The height of the fundus of the uterus by months. How is the fundal height measured and what does this indicator mean? Method for measuring the uterus during pregnancy
- this is the level at which the bottom of the uterus is located for a certain period pregnancy and also after childbirth. The fundus of the uterus is the upper domed part of the uterus, which is located above the place where the body of the uterus connects to the fallopian tubes. With its bottom, the uterus is tilted forward. It is the bottom of the pregnant uterus that can be felt with your hands, since this part of the uterus “rises” during growth, moving from the small pelvis to the abdominal cavity towards the diaphragm ( muscular plate that separates the thoracic cavity from the abdominal cavity).
How to measure the height of the fundus of the uterus?
You can measure the height of the fundus of the uterus after a week of pregnancy. Until this time, the uterus is located inside the small pelvis, that is, it does not protrude above the pubic bone, therefore it cannot be felt and measured from the outside. Until the 13th week of pregnancy, that is, even in the first trimester, the bottom of the uterus can only be felt with a bimanual or two-handed examination, when the gynecologist inserts one hand into the vagina, and with the other hand presses on the lower abdomen, trying to bring both hands closer. However, such a technique does not give out special information about the gestational age, therefore all measurements of the height of the uterine fundus are made in the second trimester of pregnancy ( after a week).
The measurement of the standing height of the fundus of the uterus is carried out in the following ways:
- using a regular centimeter tape;
- the width of the transverse fingers ( 2 cross fingers are equal to 3 - 4 centimeters);
- according to anatomical guidelines.
During the measurement of the height of the fundus of the uterus, the woman lies on the couch on her back, with a slightly bent legs. It is important to remind the pregnant woman that before measuring the height of the uterus bladder must be emptied. First, the doctor will feel the pregnant woman's abdomen to determine the position of the fetus, the very bottom of the uterus and the part of the fetus that is located in the bottom area. To do this, the doctor stands to the left of the pregnant woman facing her, puts the palms of his hands on the area of the fundus of the uterus, directing the fingertips of both hands to each other. This technique is called the first Leopold technique. After the doctor determines the most distant point of the fundus of the uterus above the pubic bone, he, using a centimeter tape, measures the distance from the edge of the womb ( pubic bone) to the point where the bottom of the uterus was determined.
You can use your fingers instead of a measuring tape. Fingers pressed together, usually index and middle, are placed transversely on the pregnant woman's abdomen. The height of the uterine fundus in this case is determined by the number of fingers between the main anatomical landmarks - the womb, navel and xiphoid process of the sternum.
Why is it necessary to measure the height of the uterine fundus?
The height of the uterine fundus is an indicator that indicates a normal or disturbed course of pregnancy, possible abnormalities of the fetus and maternal illness. This is one of the indicators of the so-called gravidogram ( "gravida" in Latin means "pregnant"). A gravidogram is a table that a doctor fills out at each visit to a pregnant woman, and which reflects the course of pregnancy in the form of graphs. It is necessary to monitor the change in the height of the fundus of the uterus throughout the pregnancy, comparing the change in height every week. So get the curve of the standing height of the fundus of the uterus.
Measurement of the fundal height is needed to determine the following:
- gestational age and compliance with the height of the fundus of the uterus to the gestational age;
- term of the child and its estimated weight;
- the function of uterine contractility immediately after childbirth;
- degree of uterine contraction postpartum period and return to pre-pregnancy size.
Pregnancy term by the height of the fundus of the uterus (height of the fundus of the uterus by weeks)
The height of the uterine fundus is one of the parameters by which obstetricians determined the gestational age. With the advent of ultrasound ultrasound) the method of determining the gestational age by the height of the uterine fundus has somewhat lost its relevance, due to lower accuracy, but, nevertheless, is still used when examining a pregnant woman. The fact is that, despite the accuracy, ultrasound cannot be used too often, and the measurement of the height of the uterine fundus remains non-instrumental and the easy way determining the gestational age in weeks, which can be used not only by a doctor, but also by the pregnant woman herself.
