FAQs

A - Customised Charts
 1. Use of charts
 2. Centile lines
 3. Previous birth-weights
 4. Late booking
 5. Population charts
 6. Twins
 7. Ethnicity
 8. Lost charts
 9. Maternal weight
10. Surrogacy
B - FH measurements
C - Ultrasound
D - Post/Neonatal
E - Technical queries

Customised Charts (Charts and Chart Generation)

A1 What’s the use of customised growth charts?
Customised charts predict the growth potential of each baby and display the gestation related optimal weight (GROW) curves. This is done by adjusting for known constitutional / physiological variables (maternal height, weight, ethnic origin and parity), and excluding pathological factors such as smoking and diabetes. As a result, GROW charts are better at identifying pathological growth and confirming when growth is normal than any population based chart. For further information, please see www.gestation.net/literature.htm
A2 What do the lines on the chart signify?
The middle line (50th centile) is the optimal growth curve, which goes through the ‘Term Optimal Weight’ (TOW) point at 40 weeks. The upper and lower lines show the 90th and 10th centile limits, respectively, for fetal weight. The curves can also be used to plot the slope of fundal height measurements. With any assessment of growth, the slope of serial measurements is more important than individual points.
A3 Do previous birth weights affect the centile lines on the chart?
No, but it is important to input previous baby weights so that the software can display centiles for each baby, to assist risk assessment in the current pregnancy.
A4 Do I need to generate a GROW chart for a woman who books at 30 weeks gestation?
Yes, and the entry of her weight will be an approximation (unless her pre- or early pregnancy weight is known). In any case, late bookers should be considered for serial scans as the accuracy of the gestational age and EDD is likely to be poor.
A5 The electronic system in the GP surgery where I am based shows a population based fundal height chart. Many GPs do not have training in the use of customised charts they are falsely reassured by this information. Help!
It is vital that all clinicians providing antenatal care for women are trained and competent in the use of standardised fundal height measurement and plotting on the mother’s own customised growth chart. One size does not fit all – the chart needs to be adapted to the characteristics of the pregnancy.
A6 Can I use a customised growth chart for twins?
Yes – optimal growth in twins is similar to singletons until 37 weeks, which represents the EDD for twins [1]. The chart should be used for serial EFWs only, as fundal height measurements are not reliable in twins. Both babies can be plotted on the same chart.
  1. Gardosi J, Kady S, Francis A. Intrauterine growth in twin pregnancies. 2005;27(5): 163-166. ISSN 1971-1433 http://eprints.bice.rm.cnr.it/4881/1/article%2870%29.pdf
For Perinatal Institute response to the TAMBA twin growth charts, please see here
A7 Ethnicity is often associated with social deprivation. How do you know that it is valid to adjust for ethnic origin?
The GROW method for calculating growth potential considers other factors, including index of multiple deprivation (IMD), and calculates the differences in growth and birth weight which still exist AFTER excluding pathological factors as well as social deprivation [1].
There is other evidence that standards should be adjusted for ethnic variation, from the UK [2], US [3] and Canada [4,5]:
  1. Gardosi J. Ethnic differences in fetal growth. Ultrasound Obstet Gynecol. 1995 Aug;6(2):73-4
  2. Seaton SE, Yadav KD, Field DJ, Khunti K, Manktelow BN. Birthweight centile charts for South Asian infants born in the UK. Neonatology. 2011;100(4):398-403. doi: 10.1159/000325916
  3. Alexander GR, Kogan MD, Himes JH, Mor JM, Goldenberg R. Racial differences in birthweight for gestational age and infant mortality in extremely low risk US populations. Paediatr Perinat Epidemiol 1999;13:205–17.
  4. Kierans W, Joseph K, Luo ZC, Platt R, Wilkins R, Kramer M. Does one size fit all? The case for ethnic-specific standards of fetal growth. BMC Pregnancy Childbirth 2008;8:1.
  5. Hanley GE, Janssen PA. Ethnicity-specific birthweight distributions improve identification of term newborns at risk for short-term morbidity. Am J Obstet Gynecol 013;209(5):428.e1– doi: 10.1016/j.ajog.2013.06.042
A8 Can I reproduce a chart if it is lost or damaged during the antenatal period?
As no patient identifiers are retained/saved during chart production, it is not possible to recall or reproduce a chart, even if the chart ID number is known. If a chart is lost or damaged it must be reproduced.
A9 When calculating the previous baby centiles the GROW-App uses the mother’s weight for the current pregnancy; what should we do if there was a significant weight difference between pregnancies?
If you feel the mothers weight was substantially different – say more than 10 kg – then this will affect the accuracy of the birthweight centile of the babies on the GROW chart. In this case you can recalculate the previous centile entering the previous maternal weight, using our individual centile calculator which is available from grow@perinatal.org.uk
A10 How do we produce a customised chart for a surrogate mother, or when a donor egg is used?
In all circumstances it is the characteristics of the host mother that is used to produce the customised growth chart.

