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Birth Classes
. CLASS ONE, Section II
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II. Embryonic/fetal growth and development

  A. Nagele's Rule: Take the first day of the last menstrual period, 
       to estimated delivery date subtract 3 months, and add 7 days .

  B. Fetal growth chart (under construction)

  C. Techniques to assess fetal growth and development

1) Abdominal girth measurement: a good indicator between 13-28 weeks (See Box 1, Figure1, below)

2) Ultrasound: not always done solely to determine sex of baby

(a) Biparietal diameter (BPD)   (b) Femur length (second to third trimester)   (c) Abdominal circumference of fetus (most useful at 34 to 36 weeks): Use head circumference and abdominal circumference ratio to assess disproportion between head and body and to assess fetal weight.
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Figure 1
Fundal height is used as an indicator of fetal growth in relation to uterine size and weeks of gestation. McDonald's technique is to use pliable, not stretchable, paper tape to measure the distance from the upper border of the symphysis pubis to the top of the uterine fundus.

McDonald's Rule

Height of fundus (cm) 2 2/7 4 gestation in lunar months. 

Height of fundus (cm) 2 8/7 4 gestation of pregnancy in weeks.

Considerations in using fundal height measurement: Factors such as hydramnios, multiple gestation, very large fetus, and obesity affect measurement accuracy. For women over 200 lbs., subtract 1 cm. from the measurement obtained. Approaches must be standardized when more than one caregiver is taking serial measurements.
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