What should fundal height be at 14 weeks

Headaches can be common, and may be related to hormone changes in pregnancy. If you have headaches which are not relieved with Tylenol, fluids and rest, talk with your healthcare professional. Be sure to seek medical care if you are experiencing any visual changes.

Between weeks 15 and 18, certain tests can be done to rule out congenital abnormalities. These include non-invasive blood tests as well as amniocentesis. While this is the usual period during which amniocentesis occurs, it can be carried out at any time after your first trimester.

This is a test that involves drawing out in an injection some of the amniotic fluid that surrounds a fetus. Around three teaspoons tbsp of amniotic fluid is removed and tested.

While amniocentesis does carry a risk of miscarriage, this is between 1 in every and cases. Genetic screening is often recommended in high-risk pregnancies, such as those in women over the age of 35 years. Your doctor will review with you the different blood tests available versus amniocentesis, and help you choose the option best for you. Babies at this age have also been seen sucking their thumbs on ultrasound pictures.

Your healthcare provider will begin measuring your fundus, or fundal height, at your prenatal appointments. This is the distance between the top of your pubic bone and the top of your uterus. Larger clinics where you are not ensured to see the same provider on a continual basis may chart this to measure growth. It can also give insight into the position of the baby.

An elevated fundal height can indicate breech presentation, while a smaller fundal height can indicate a sideways position.

An ultrasound or pelvic examination can confirm these. Many women have questions about sleeping positions during pregnancy. It is best to begin sleeping on your side. This is the most comfortable and healthy sleeping position. Sleeping on your back causes your uterus to place pressure on the aorta and inferior vena cava, which supplies blood to your lower body and the baby. How many weeks pregnant is the woman in each case, based on the finger method of measuring fundal height shown in Figure In Figure The measurement in Figure Look at your own hands.

Because of the big variation in the thickness of our fingers, there could be up to three weeks difference between the fundal height measurement of the same woman made by two different people. Even if the same health worker measures the fundal height of the same woman several times on the same day, the answer may be different each time, because the finger method is not very precise. Finally, you might have realised that the distance between the symphysis pubis pubic bone and the umbilicus bellybutton varies between women when they are not pregnant, and this variation affects the accuracy of the fundal height measurement using the finger method.

To overcome these limitations, it is recommended that you measure fundal height using a soft tape measure if you have one, as described next. During the second half of pregnancy, the size of the uterus in centimetres is close to the number of weeks that the woman has been pregnant.

For example, if it has been 24 weeks since her last normal menstrual period, the uterus will usually measure cm. The uterus should grow about 1 cm every week, or 4 cm every month. Doctors, nurses and many midwives are taught to count pregnancy by weeks instead of months.

They start counting at the first day of the last normal menstrual period LNMP , even though the woman probably got pregnant two weeks later.

Counting this way makes most pregnancies 40 weeks long or you can say a normal gestation is 40 weeks. If you are measuring correctly and you do not find the top of the uterus where you expect it to be, based on the date the woman gave you for her LNMP, it could mean three different things:.

There are several reasons why a due date figured from the LNMP could be wrong. Sometimes women do not remember the date of their LNMP correctly. Sometimes a woman misses her menstruation for another reason, and then gets pregnant later. This woman could really be less pregnant than you thought, so the uterus is smaller than you expect.

Or sometimes a woman has a little bleeding after she gets pregnant. If she assumed that was her LNMP, this woman will be one or two months more pregnant than you thought. The uterus will be bigger than you expect. Remember due dates are not exact. Women often give birth up to 2 or 3 weeks before or after their due date. This is usually safe. If the due date does not match the size of the uterus at the first visit, make a note.

Wait and measure the uterus again in two to four weeks. If the uterus grows about two finger-widths or 1 cm a month, the due date that you got from feeling the top of the uterus is probably correct.

The due date you got by counting from the LNMP was probably wrong. If the uterus grows more than 2 finger-widths a month, or more than 1 cm a week, several different causes are possible:. If you think there might be twins, even if you can find only one heartbeat, refer the woman to the nearest health centre. It can be very difficult to know for sure that a mother is pregnant with twins. Signs of twins are that:. For now, we are focusing on twins as a possible reason for the uterus being larger than expected.

Here are two ways to try to hear the heartbeats of twins:. Because twin births are often more difficult or dangerous than single births, it is safer for the woman to go to a hospital to give birth. Since twins are more likely to be born early, the mother should try to have transportation ready at all times after the 6th month. If the hospital is far away, the mother may wish to move closer in the last months of pregnancy.

Be sure to have a plan for how to get help in an emergency. Refer the woman to a health centre if you suspect she may have diabetes. She had diabetes in a past pregnancy. One of her past babies was born very big more than 4 kilograms , or was ill or died at birth and no one knows why. She is fat. She is thirsty all the time. She has frequent itching and a bad smell coming from her vagina. Her wounds heal slowly.

She has to urinate more often than other pregnant women. Her uterus is bigger than normal for how many months she has been pregnant. She has sugar in her urine when you do the dipstick test Section 9. Too much water amniotic fluid is not always a problem, but it can cause the uterus to stretch too much. Then the uterus cannot contract enough to push the baby out, or to stop the bleeding after the birth.

In rare cases, it can mean that the baby will have birth defects. Try to refer the woman to the nearest health facility that can give her a sonogram ultrasound examination if the uterus is measuring too big and you do not suspect twins. Sometimes a woman gets pregnant, but a tumour grows instead of a baby. This is called a molar pregnancy Figure Blood spotting and tissue sometimes shaped like grapes may be discharged from her vagina.

If you detect the signs and symptoms of a molar pregnancy, refer the woman to a hospital as soon as possible. The tumour can become a cancer and kill her, sometimes very quickly. If you do not have the right equipment to check her blood pressure, and the uterus is growing too slowly, refer her to the nearest health centre for evaluation.

If you suspect that the baby may have died, refer the mother to a health centre for the stillbirth. 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 Should we do a fundal height measurement on admission in labour? Fundal height measurement at the onset of labour is part of routine assessment and should be recorded in the Birth Labour Notes. 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.

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? We therefore recommend an additional visit and assessment at 31 weeks.