is, it does not protrude above the pubic bone, so it cannot be touched or measured from the outside. Until the 13th week of pregnancy, that is, even in the first trimester, the fundus of the uterus can only be felt with a bimanual or two-handed examination, when the gynecologist inserts one hand into the vagina and with the other hand presses on the lower abdomen, trying to bring both hands closer. However, this technique does not provide any special information about the gestational age, so all measurements of the height of the uterine fundus are made in the second trimester of pregnancy ( after a week).
Measuring the height of the uterine fundus is carried out in the following ways:
- using a regular measuring tape;
- width of transverse fingers ( 2 cross fingers are equal to 3 - 4 centimeters);
- according to anatomical landmarks.
When measuring the height of the uterine fundus, the woman lies on the couch on her back, with her legs slightly bent. It is important to remind the pregnant woman that the bladder must be emptied before measuring the height of the uterus. First, the doctor will palpate the pregnant woman’s abdomen to determine the position of the fetus, the fundus of the uterus itself, and the part of the fetus that is located in the fundus area. To do this, the doctor stands to the left of the pregnant woman, facing her, places the palms of his hands on the fundus of the uterus, pointing the fingertips of both hands towards each other. This move is called Leopold's first move. After the doctor determines the most distant point of the uterine fundus above the pubic bone, he uses a centimeter tape to measure the distance from the edge of the pubis ( pubic bone) to the point where the fundus of the uterus is determined.
You can use your fingers instead of a measuring tape. Fingers pressed together, usually the index and middle fingers, are placed transversely on the pregnant woman's abdomen. The height of the uterine fundus in this case is determined by the number of fingers between the main anatomical landmarks - the womb, navel and xiphoid process of the sternum.
Why do you need to measure the height of the uterine fundus?
The height of the uterine fundus is an indicator that indicates the normal or disturbed course of pregnancy, possible fetal anomalies and maternal illness. This is one of the indicators of the so-called gravigram ( "Gravida" means "pregnant" in Latin.). A gravidogram is a table that the doctor fills out at each visit to a pregnant woman, and which reflects the course of pregnancy in the form of graphs. It is necessary to monitor changes in the height of the uterine fundus throughout pregnancy, comparing the change in height each week. This is how a curve of the height of the uterine fundus is obtained.
Measuring the height of the uterine fundus is necessary to determine the following:
- gestational age and compliance of the height of the uterine fundus with the gestational age;
- full term of the child and his expected weight;
- function of uterine contractility immediately after childbirth;
- the degree of uterine contraction in the postpartum period and return to pre-pregnancy sizes.
Gestation period according to the height of the uterine fundus (height of the uterine fundus by week)
The height of the uterine fundus is one of the parameters used by obstetricians to determine the duration of pregnancy. With the advent of ultrasound ( Ultrasound) the method of determining the gestational age by the height of the uterine fundus has somewhat lost its relevance due to less accuracy, but is still used when examining a pregnant woman. The fact is that, despite the accuracy, ultrasound cannot be used too often, and measuring the height of the uterine fundus remains non-instrumental and the easy way determining the gestational age in weeks, which can be used not only by the doctor, but also by the pregnant woman herself.
Fundal height of the uterus by week
| in centimeters) | Location of the uterine fundus near anatomical landmarks | Approximate gestational age ( in weeks) |
| In the middle between the womb and the navel. | ||
| 2 transverse fingers below the navel. | ||
| At the level of the navel. | ||
| 2 transverse fingers above the navel. | ||
| At the level of the costal arches, almost at the xiphoid process. | ||
| Midway between the navel and the xiphoid process of the sternum. |
The minimum height of the uterine fundus is 5 centimeters above the womb, and the maximum is 40 centimeters. After the 20th week of pregnancy, the fundal height should be almost equal to the pregnancy period, plus or minus 1 - 3 centimeters.
The uterine fundus is at its highest level at 36 weeks of pregnancy, when the uterus reaches the diaphragm. The descent of the uterine fundus closer to 40 weeks is due to the fact that the fetal head descends into the pelvic cavity, which is typical for primiparous women. In multiparous women, this does not happen due to overstretched muscles of the abdominal wall, which do not put pressure on the uterus, as in primiparous women; as a result, the fundus of the uterus deviates slightly anteriorly. Thus, in primiparous women, the height of the uterine fundus at 32 and 40 weeks of pregnancy is the same.