FAQs

A - Customised Charts (Charts and Chart Generation)

A1 What’s the use of customised growth charts?
Customised charts predict the growth potential of each baby and display the gestation related optimal weight (GROW) curves. This is done by adjusting for known constitutional / physiological variables (maternal height, weight, ethnic origin and parity), and excluding pathological factors such as smoking and diabetes. As a result, GROW charts are better at identifying pathological growth and confirming when growth is normal than any population based chart. For further information, please see www.gestation.net/literature.htm
A2 What do the lines on the chart signify?
The middle line (50th centile) is the optimal growth curve, which goes through the ‘Term Optimal Weight’ (TOW) point at 40 weeks. The upper and lower lines show the 90th and 10th centile limits, respectively, for fetal weight. The curves can also be used to plot the slope of fundal height measurements. With any assessment of growth, the slope of serial measurements is more important than individual points.
A3 Do previous birth weights affect the centile lines on the chart?
No, but it is important to input previous baby weights so that the software can display centiles for each baby, to assist risk assessment in the current pregnancy.
A4 Do I need to generate a GROW chart for a woman who books at 30 weeks gestation?
Yes, and the entry of her weight will be an approximation (unless her pre- or early pregnancy weight is known). In any case, late bookers should be considered for serial scans as the accuracy of the gestational age and EDD is likely to be poor.
A5 The electronic system in the GP surgery where I am based shows a population based fundal height chart. Many GPs do not have training in the use of customised charts they are falsely reassured by this information. Help!
It is vital that all clinicians providing antenatal care for women are trained and competent in the use of standardised fundal height measurement and plotting on the mother’s own customised growth chart. One size does not fit all – the chart needs to be adapted to the characteristics of the pregnancy.
A6 Can I use a customised growth chart for twins?

Yes – optimal growth in twins is similar to singletons until 37 weeks, which represents the EDD for twins [1]. The chart should be used for serial EFWs only, as fundal height measurements are not reliable in twins. Both babies can be plotted on the same chart.

