Growth Assessment Programme (GAP) New Zealand

As part of a national strategy to reduce neonatal encephalopathy, the Accident Compensation Commission (ACC) have commissioned the Perinatal Institute (PI) to offer the comprehensive GAP programme to all District Health Boards (DHBs). Content of the programme has been adapted for New Zealand following advice from the New Zealand College of Midwives (NZCOM) and Professor Lesley McCowan, an international expert in SGA. GAP SLA
The following details the GAP programme and PI Terms of Service:  Terms of service

Recent Publications

* NEW * A fetal weight projection model to define growth velocity, and validation against pregnancy outcome in a cohort of serially scanned pregnancies       
* NEW * Customized GROW vs INTERGROWTH-21st birthweight standards to identify small for gestational age associated perinatal outcomes at term         
Reduction of stillbirths in England from 2008 to 2017 according to uptake of the Growth Assessment Protocol: 10‐year population‐based cohort study       
Customized growth charts: rationale, validation and clinical benefits       
Fetal growth surveillance – Current guidelines, practices and challenges       
Customised vs INTERGROWTH-21st standards               
Neonatal morbidity and small and large size for gestation: a comparison of birthweight centiles    


GAP is based on the following key elements:

  1. Evidence based guidelines and risk assessment algorithms
  2. Education and accreditation of all staff involved in clinical care
  3. Implementation of customised GROW chart and audit tool
  4. Rolling audit and benchmarking of performance

Further information - see MIDIRS article:   


GAP Education - dates of forthcoming workshops are listed here.

Fundal Height Measurement - click here for video demonstration. (Enter password “measureright”).

Lecture - click here to view a presentation by Prof Jason Gardosi on Preventing Stillbirth: A National Campaign on 1/7/2016 


• Most 'unexplained' stillbirths were growth restricted    • Customised charts and appropriate protocols should be used   
• Most stillbirths with IUGR are avoidable    • Standardised FH measurement and referral improves detection      
• A/N detection improves outcome and reduces SB    • In high risk pregnancy, serial scans improve detection   


Education in GAP is provided in two ways:

• A 3-hour workshop which covers risk assessment for SGA and appropriate care planning, standardised fundal height measurement, use of gestation related optimal growth (GROW) charts, referral for growth scanning, interpretation of scan findings and management once SGA is suspected/diagnosed. The programme is multidisciplinary, and encourages discussion between midwives, obstetricians and sonographers.

• An e-learning module is available and GAP users are encouraged to complete e-learning on an annual update. The login and password for e-learning is provided by the PI on request via email. Please provide details of name, clinical role, midwifery or medical council number and affiliated DHB to

New Zealand GAP lead educators - Joyce Cowan and Clare Senner lead GAP workshops and work with a team of champions who are funded to work in their respective DHBs to provide support and cascade education following implementation of the programme.

Flexible Image

New Zealand GAP leads - Joyce Cowan & Clare Senner