Discrepancy between the height of the uterine fundus and the gestational age
As the fetus grows, the uterus grows, so the height of its fundus is determined higher every week. Until 28 weeks, the height of the uterine fundus increases by 1–2 cm per week, from 28 to 36 weeks – by 0.5–1.5 cm per week, and after 36 weeks by 0.2–0.5 cm per week. If there is no increase in height or, conversely, the uterus “rises” too quickly, then this situation is called a discrepancy between the gestational age and the height of the uterine fundus.
The discrepancy between the height of the uterine fundus and the gestational age is influenced by the following factors:
- maternal factors– width of the female pelvis, maternal illness, uterine pathology;
- fetal factors– fetal weight, amount of amniotic fluid, position of the fetus in the uterus, pathology affecting the fetus.
Reasons for discrepancy between the height of the uterine fundus and the gestational age
| The height of the fundus of the uterus “lags behind” by 2 centimeters or more | The height of the uterine fundus is measured 2 or more centimeters more than expected |
|
|
The most common reason for a discrepancy between the timing of pregnancy and the height of the uterine fundus is incorrect calculation. The approximate gestational age is determined by the date of conception or the date of the last menstrual period. Not all women monitor their menstrual cycle and the day of ovulation ( the day the egg is released in the middle of the cycle, when it is possible to conceive a child), the regularity of menstrual flow and cannot always accurately indicate the day when sexual intercourse supposedly took place, which led to conception and pregnancy. That is why, if a pregnant woman is registered not in the first, but in the second trimester of pregnancy, then there is a possibility of incorrectly calculating the due date.
Fetal body weight depends on genetic programs and is not always a sign of pathology. However, if the growth rate of the uterus lags or accelerates, doctors closely monitor such pregnant women.
The width of the pelvis also affects the height of the uterine fundus. In expectant mothers with a narrow pelvis, the uterus moves faster from the pelvic cavity, since the pelvis itself is often insufficient, and the uterus moves earlier due date begins to grow upward. With a wide pelvis, the uterus fits well into the pelvic cavity and is in no hurry to increase its size in length.
The amount of amniotic fluid affects the height of the uterine fundus, since the fluid helps to increase the size of the uterus. If amniotic ( amniotic) there is little fluid, the uterus grows more slowly, while with an excess volume of amniotic fluid, it is forced to stretch.
The position of the fetus in the uterus always affects the height of its fundus. The fundus of the uterus is high only if there is a large part of the fetus there ( head or buttocks with folded legs), that is, if the fruit is located longitudinally ( vertically). If the back of the fetus is located in the area of the uterine fundus, then this position is defined as transverse or oblique. With a transverse and oblique position of the fetus, the uterus grows wider, so the fundus is determined lower. At the same time, if by the end of pregnancy it is not the fetal head that is facing the vagina, but its buttocks or legs, then the uterus is higher than it should be.
To clarify the reason for the discrepancy between the height of the uterine fundus and the gestational age, the pregnant woman is prescribed an ultrasound.
Height of the uterine fundus and fetal body weight
The uterine fundal height parameter can be used to roughly estimate the weight of the fetus and to determine its full term. For this, the Jordania formula is used, according to which, if you multiply the height of the uterine fundus by the circumference of the pregnant woman’s abdomen, you will get the weight of the fetus. Abdominal circumference is also measured using a measuring tape and always at the level of the navel.
Height of the uterine fundus after childbirth
After childbirth, the uterus decreases in volume, its walls become thicker, the shape is spherical, and then gradually returns to pear-shaped. All these reverse changes are called uterine involution. The degree of involution of the uterus can be judged precisely by the height of its fundus, starting from the third stage of labor ( the period after the birth of the fetus until the separation and birth of the placenta) and throughout the entire postpartum period.