  1. Gardosi J, Kady S, Francis A. Intrauterine growth in twin pregnancies. 2005;27(5): 163-166. ISSN 1971-1433 http://eprints.bice.rm.cnr.it/4881/1/article%2870%29.pdf
For Perinatal Institute response to the TAMBA twin growth charts, please see here
A7 Ethnicity is often associated with social deprivation. How do you know that it is valid to adjust for ethnic origin?
The GROW method for calculating growth potential considers other factors, including index of multiple deprivation (IMD), and calculates the differences in growth and birth weight which still exist AFTER excluding pathological factors as well as social deprivation [1].
There is other evidence that standards should be adjusted for ethnic variation, from the UK [2], US [3] and Canada [4,5]:
  1. Gardosi J. Ethnic differences in fetal growth. Ultrasound Obstet Gynecol. 1995 Aug;6(2):73-4
  2. Seaton SE, Yadav KD, Field DJ, Khunti K, Manktelow BN. Birthweight centile charts for South Asian infants born in the UK. Neonatology. 2011;100(4):398-403. doi: 10.1159/000325916
  3. Alexander GR, Kogan MD, Himes JH, Mor JM, Goldenberg R. Racial differences in birthweight for gestational age and infant mortality in extremely low risk US populations. Paediatr Perinat Epidemiol 1999;13:205–17.
  4. Kierans W, Joseph K, Luo ZC, Platt R, Wilkins R, Kramer M. Does one size fit all? The case for ethnic-specific standards of fetal growth. BMC Pregnancy Childbirth 2008;8:1.
  5. Hanley GE, Janssen PA. Ethnicity-specific birthweight distributions improve identification of term newborns at risk for short-term morbidity. Am J Obstet Gynecol 013;209(5):428.e1– doi: 10.1016/j.ajog.2013.06.042
A8 Can I reproduce a chart if it is lost or damaged during the antenatal period?
As no patient identifiers are retained/saved during chart production, it is not possible to recall or reproduce a chart, even if the chart ID number is known. If a chart is lost or damaged it must be reproduced.
A9 When calculating the previous baby centiles the GROW-App uses the mother’s weight for the current pregnancy; what should we do if there was a significant weight difference between pregnancies?
If you feel the mothers weight was substantially different – say more than 10 kg – then this will affect the accuracy of the birthweight centile of the babies on the GROW chart. In this case you can recalculate the previous centile entering the previous maternal weight, using our individual centile calculator which is available from grow@perinatal.org.uk
A10 How do we produce a customised chart for a surrogate mother, or when a donor egg is used?
In all circumstances it is the characteristics of the host mother that is used to produce the customised growth chart.

B - Fundal Height (Fundal Height Measurement and Plotting)