The height of the fundus of the uterus by weeks
| in centimeters) | The location of the fundus of the uterus near anatomical landmarks | Approximate gestational age in weeks) |
| In the middle between the womb and the navel. | ||
| 2 fingers below the navel. | ||
| At the level of the navel. | ||
| 2 fingers above the navel. | ||
| At the level of the costal arches, almost at the xiphoid process. | ||
| In the middle between the navel and the xiphoid process of the sternum. |
The minimum height of the fundus of the uterus is 5 centimeters above the womb, and the maximum is 40 centimeters. After the 20th week of pregnancy, conditionally, the height of the bottom should be almost equal to the gestational age, plus or minus 1 - 3 centimeters.
The fundus of the uterus is maximally high at the 36th week of pregnancy, when the uterus reaches the diaphragm. The descent of the bottom of the uterus closer to the 40th week is due to the fact that the fetal head descends into the pelvic cavity, which is typical for nulliparous women. In multiparous women, this does not happen because of the overstretched muscles of the abdominal wall, which do not put pressure on the uterus, as in primiparas, as a result, the bottom of the uterus deviates somewhat anteriorly. Thus, in primiparous women, the height of the uterine fundus at 32 and 40 weeks of pregnancy is the same.
Discrepancy between the height of the fundus of the uterus and the duration of pregnancy
As the fetus grows, the uterus grows, so the height of its bottom is determined higher every week. Up to 28 weeks, the height of the fundus of the uterus increases by 1–2 cm per week, from 28 to 36 weeks - by 0.5–1.5 cm per week, and after 36 weeks by 0.2–0.5 cm per week. If there is no increase in height, or, conversely, the uterus “rises” too quickly, then this situation is called a discrepancy between the gestational age and the height of the uterine fundus.
The discrepancy between the height of the uterine fundus and the gestational age is influenced by the following factors:
- maternal factors.- the width of the female pelvis, mother's diseases, pathology of the uterus;
- fetal factors.- fruit weight, quantity amniotic fluid, position of the fetus in the uterus, pathology affecting the fetus.
Causes of discrepancy between the height of the uterine fundus and the gestational age
| The height of the fundus of the uterus "lags behind" by 2 centimeters or more | The height of the bottom of the uterus is measured 2 or more centimeters more than it should be |
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The most common reason for the discrepancy between the timing of pregnancy and the height of the uterine fundus is an incorrect calculation. The approximate gestational age is determined by the date of conception or the date of the last menstruation. Not all women follow the menstrual cycle, the day of ovulation ( the day of the release of the egg in the middle of the cycle, when it is possible to conceive a child), the regularity of menstrual flow and cannot always accurately indicate the day when the alleged sexual intercourse took place, which led to conception and pregnancy. That is why, if a pregnant woman is registered not in the first, but in the second trimester of pregnancy, then there is a possibility of incorrectly calculating the period.
The body weight of the fetus depends on genetic programs and is not always a sign of pathology. However, when the growth rate of the uterus lags behind or ahead of time, doctors closely monitor such pregnant women.
The width of the pelvis also affects the height of the uterine fundus. In expectant mothers with a narrow pelvis, the uterus moves faster from the pelvic cavity, since the pelvis itself often turns out to be incapable, and the uterus begins to grow up ahead of schedule. With a wide pelvis, the uterus is completely placed in the pelvic cavity and is in no hurry to increase its size in length.
The amount of amniotic fluid affects the height of the uterine fundus, since the fluid contributes to an increase in the size of the uterus. If amniotic ( amniotic) there is little fluid, then the uterus grows more slowly, while with an excess volume of amniotic fluid, it is forced to stretch.
The position of the fetus in the uterus always affects the height of its fundus. The bottom of the uterus is high only if there is a large part of the fetus ( head or buttocks with legs folded), that is, if the fetus is located longitudinally ( vertically). If the back of the fetus is located in the region of the bottom of the uterus, then this position is defined as transverse or oblique. With a transverse and oblique position of the fetus, the uterus grows more in breadth, so the bottom is determined lower. At the same time, if by the end of pregnancy, not the head of the fetus, but its buttocks or legs, is turned towards the vagina, then the uterus is higher than it should be.
