title: Symphysis-fundus height measurement to predict small-for-gestational-age status at birth: a systematic review.
abstract: BACKGROUND
  Fetal growth restriction is among the most common and complex problems in modern obstetrics. Symphysis-fundus (SF) height measurement is a non-invasive test that may help determine which women are at risk. This study is a systematic review of the literature on the accuracy of SF height measurement for the prediction of small-for-gestational-age (SGA) status at birth in unselected and low-risk pregnancies.
  
  
  METHODS
  The Medline, Embase, Cinahl, SweMed, and Cochrane Library databases were searched with no limitation on publication date (through September 2014), which returned 722 citations. Two reviewers then developed a short list of 51 publications of possible relevance and assessed them using the following inclusion criteria: cohort study of test accuracy performed in a routine prenatal care setting; SF height measurement for all participants; classification of SGA, defined as birth weight (BW) < 10th, 5th, or 3rd percentile or ≥ one or two standard deviations below the mean; study conducted in Northern, Western, or Central Europe; USA; Canada; Australia; or New Zealand; and sufficient data for 2 × 2 table construction. Quality of the included studies was assessed in duplicate using criteria suggested by the Cochrane Collaboration. Review Manager 5.3 software was used to analyze the data, including plotting of summary receiver operating curve spaces.
  
  
  RESULTS
  Eight studies were included in the final dataset and seven were included in summary analyses. The sensitivity of SF height measurement for SGA (BW < 10(th) percentile) prediction ranged from 0.27 to 0.76 and specificity ranged from 0.79 to 0.92. Positive and negative likelihood ratios ranged from 1.91 to 9.09 and from 0.29 to 0.83, respectively.
  
  
  CONCLUSIONS
  SF height can serve as a clinical indicator along with other clinical findings, information about medical conditions, and previous obstetric history. However, SF height has high false-negative rates for SGA. Clinicians must understand the limitations of this test. The protocol has been registered in the international prospective register of systematic reviews, PROSPERO (Registration No. CRD42014008928, http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42014008928 ).
authors.affiliation: Department of Obstetrics and Department of Gynecology, Women's and Children's Division, Oslo University Hospital, Oslo, Norway. aase.pay@fhi.no.|Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway. aase.pay@fhi.no.
authors.forename: Aase Serine D
authors.initials: AS
authors.lastname: Pay
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden. johanna.wiik@gmail.com.
authors.forename: Johanna
authors.initials: J
authors.lastname: Wiik
authors.affiliation: Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Technology and Science, Trondheim University Hospital, Trondheim, Norway. bjbac@online.no.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Backe
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden. bo.jacobsson@obgyn.gu.se.|Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway. bo.jacobsson@obgyn.gu.se.
authors.forename: Bo
authors.initials: B
authors.lastname: Jacobsson
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden. annika.strandell@vgregion.se.
authors.forename: Annika
authors.initials: A
authors.lastname: Strandell
authors.affiliation: Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway. atle.klovning@medisin.uio.no.
authors.forename: Atle
authors.initials: A
authors.lastname: Klovning
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011237:Predictive Value of Tests; D011247:Pregnancy; D011631:Pubic Symphysis / Q000000981:diagnostic imaging*; D016216:Ultrasonography, Prenatal / Q000379:methods*