Growth Assessment Protocol (GAP)              

The Perinatal Institute offers GAP as a comprehensive program with a service level agreement which can be viewed here: GAP SLA

Our Terms of Service are set out here.

GAP Guidance

The GAP Care Pathway is aligned with and complementary to the Fetal Growth element of the NHS Saving Babies Lives' Care Bundle v3.
It is available here: GAP Guidance

See also our FAQ pages

GAP E-Learning

To access the E-Learning portal please use the following link:   GAP-Elearning

GAP is based on the following key elements:

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



GAP training:  dates of forthcoming workshops are listed here.

SFH - Standardised fundal height measurement video. 

GROW 2.0:  Upgrade to electronic chart and recording system

Recent abstracts presented by the Perinatal Institute:

BMFMS April 2024:

RCOG June 2023:


Accuracy of antenatal ultrasound in predicting large-for-gestational-age babies: population-based cohort study.
Am J Obstet Gynecol. 2024;S0002-9378(24):00578–7.
Fetal size vs growth: comparative analysis of 3 models of growth velocity based on third trimester estimated fetal weights for identifying stillbirth risk.
Am J Obstet Gynecol. 2023;S0002-9378(23):02188–9.
Stillbirth risk and SGA according to Hadlock, Intergrowth-21st, WHO and GROW fetal weight standards:
analysis by maternal ethnicity and BMI.
Am J Obstet Gynecol. 2023;229(5): 547.e1-547.e13.
Outcome-based comparative analysis of five fetal growth velocity models to define slow growth
Ultrasound Obstet Gynecol. 2023;62(6):805-12
Evaluating the Growth Assessment Protocol for stillbirth prevention: progress and challenges
J Perinatal Med. 2022;50(6): 737-47.
Reduction of stillbirths in England from 2008 to 2017 according to uptake of the Growth Assessment Protocol:
10‐year population‐based cohort study
Ultrasound Obstet Gynecol. 2021;57:401-8
Prospective risk of stillbirth according to fetal size at term
J Perinatal Med. 2022;50(6): 748-52.
A fetal weight projection model to define growth velocity, and validation against pregnancy outcome in a cohort of serially
scanned pregnancies
Ultrasound Obstet Gynecol. 2022;60(1):86-95.
Customized GROW vs INTERGROWTH-21st birthweight standards to identify small for gestational age associated perinatal
outcomes at term
Am J Obstet Gynecol MFM. 2022;4(2):100545.
Customized growth charts: rationale, validation and clinical benefits
Am J Obstet Gynecol. 2018;218(2S):S609-18.
Fetal growth surveillance – Current guidelines, practices and challenges
Ultrasound. 2018;26(2):69-79.
Customised vs INTERGROWTH-21st birthweight standards to identify small for gestational age associated
perinatal outcomes at term
Am J Obstet Gynecol. 2018;218(2S):S692-9.
Preventing stillbirths through improved antenatal recognition of pregnancies at risk due to fetal growth restriction
Public Health 2014; 128:698-702
Association between reduced stillbirth rates in England and regional uptake of accreditation training in customised fetal
growth assessment
BMJ Open 2013;3:e003942
The Growth Assessment Protocol: a national programme to improve patient safety in maternity care
MIDIRS, 2013; 23:516-23
Tackling Stillbirth: simple and cheap techniques could save hundreds of babies a year
The Times Leading Article 18.12.2013

ONS stillbirth rates in England

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According to ONS figures, stillbirth rates in England have fallen consistently
for 9 years to their lowest point of 3.80/1000 in 2020. This represents a 29.0% reduction from the 2000-09 (10 year) average of 5.35, and equates to 1,022 babies saved per year.

Our 10 year, unit level analysis ( showed

  • an overall decline, associated with better protocols and awareness;
  • Trusts that fully implemented the GAP programme achieved a larger reduction; and
  • the steepest drop was observed in GAP units with the highest SGA detection rates

There was a flattening of the downward trend during the pandemic in 2020 and a sharp increase in 2021. In 2022, stillbirth rates started to fall again and returned to pre-pandemic levels at 3.93/1000.