To clarify the cause of the discrepancy between the height of the uterine fundus and the gestational age, an ultrasound scan is prescribed for the pregnant woman.
The height of the fundus of the uterus and the body weight of the fetus
The fundal height parameter can be used to roughly estimate the weight of the fetus and to determine its full-term. For this, the Zhordania formula is used, according to which, if you multiply the height of the fundus of the uterus by the circumference of the pregnant woman's abdomen, you get the mass of the fetus. The circumference of the abdomen is also measured using a centimeter tape and always at the level of the navel.
The height of the fundus of the uterus after childbirth
After childbirth, the uterus decreases in volume, its walls become thicker, the shape is spherical, and then gradually returns to pear-shaped. All these reverse changes are called uterine involution. The degree of involution of the uterus can be judged precisely by the height of its fundus, starting from the third stage of labor ( the period after the birth of the fetus until separation and birth of the placenta) and throughout the postpartum period.
Immediately after the birth of the fetus, the uterus sharply decreases in volume and is determined at the level of the navel. After separation of the placenta from the wall of the uterus, its bottom rises above the navel and deviates to the right side. After the birth of the placenta, the uterus is already sharply reduced and is determined by two transverse fingers below the navel. On the 1st day after birth, the bottom of the uterus is determined at the level of the navel or 13-15 centimeters above the pubic bone. Every day, the bottom of the uterus drops by 1 - 1.5 centimeters. On the 5th day, the bottom of the uterus is located in the middle of the distance between the pubic bone and the navel, and already 2 weeks after birth, the uterus is again hidden behind the pubic bone.
If in a pregnant woman the height of the uterine fundus was higher than it should be according to the terms of pregnancy, then, most likely, the processes of uterine involution in the postpartum period will proceed more slowly.
How to measure the height of the fundus of the uterus at home?
The procedure for measuring the height of the uterine fundus is simple and can be carried out at home by a woman on her own. You need to measure the height with a centimeter tape. In the absence of a centimeter tape, a woman can also use her fingers, placing them transversely on the front wall of the abdomen. Measurement with fingers is carried out taking into account the fact that 2 transverse fingers are equal to approximately 3 - 4 centimeters. Before measuring the height of the fundus of the uterus, it is necessary to empty the bladder, since the filled bladder can slightly push the uterus up, in addition, this disrupts the process of feeling the fundus of the uterus.
When independently determining the height of the fundus of the uterus, a woman should do the following:
- lie down on a hard surface a soft mattress will not work, as the body will "fail" and the natural bulge of the pregnant uterus may become less pronounced);
- feel the pubic bone bone in the lower abdomen);
- feel the bottom of the uterus, gradually rising from the pubis to the navel and above ( the bottom of the uterus feels like a comb with fuzzy contours);
- measure the distance between the pubis and the fundus of the uterus, placing a zero mark on the upper edge of the pubic bone.
Is it always possible to determine the gestational age by the height of the uterine fundus?
Measurement of the fundal height is not an accurate method for determining the gestational age. The bottom of the uterus may not correspond to the gestational age, be determined above or below the prescribed level during a normal pregnancy. There are many factors that affect the height of the uterine fundus. With obesity, diabetes in a future mother, if there are several fetuses inside the uterus, the bottom of the uterus is determined higher. If the fetus in the uterus is not located vertically, but horizontally or diagonally, as well as with a small amount of amniotic fluid, a small weight of the baby, the bottom of the uterus is located lower than it should be at a particular gestational age.
Where should the fundus of the uterus be determined by gestational age?
