Abstract:
A fetal growth chart is a vital tool for assessing fetal risk during pregnancy. Since fetal weight
cannot be directly measured, its reliable estimation at different stages of pregnancy has
become an essential issue in obstetrics and gynecology and one of the critical elements in
developing a fetal growth chart for estimated fetal weight. In Indonesia, however, a reliable
model and data for fetal weight estimation remain challenging, and this causes the absence
of a standard fetal growth chart in antenatal care practices. This study has reviewed and
evaluated the efficacy of the prediction models used to develop the most prominent growth
charts for estimated fetal weight. The study also has discussed the potential challenges
when such surveillance tools are utilized in low resource settings. The study, then, has proposed
an alternative model based only on maternal fundal height to estimate fetal weight.
Finally, the study has developed an alternative growth chart and assessed its capability in
detecting abnormal patterns of fetal growth during pregnancy. Prospective data from twenty
selected primary health centers in South Kalimantan, Indonesia, were used for the proposed
model validation, the comparison task, and the alternative growth chart development using
both descriptive and inferential statistics. Results show that limited access to individual fetal
biometric characteristics and low-quality data on personal maternal and neonatal characteristics
make the existing fetal growth charts less applicable in the local setting. The proposed
model based only on maternal fundal height has a comparable ability in predicting fetal
weight with less error than the existing models. The results have shown that the developed
chart based on the proposed model can effectively detect signs of abnormality, between 20
and 41 weeks, among low birth weight babies in the absence of ultrasound. Consequently,
the developed chart would improve the quality of fetal risk assessment during pregnancy
and reduce the risk of adverse neonatal outcomes.
