Clinician bias in fundal height measurement.
OBJECTIVE
To establish whether the degree of clinician bias in fundal height measurement is affected by patient body mass index (BMI) or provider experience.


METHODS
Singleton, ultrasound-dated pregnancies between 24 weeks and 40 weeks underwent fundal height measurements (n=103) by two providers, each using one blank and one marked measuring tape. Outcomes were the differences between the blank and marked measurements (bias) and between fundal height and gestational age for blank and marked tapes. Mixed models for repeated measures (provider and tape type) were used to estimate outcomes and compare them according to provider experience level and for patient background and anthropometric characteristics.


RESULTS
Bias increased with patient BMI, although only among providers with less than 2 years of experience (juniors, P=.004) and not for those with more experience (seniors, P=.38). Similarly, bias decreased over the study enrollment period among junior, but not senior providers. Providers of all levels were more likely to measure a fundal height within 3 cm of gestational age using a marked tape than a blank tape (odds ratio 1.83, 95% confidence interval 1.41-2.38).


CONCLUSIONS
Clinicians are biased in their fundal height measurements by knowledge of gestational age and use of a marked measuring tape. This tendency increases with higher patient BMI and with less provider experience.
Jelks
Andrea
A
Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California, USA. andrea@jelksmedical.com
Cifuentes
Rodrigo
R
Ross
Michael G
MG
D000293:Adolescent; D000328:Adult; D000886:Anthropometry / Q000295:instrumentation / Q000379:methods*; D015992:Body Mass Index; D001835:Body Weight; D002983:Clinical Competence; D005260:Female; D005865:Gestational Age; D006801:Humans; D015588:Observer Variation; D009929:Organ Size; D011247:Pregnancy / Q000706:statistics & numerical data*; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data*; D014599:Uterus / Q000033:anatomy & histology*