The main landmarks by which you can easily determine the height of the fundus of the uterus and the approximate duration of pregnancy are the pubic symphysis ( fusion site of two pubic bones in the lower abdomen), the navel and the lower part of the sternum or xiphoid process. If the bottom of the uterus cannot be felt, then the gestational age is less than 12 weeks. As soon as the bottom of the uterus begins to rise above the pubic symphysis, it can be felt. The approximate gestational age in this case will be 13 - 14 weeks. If the bottom of the uterus is determined at the level of the navel, then the 24th week of pregnancy is already underway, and if it is above the navel, it is 28. At 32 weeks, the bottom of the uterus is located almost in the middle between the navel and the sternum. At the same level, the bottom of the uterus will be before childbirth, at the last 40 weeks of pregnancy. Between 32 and 40 weeks, the fundus of the uterus rises, almost reaching the sternum.
When is the height of the fundus of the uterus measured 15 centimeters above the womb?
If the bottom of the uterus is determined 15 centimeters above the womb ( pubic bone), which means that the bottom of the uterus is located approximately at the level of the navel. This level of height has the bottom of the uterus for a period of 20 - 22 weeks of pregnancy. Also, at the level of the navel, the height of the fundus of the uterus is determined the next day after childbirth.
At what week of pregnancy does the uterine fundus reach 38 centimeters?
The height of the fundus of the uterus 38 cm is determined approximately at 36 weeks of pregnancy. After this period, one should not expect an even greater rise in the fundus of the uterus. In the last month of pregnancy, and especially in the last 2 weeks, the uterine fundus can be measured at the same level or even slightly lower than at 36-38 weeks. The fact is that closer to childbirth in nulliparous women, the head of the fetus drops a little and takes a position closer to the entrance to the small pelvis, ceases to be mobile ( the doctor probes the already fairly fixed fetal head in the lower abdomen). In multiparous women, this may not happen if the muscles of the abdominal wall were significantly overstretched during previous pregnancies.
Evaluation of the height of the uterine fundus by weeks of pregnancy has a serious diagnostic value. In addition to calculating the gestational age, gynecologists predict the condition of the fetus every week, and suggest possible deviations from its normal development.
The length of the uterus is not more than 8 centimeters in a woman of reproductive age. Of these, the neck takes about 2.5 cm. Height - 4 cm. The uterus increases during pregnancy and by the 40th week of the term has a similar length - 40 cm. Before pregnancy, the weight of the organ is 50 grams. In the third trimester - about 4 kilograms.
The height of the fundus of the uterus by week - how to determine
- On early dates palpate the size of the uterus through the vagina.
- 12th week - the uterus reaches the pubic symphysis.
- From the 13th week, it goes beyond the pelvic region, and is palpable through the abdominal wall.
- In the supine position, a pregnant centimeter tape measures the distance between the pubic symphysis and the highest point of the uterus (bottom).
- The results are recorded in a notebook to track their dynamics.
- Approximate dimensions of the height of the bottom of the uterus by weeks in centimeters: 8-9 weeks - 8-9; 16-17 weeks - 14-19; 38-39 weeks - 35-38.
- The bottom standing height (VVD) roughly corresponds to the gestational age in weeks.
If at a certain time the height of the uterine fundus exceeds normal values, then the doctor may suspect a multiple pregnancy, and if less, low fetal growth rates, oligohydramnios, oblique or transverse position.
A one-time determination of the height of the uterine fundus is uninformative.
It should be noted that the size of the IRR at various stages of pregnancy is average. It differs in large and short women, who have anatomically different sizes queens.
The height of the fundus of the uterus during pregnancy by week
IN 8-9 weeks the uterus is the size of a goose egg. Until this time, it is not palpable through the abdominal wall, as it is located in the pelvic area. Only from 3 months - located above the pubis. The placental system begins to function actively, and the corpus luteum gradually disappears. The embryo begins to move, blood vessels form in it.
10-13 weeks. The length of the uterus is 11 cm. Toxicosis increases due to the cleansing of the mother's body, which is being rebuilt to normalize the trophism of the fetus.
14-16 weeks. The embryo completes the process of creating organs. The uterus increases to 14 cm.
16 weeks- the bottom of the uterus is located in the middle of the distance between the navel and the pubis.
17-18 weeks. Formed placental system. The fetus has a fully developed cerebellum, limbs, immune system. The length of the uterus is 18-19 cm.