B1 Why can we not use the conventional rules and charts for fundal height?
As is the case with fetal weight, the growth of the uterine fundus also varies with pregnancy characteristics. The old rule of [gestational age in weeks] = [fundal height in cm] is simply not true, and acceptance of a normal range of +/- 2 or 3 cms is unsafe if not dangerous, as a fetus not growing for up to 6 weeks could be passed as normal.
B2 Why do you call it ‘fundal height’ (FH) if the usual term is symphysio-fundal height (SFH)?
The easiest and most accurate way to measure the size of the uterus is to have both hands free for palpation to determine the precise location of the fundus; the beginning of the tape can be fixed there with one hand, and the other hand then takes the tape downwards for the relatively easy task of finding the top of the symphysis pubis. Thus the recommended measurement is from the variable point to the fixed point. Symphysio-fundal height is a misnomer as it suggests that the measurement is done the wrong way around.
B3 Is it ok to start fundal height measurements from 25 weeks as we have an appointment then?
The Perinatal Institute recommends starting at 26-28 weeks. Measurements can be made earlier to coincide with appointments, but the normal range gets narrower the earlier the gestational age, and this can increase the false positive rates and result in unnecessary maternal anxiety.
B4 Why does the chart start at 24 weeks when you do not recommend fundal height measurements until 26-28 weeks?
The chart starts at 24 weeks so that estimated fetal weights (EFW) can be plotted from this gestation, as some women with increased risk factors will commence serial scans from 24 weeks.
B5 When there is a mal-presentation, how would you perform the fundal height measurement?
Regardless of the presentation of the fetus, the fundal height measurement should be performed using the standardised fundal height technique and referral made for an ultrasound scan if the plotted measurement does not follow the expected trajectory of growth.
B6 Why is it important for the woman to have an empty bladder when measuring fundal height?
A full bladder can lift the uterus up and would therefore give a false fundal height measurement.
B7 If a woman is seen in the day assessment unit for whatever reason and she has had her fundal height measured within the last two weeks, should she be re-measured?
Apart from the investigations indicated by the clinical picture, we recommend measurements to be spaced 2-3 weeks apart, allowing time for growth, and preferably by the same person to reduce inter-observer variation.
B8 Should I undertake a fundal height measurements if a woman is admitted with spontaneous rupture of membranes?
While there is little available evidence, we consider fundal height measurements as useful in pre-labour SROM, as the amount of fluid lost is usually small and unlikely to affect the measurement significantly. Most of the liquor tends to get reconstituted but the presence of oligohydramnios is an indication for ultrasound scan assessment.
B9 What do we do if the fundal height measurement pattern has changed when measured on admission in labour, especially in a midwifery led care environment?
Fundal height measurement at the onset of labour is part of routine assessment and should be recorded in the Birth (Labour) Notes. It is unusual for the fundus to ‘drop’ with head engagement and/or rupture of membranes, and a low fundal height measurement should raise the suspicion of ?FGR and be an indication for review.
B10 Do we need to take into account descent of the head when plotting fundal height?
Even as the head engages the height of the uterine fundus should continue to grow until delivery, and there is no flattening of the fundal height curve at term. If the measurements suggest static growth, a referral should be made for an ultrasound scan to assess fetal well being.
B11 Should fundal height measurements be continued when a mother has serial scans?
If serial scans are done according to recommended frequency (3 weekly until delivery), fundal height measurement and plotting is not required.
B12 We seem to have a lot of referrals for scans based on SFH
We have observed that this happens in units where staff had insufficient training in measurement technique and protocols - see article (MIDIRS). Common reasons for unnecessary referrals include:
  • not using standardised fundal height measurement technique;
  • not plotting against the actual gestational age;
  • assuming measurement in cm should equal gestational age in weeks;
  • first fundal height plot above 90th ;
  • consecutive measurements above 90th or below 10th centile line, even though they show normal growth I.e. slope is parallel to growth curves on chart.
A controlled trial (BJOG) showed that fundal height measurements plotted on customised charts and appropriate referral pathways do not increase the need for scans but REDUCE it because of fewer unnecessary referrals, while FGR detection rates are increased.
B13 GAP training suggests that we should be completing fundal height measurements every 2 to 3 weeks. However according to NICE guidelines multiparous women should not have a scheduled antenatal appointment between 28 and 34 weeks. What should we do?
Based on case reviews of stillbirths, we believe that, from the fetus’ perspective, and appropriate monitoring of fetal growth in the third trimester, a six week gap is too long. We therefore recommend an additional visit and assessment at 31 weeks.
B14 When I make a referral following a concern from a fundal height measurement my colleagues/obstetrician will re-measure the fundal height to decide if an ultrasound is required. What should I do?
When all staff have been trained to use a standardised technique of fundal height measurement and have completed a competency assessment, there should be direct referral for an ultrasound scan to assess fetal wellbeing with an estimated fetal weight and or liquor volume /Doppler studies. The estimated fetal weight measurement should be plotted on the customised growth chart and a plan made accordingly.
B15 If the fundal height measurements are plotting above the 90th centile, does this mean the baby is large for dates and does this indicate the need for a growth scan?
Fundal height measurements include skin and subcutaneous fat as well as the uterus and its contents, and should NOT be equated with fetal weight. If however growth is accelerating, i.e. steeper than the normal fundal height curves on the chart, then further tests including a scan (for EFW) and a GTT may be indicated, according to local protocol.

See here for examples.

B16 What is slow growth, and how many crossed centiles does it represent?
There is to our knowledge no evidence based definition of slow growth. Instead, we recommend using the 90th and 10th centile lines as the upper and lower limits to define ’normal growth’, and visual assessment as to whether the plotted sequential measurements follow a curve, the slope of which is within the 90th and 10th centile line ‘slope limits’. This applies to measurements of fundal height (FH) as well as estimated fetal weight (EFW).

We avoid using the term ‘crossing centiles’ as this is often misinterpreted as crossing one of the three lines on the customised growth chart (90th, 50th and 10th). A drop from 45th to 15th centile can be significant yet crosses neither of these lines.

