Measurement of the fundus of the uterus

Fundus measurement in pregnancy

The obstetric art was born long before use ultrasound and then young midwives are taught how to use their hands but above all why to use them. The midwife's hands come close to the belly of the woman lying on her back, almost in an embrace around the baby and then like a seamstress with her centimeter takes the measurements.

This approach and brushing of the belly is called first Leopold's maneuver, through which the midwife, with the two hands placed in a basin delimits the height reached by the uterus with respect to the pelvis. Then she takes an inch from a seamstress and rests the tip on the pubic symphysis (bone that is felt anterior to the pelvis, just below the pubic hairline) and stretches it up to the level of the bottom of the uterus, identified earlier.

Look at the measurement and report it on the medical record, specifically on one growth chart. This procedure is carried out at each pregnancy check, to allow you to visualize the growth over the months. Why is this measurement done? It is a clinical method of assessing the child's growth and the amount of amniotic fluid present but, thinking about it, these things could easily be done by the ultrasound. The peculiarity of this technique consists in the fact that it allows to evaluate the tonicity of the walls of the uterus, that is, how much it reacts by contracting to the touch. And this is important for the purposes of labor and contractions, to predict the resistance of the uterus to the effort and the effectiveness they will have. 

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But by how much does the belly have to grow with each check?

Growth is expected to be around 1 centimeter a week, then we will have about 16cm at 20 weeks and so on up to about 2 weeks after birth, when a particular fact occurs, the growth of the belly stops indeed, sometimes, it also decreases in volume. This is because the baby at term of pregnancy descends into the pelvis, engages itself, in technical language and therefore with it the volume of the uterus also decreases.

It is important to evaluate the growth of the uterine fundus over time because an excessive difference between the measurements can set off an alarm bell, and require more insights. In particular, if the bottom of the uterus is 2 cm lower than what we can expect, we can suspect: reduction of amniotic fluid or a delay in the growth of the child.


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In the opposite case, i.e. when the difference between what we expect and the actual measurement is greater than 2 cm, there could be problems of excess fluid (polyhydramnios), gestational diabetes or one fetal macrosomia (i.e. a very large child, over 4kg at birth). All these conditions require greater attention, constant use of ultrasound and possibly other more specific instrumental tests.

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Being a clinical measurement, it could seem variable and unreliable as much as instrumental parameters such as those detected by ultrasound. Obviously this type of measurement assumes that there is a knowledge of the woman, of her clinical history and is therefore related to some individual parameters. For example, if a woman is 150cm tall and weighs 40kg, it could be that the child does not grow within the average parameters of the growth charts and is therefore small. What she matters is that she follows a line of growth of hers and that this growth is constant.

It is not a measurement with 100% accuracy, it must be said, but even ultrasound is not foolproof and is subject to some variability. It is therefore important that this measurement takes place not so much for data collection, but to create that relationship of contact, proximity and knowledge, of human warmth that is being lost with the sole use of technology. Pregnant women feeling this contact feel understood and listened to, and it is proven that support during pregnancy it means better birth experiences and better satisfaction for women.

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