WITH 20th week the size of the standing of the bottom of the uterus begins to approximately correspond to the duration of pregnancy. So on the 21st week, the value of the distance between the pubis and the bottom of the uterus is approximately equal to 21 cm. In the future, it increases by 1 cm every week. The bottom of the uterus is projected at this time below the navel by 2 fingers.
22-24 weeks. The embryo develops muscles and bones. Its weight is about 600 grams. At the 24th week, the pulmonary system begins to form. The uterus increases to 23 cm. At the 24th week, the bottom of the uterus is located in the navel with a height of 24 centimeters.
28 weeks the height of the bottom of the uterus is 28 cm. The bottom of the uterus is placed 2 cm above the navel (two folded fingers).
29-30 weeks. In the third trimester, the uterus is about 31 cm. In a pregnant woman, blood pressure rises due to large sizes fetus.
32 weeks- the location of the uterus in the middle of the distance between the xiphoid process of the sternum and the navel (9th month), and is 32 centimeters.
36 weeks- on the line that connects both costal arches.
38 weeks. After the 38th week, the uterus begins to descend. The bottom of the organ presses on the stomach and diaphragm. The mother slowly digests food, heartburn appears. The weight of the child is 2100-2250 grams.
On 40th week VDM - 32 cm. The bottom is again located between the ribs and the navel. Pregnancy is considered full-term. The child is actively growing, and the mother's body is preparing for childbirth. When the baby descends into the pelvis, childbirth will come.
The height of the fundus of the uterus by week, which affects it:
- fruit size,
- Anatomical features of the woman's body,
- The position of the fetus
- Number of embryos
- Expression of amniotic fluid.
If the bottom of the uterus during pregnancy is below normal
- oligohydramnios,
- Wide pelvis in large women
- Erroneous values in determining the timing of pregnancy,
- Delayed fetal development.
Assessment of the size of the location of the bottom of the uterus during pregnancy should include a whole series of measurements.
If the bottom of the uterus during pregnancy is above normal
- narrow pelvis,
- big fruit,
- polyhydramnios,
- multiple pregnancy,
- Wrong position.
Simultaneously with the height of the fundus of the uterus, gynecologists calculate the amount of amniotic fluid, which affects the development of the fetus. This indicator depends on the individual characteristics of the development of the woman and the total thickness of the subcutaneous heat. At the end of the gestation period, both indicators allow you to calculate the weight of the fetus according to the formula: VVD - abdominal volume. The normal value is approximately 3420 grams.
Most women different ages, taking care of their health, did ultrasound of the pelvic organs more than once. And more than once heard about the size of the uterus. Normally, when a woman is not pregnant, the approximate size of the uterus should correspond to the following parameters.
In women of childbearing age:
- length - 4.5 - 6.7 cm,
- width - 4.6 - 6.4 cm,
- thickness - 3.5 cm.
In postmenopausal women, the size of the uterus decreases:
- length - 4.2 cm,
- width - 4.4 cm,
- thickness - 3.0 cm.
Deviations from normal sizes in one direction or another may indicate the presence of certain diseases.
During pregnancy, as the fetus grows, the size of the uterus increases.
During pregnancy, the size of the uterus can determine the duration and nature of its course, analyze the development of the fetus and notice any deviations in time.
In early pregnancy, the size of the uterus is determined by digital vaginal probing by a gynecologist and using ultrasound. And starting from the second trimester, the doctor already determines such a value as the height of the fundus of the uterus (VVD).
During pregnancy, along with the fetus, the uterus grows all the time and extends beyond the pelvic floor, taking up space in the abdominal cavity. Therefore, the doctor probes it through the abdominal cavity.
The obstetrician-gynecologist measures the height of the fundus of the uterus at each visit to the pregnant woman. During the measurement, the patient should lie on the couch, on her back. The IRR is measured using a centimeter tape from the pubic symphysis to the highest point of the uterus. The results are recorded to analyze the development of the fetus throughout the pregnancy.