C - Ultrasound (Scans and Resources)

C1 Our Trust is worried that introduction of customised charts will put an excessive load on scan resources

GROW charts used by properly trained staff do not increase scan requirements in low risk pregnancies. (see B10)

Increased demand on ultrasound resources is usually a result of raised awareness of the need for serial scanning in pregnancies at increased risk, as recommended by the 2013 RCOG guidelines. The additional demand depends on the current unit policies. Approximately 25-30% of pregnancies have an increased risk of SGA and stillbirth, and case reviews have shown that lack of appropriate surveillance in high risk pregnancies is frequently associated with avoidable deaths.

A cost benefit analysis to help maternity units formulate a business case for increased resources is available here.

C2 How should fetal growth be assessed in a mother who has had a previous small for gestational age baby?
This mother is at increased risk of having another SGA baby; she requires serial ultrasound assessment (3 weekly until delivery) as per RCOG guidelines.
C3 Our ultrasound department does not accept referrals for scans at term because they say it is not accurate - what shall I do?
Scans for EFW after 37 weeks are at least as accurate as before 37 weeks, with over 70% being within +/- 10%. – see Francis et al, ADC-FNN 2011
C4 How does engagement of the fetal head affect calculation of the EFW?
If head circumference or biparietal diameter cannot be measured accurately because it is too deep in the pelvis, an accurate EFW can also be calculated by a formula which uses abdominal circumference and femur length alone (e.g Hadlock 2).
C5 Should we still be using individual biometry ultrasound charts for assessing fetal growth?
Individual parameters should be recorded but plotting them on charts held by mothers can be confusing as we do not have individually customisable charts for HC, AC, FL etc, and population based ‘one size fits all’ charts do not reflect actual growth in a multicultural population. In contrast EFW charts can be adjusted according to individual pregnancy characteristics.
C6 If the EFW is below the 10th centile but the population based individual biometry is within normal ranges, what should we do?
Customised EFW is more accurate and is better able to distinguish between normal and pathological growth. Individual parameters cannot be customised (see C5, above).
C7 I am a community midwife, if I identify a growth problem with a woman I cannot refer directly for scan, but have to refer to a consultant clinic for review. Sometimes the woman will be referred back to me without a scan, sometimes she will be scanned but I feel the delay in getting the scan is unacceptable. What can I do?
Discuss this with your manager. If a clinician with the appropriate training makes a referral because of concerns about the fundal height measurement, we recommend that the measurement should not be repeated and the mother be referred directly and expeditiously for an ultrasound scan to assess fetal growth.
C8 My Trust can only afford to carry out one scan at 34 weeks for obese women. How should I monitor growth for the rest of the pregnancy?
Mothers with a BMI>35 should receive serial (at least 3 weekly) third trimester scans until delivery, as recommended by the RCOG Green Top guidelines. Fundal height measurements are unreliable in mothers with an increased BMI.
C9 What is slow growth, and how many crossed centiles does it represent?
There is to our knowledge no evidence based definition of slow growth. Instead, we recommend using the 90th and 10th centile lines as the upper and lower limits to define ’normal growth’, and visual assessment as to whether the plotted sequential measurements follow a curve, the slope of which is within the 90th and 10th centile line ‘slope limits’. This applies to measurements of fundal height (FH) as well as estimated fetal weight (EFW).

We avoid using the term ‘crossing centiles’ as this is often misinterpreted as crossing one of the three lines on the customised growth chart (90th, 50th and 10th). A drop from 45th to 15th centile can be significant yet crosses neither of these lines.
C10 Is there any evidence regarding routine third trimester scan to detect SGA or FGR?
Antenatal detection of late onset fetal growth restriction remains a challenge. There is wide variation in current ultrasound scan regimes which include a last assessment at 34, 35 or 36 weeks’ gestation. We have recently looked at the sensitivity of 34-36 weeks scan in detecting SGA at birth and found it to range between 19% and 36%. We looked at the LAST scan done, regardless of indication, and performance was poor – probably because
  • One-off scans are a spot check only, and cannot provide information on growth trajectory.
  • Most fetal growth restriction (FGR) is late onset, so may not manifest at the time of the scan. Most instances of small for gestational age (SGA) in fact occur at term.
The SGA detection rate is probably even lower in the general, unselected population. The Cochrane Review states unequivocally that ‘There is no evidence that routine ultrasound in late pregnancy improves perinatal outcomes’ http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001451.pub4/full