Immediately after the birth of the fetus, the uterus sharply decreases in volume and is located at the level of the navel. After the placenta separates from the wall of the uterus, its fundus rises above the navel and deviates to the right side. After the birth of the placenta, the uterus already contracts sharply and is located two transverse fingers below the navel. On the 1st day after birth, the uterine fundus is determined at the level of the navel or 13–15 centimeters above the pubic bone. Every day the fundus of the uterus drops by 1 - 1.5 centimeters. On the 5th day, the fundus of the uterus is located in the middle of the distance between the pubic bone and the navel, and already 2 weeks after birth the uterus again disappears behind the pubic bone.
If a pregnant woman had a higher uterine fundus height than expected for the duration of pregnancy, then, most likely, the processes of uterine involution in the postpartum period will proceed more slowly.
How to measure the height of the fundus of the uterus at home?
The procedure for measuring the height of the uterine fundus is simple and can be done at home by a woman herself. You need to measure the height using a centimeter tape. In the absence of a measuring tape, a woman can also use her fingers, placing them transversely on the front wall of the abdomen. Measurement using fingers is carried out taking into account the fact that 2 transverse fingers are equal to approximately 3 - 4 centimeters. Before measuring the height of the uterine fundus, you need to empty the bladder, since a full bladder can slightly push the uterus upward, in addition, this disrupts the process of palpating the uterine fundus.
When independently determining the height of the uterine fundus, a woman should do the following:
- lie down on a hard surface ( a soft mattress is not suitable, as the body will “sink” and the natural bulge of the pregnant uterus may become less pronounced);
- feel the pubic bone ( bone in the lower abdomen);
- palpate the fundus of the uterus, gradually rising from the pubis to the navel and higher ( the fundus of the uterus feels like a ridge with unclear contours);
- measure the distance between the pubis and the fundus of the uterus by placing the zero mark on the upper edge of the pubic bone.
Is it always possible to determine the gestational age based on the height of the uterine fundus?
Measuring the height of the uterine fundus is not an accurate method for determining the gestational age. The fundus of the uterus may not correspond to the duration of pregnancy, and may be determined above or below the required level during a normal pregnancy. There are many factors that influence the height of the uterine fundus. For obesity, diabetes mellitus at expectant mother, if there are several fetuses inside the uterus, the uterine fundus is determined higher. If the fetus in the uterus is not located vertically, but horizontally or diagonally, as well as with a small amount of amniotic fluid, a small weight of the baby, the fundus of the uterus is located lower than it should be at a specific stage of pregnancy.
Where should the uterine fundus be determined according to pregnancy?
The main landmarks by which you can easily determine the height of the uterine fundus and the approximate gestational age are the pubic symphysis ( the fusion site of the two pubic bones in the lower abdomen), the navel and the lower part of the sternum or xiphoid process. If the fundus of the uterus cannot be felt, then the pregnancy is less than 12 weeks. As soon as the fundus of the uterus begins to rise above the pubic symphysis, it can be palpated. The approximate gestational age in this case will be 13–14 weeks. If the fundus of the uterus is determined at the level of the navel, then it is already 24 weeks of pregnancy, and if above the navel - 28. At week 32, the fundus of the uterus is located almost in the middle between the navel and the sternum. The fundus of the uterus will be at this same level before childbirth, in the last 40 weeks of pregnancy. Between 32 and 40 weeks, the fundus of the uterus rises, almost reaching the sternum.
When is the height of the uterine fundus measured 15 centimeters above the womb?
If the fundus of the uterus is determined to be 15 centimeters above the womb ( pubic bone), this means that the fundus of the uterus is located approximately at the level of the navel. The fundus of the uterus has this level of height at 20–22 weeks of pregnancy. Also, at the level of the navel, the height of the uterine fundus is determined the next day after birth.
At what week of pregnancy does the height of the uterine fundus reach 38 centimeters?
The height of the uterine fundus is 38 cm and is determined approximately at 36 weeks of pregnancy. After this period, you should not expect an even greater rise in the fundus of the uterus. IN last month pregnancy, and especially in the last 2 weeks, the fundus of the uterus can be measured at the same level or even slightly lower than at 36 - 38 weeks. The fact is that closer to childbirth in primiparous women, the fetal head drops slightly and takes a position closer to the entrance to the pelvis and ceases to be mobile ( the doctor probes the already fairly fixed fetal head in the lower abdomen). In multiparous women, this may not happen if the abdominal wall muscles were significantly overstretched during previous pregnancies.
