Growth Assessment Protocol (GAP)                 GAP Gazette December 2021

The Perinatal Institute has put together a comprehensive programme which is offered to units already using the GROW software
and new units who now want to implement GROW. The following links give details of the programme: GAP SLA   
The following details the Perinatal Institute Terms of Service

GAP E-Learning

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

GAP Guidance

The GAP Care Pathway aligned with NHS Saving Babies Lives' Care Bundle version 2 is available here: GAP Guidance

Recent Publications

* NEW * Evaluating the Growth Assessment Protocol for
stillbirth prevention: progress and challenges                                                                          

* NEW * Prospective risk of stillbirth according to fetal size at term                                    

* 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                                                                        

GAP is based on the following key elements:

  1. Evidence based guidance 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 and benchmarking of performance


Further information - see MIDIRS article:     


GAP training - dates of forthcoming workshops are listed here.

GAP uptake - click here for a list of UK Trusts and Health Boards

Fundal Height Measurement - click here for video demonstration.

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   

Effect on Stillbirth

A co-ordinated growth assessment programme has reduced ONS stillbirth rates in three English regions with high uptake (West Midlands, Yorkshire & The Humber, North East). For detailed analysis, see BMJ Open 2013 and J Public Health 2014

The reduction is mainly in stillbirths with IUGR                             The Times Leading Article 

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According to the latest (2020) ONS figures, stillbirth rates in England have fallen consistently for 9 years to 3.80/1000.

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.

The recently published 10 year analysis of unit level ONS data in England showed that:

  • There was an overall decline, associated with better protocols & awareness
  • NHS Trusts that fully implemented the GAP programme achieved a larger reduction
  • Steepest drop was observed in GAP units with best SGA detection rates
  • The study also highlighted that there is much more room for improvement!