The ‘one off’ scan is an inefficient use of resources in light of the chronic ultrasound shortages in the NHS. The focus should be to ensure that we have sufficient resources so that mothers with pre-existing risk of FGR get serial scans, as recommended by RCOG guidelines and the NHS Saving Babies’ Lives care bundle. Therefore, a routine scan in the third trimester is ineffective due to poor detection rate, and potentially dangerous due to false reassurance.
C11 How do customised centiles perform in the identification of macrosomia?
Macrosomia represents a risk for shoulder dystocia and adverse outcome for baby and mother. Various ways have been used to define macrosomia over the years, including >4kg, >4.5 kg, or > 90th or 95th population based centile. We recommend using >90th customised GROW centile, based on recent studies that have shown that customised centiles improve the identification of macrosomia that is associated with pathological outcome:

  1. Adam, S, Lombaard, H. A. D, Zyl, D.G. van. Are we missing at-risk babies? Comparison of customised growth charts v. standard population charts in a diabetic population. South Afr. J. Obstet. Gynaecol. 2014; 20, 88–90.
  2. Cha, H.H, Kim, J.Y, Choi, S.J, Oh, S.Y, Roh, C.R, Kim, J.H. Can a customized standard for large for gestational age identify women at risk of operative delivery and shoulder dystocia? J. Perinat. Med. 2012; 40, 5, 483-488.
  3. Larkin, J.C, Speer, P.D, Simhan, H.N. A customized standard of large size for gestational age to predict intrapartum morbidity. Am. J. Obstet. Gynecol. 2011;204, 499.e1-499.e10.
  4. Narchi H, Skinner A. Infants of diabetic mothers with abnormal fetal growth missed by standard growth charts J Obstet Gynecol 2009;29(7): 609-613
  5. Pasupathy, D, McCowan, L.M.E, Poston, L, Kenny, L.C, Dekker, G.A, North, R.A, SCOPE consortium. Perinatal Outcomes in Large Infants Using Customised Birthweight Centiles and Conventional Measures of High Birthweight: Perinatal outcomes in large infants. Paediatr. Perinat. Epidemiol. 2012; 26, 543–552.

D - Postnatal and Neonatal

D1 At my Trust we use 2500g as our cut off for postnatal monitoring of growth restricted babies rather than below the 10th centile as we do not want to medicalise care for healthy babies. Is this appropriate?
Since gestational age is now routinely determined at the beginning of each pregnancy, the 2.5 kg cut off is no longer useful, as it mixes up smallness due to immaturity, constitutional factors, and growth restriction. The term ‘small for gestational age’ (SGA) gets around this problem by adjusting the fetal or neonatal size according to the gestational age, with the usual cut-off being the 10 centile, and this limit is further refined by using the customised GROW (gestation related optimal weight) standard. See RCOG Green Top guidelines
D2 We have implemented GROW and use customised centiles to assess whether the birthweight is SGA. However our neonatologists use the WHO standard to screen for SGA as a risk factor for hypoglycaemia. The two assessments are often out of sync. Which one should we use?
The UK-WHO standard, as used in the parent held Red Book for neonates, is an internationally derived population reference which does not adjust for individual constitutional factors that affect the normal range of birthweight, as recommended by the RCOG. Various studies have shown that a customised standard is better in defining babies at risk of perinatal mortality and morbidity [1-5]. A recently completed comparative analysis with the UK-WHO standard (to be submitted for publication) has shown that the customised GROW standard identifies a third more cases that are at significantly increased risk of low Apgar scores, admissions to the neonatal unit, and perinatal mortality.
  1. Clausson B, Gardosi J, Francis A, Cnattingius S: Perinatal outcome in SGA births defined by customised versus population-based birthweight standards BJOG 2001 108:830-4
  2. McCowan L, Harding J, Stewart A (2005) Customised birthweight centiles predict SGA pregnancies with perinatal morbidity BJOG 2005; 112: 1026-1033
  3. Figueras F, Figueras J, Meler E, Eixarch E, Coll O, Gratacos E, Gardosi J, Carbonell X: Customised birthweight standards accurately predict perinatal morbidity Arch Dis Child Fetal Neonatal Ed 2007; 92:277-80
  4. Gardosi J, Francis A. Adverse pregnancy outcome and association with smallness for gestational age by customised and population based birthweight percentiles. AmJObstetGynecol 2009;201:28.e1-8
  5. Odibo A, Francis A, Cahill A, Macone G, Crane J, Gardosi J Association between pregnancy complications and small-for-gestational-age birth weight defined by customised fetal growth standards versus a population-based standard J Maternal Fetal Neonatal Med 2011;24:411-7
D3 How do we calculate a customised birth weight centile?
The customised birth weight centile is calculated using any of the GROW software options (GROW-App, GROW-Centile of GROW-API). The date of birth, gender and birth weight of the baby is entered. If your hospital is using the GROW-App or GROW-API it will also ask you some additional questions:
  • Unit responsible for providing antenatal care
  • Outcome (whether the baby was a live birth or stillbirth)
  • Referral for suspected fetal growth restriction, based on fundal height measurement(s)
  • Detection of small for gestational age or fetal growth restriction (based on ultrasound scan)
This information is used to provide individual Trusts/hospitals with reports on FGR, referral and detection rates.
D4 We plot the birth weight onto the GROW chart to identify the birthweight centile- is this accurate?
Plotting the birthweight on to the chart will demonstrate a birthweight centile, however this can be calculated more accurately using the GROW web application software. The software also prompts a record whether a referral was made for a scan following a fundal height measurement due to suspicion of fetal growth restriction, and if growth restriction was detected on scan. This information is then used to produce quarterly reports on baseline SGA rates, referral and detection rates, and allows bench marking against the GAP user average.
D5 How do I calculate birthweight centiles in a twin pregnancy?
There are 2 options for how your trust can approach the centile calculation for twin 2. Either:
  • At booking produce a second chart using the identical maternal characteristics including parity. The chart number can be noted and documented in an agreed place for the second centile to be calculated at delivery. This chart does not need to be printed out and is not used during the pregnancy.
    Or,
  • At delivery, a second chart can be produced using the identical maternal characteristics as at booking including parity (do not add parity for twin 1). This chart ID can now be used to calculate the centile for twin 2.
Do not ‘over-write’ twin 1’s details on the centile page to calculate twin 2, this will affect your trust reports.

E - Technical Queries

E1 How do we print Trust specific information on the back of the GROW chart?
Simply put the GROW Chart into the printer the opposite way and print the required information. Be aware that different printers print on different sides of the page so please ensure you know which way to place the paper before printing. See the‘signs to look out for’ information poster that has been developed by Mama Academy that is available, should you wish to use it. To view, click here
E2 The chart is printing over more than one page.
This could be a problem with the way margins or scaling is setup on your computer and/or printer. Contact your local IT for support.
E3 What do I do if there is an error message when I try to print the chart?
Take a screenshot of the error and send to gap@perinatal.org.uk
E4 Can we change the layout of the chart or make some sections larger?
No, the chart is in a standard format for all users.
E5 The print is poor quality/not very clear when we produce the chart
Try unticking the “Greyscale” option for the chart, located under the chart image in the Grow-App.

  • If you are still having problems it could be due to an issue with your printer or the way the printer is setup on your computer. Contact your local IT for support.
  • If you are having problems with the GROW-App, we may ask you to send us a screenshot of what you are seeing. Click here to a view guide on taking a screenshot.
E6 The GROW-App does not fit on my screen properly?
This may be an issue with your computer resolution or the zoom setting within your browser. Contact your local IT for support.
E7 How do we put a shortcut to the GROW-App on to the desktop?
Click here to view guide on creating shortcuts.