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The height of the fundus of the uterus increases with each week of pregnancy and should normally correspond to certain values. Depending on the age of the woman, her individual features of the body structure, the size of the fetus, the size of the amniotic fluid and the number of embryos, deviations in the value of the IRR in one direction or another by 2–4 cm are possible.
Therefore, in order to correctly assess the course of pregnancy, the resulting IRR value is compared with the waist circumference and the size of the fetus.
The height of the fundus of the uterus by week of pregnancy is as follows:
at 8-9 weeks, the height of the bottom of the uterus is 8-9 cm,
at 10 - 11 weeks, the height of the bottom of the uterus is 10 - 11 cm,
at 12 - 13 weeks, the height of the bottom of the uterus is 10 - 11 cm,
at 16 - 17 weeks, the height of the bottom of the uterus is 14 - 19 cm,
at 18 - 19 weeks, the height of the bottom of the uterus is 16 - 21 cm,
at 20 - 21 weeks, the height of the bottom of the uterus is 18 - 24 cm,
at 22 - 23 weeks, the height of the bottom of the uterus is 21 - 25 cm,
at 24 - 25 weeks, the height of the bottom of the uterus is 23 - 27 cm,
at 26 - 27 weeks, the height of the bottom of the uterus is 25 - 28 cm,
at 28 - 29 weeks, the height of the bottom of the uterus is 26 - 31 cm,
at 30 - 31 weeks, the height of the fundus of the uterus is 29 - 32 cm,
at 32 - 33 weeks, the height of the bottom of the uterus is 31 - 33 cm,
at 34 - 35 weeks, the height d on the uterus is 32 - 33 cm,
at 36 - 37 weeks, the height of the fundus of the uterus is 32 - 37 cm,
at 38 - 39 weeks, the height of the fundus of the uterus is 35 - 38 cm,
at 40 - 41 weeks, the height of the bottom of the uterus is 34 - 35 cm.
At a period of 8 - 9 weeks of pregnancy, the uterus has the size of a goose egg. And before this period, it is not palpable through the abdominal wall, as it is located within the small pelvis. At week 12, the placenta develops and begins to function, and blood vessels form in the embryo. Therefore, the uterus begins to increase in size.
At a gestational age of 10-13 weeks, the IRR reaches 11 cm. During this period, the mother's body begins to rebuild to properly supply the fetus with oxygen and nutrients, so toxicosis increases.
At a period of 14 - 16 weeks, the embryo already has all the organs. During this period, the length of the uterus is 14 cm. At a period of 16 weeks, the uterus can be felt in the middle between the pubis and the navel.
For a period of 17 - 18 weeks, the IRR corresponds to 18 - 19 cm. By this time, the entire placental system is finally formed. And in the fetus, the cerebellum, immune system and limbs finish developing.
At a period of 20 weeks, the IRR is equal to the gestational age, that is, 20 cm. After the 21st week, the length of the uterus grows by approximately 1 cm per week. Its bottom can be felt at a distance of 2 fingers from the navel.
For a period of 22 - 24 weeks, the IRR reaches 23 - 24 cm and is palpable in the navel. At this time, the baby develops the bone apparatus and muscles, the pulmonary system is formed. The fruit weighs approximately 0.6 kg.
For a period of 28 weeks, the IRR is 28 cm. The bottom is palpated approximately 2 cm above the navel.
At a period of 29 - 30 weeks, the IRR approaches a value of 31 cm. The fetus is no longer small in size. Many pregnant women experience high blood pressure during this period.
At 32 weeks, the fundus of the uterus is located between the navel and the xiphoid process of the sternum. VSD - 32 cm.At a period of 36 weeks, the bottom of the uterus is already palpable at the level of the line connecting the costal arches.
At 38 weeks IRR - 36 cm.
From the 39th week, the bottom of the uterus begins to sink and put pressure on the stomach and diaphragm of the woman. As a result, a pregnant woman may experience digestive problems, manifested by heartburn. The fetus already weighs 2.1 - 2.25 kg.
For a period of 40 weeks, the IRR is less than 35 cm and sometimes decreases to 32 cm. The bottom of the uterus is again palpated between the navel and ribs. At this time, the child is already full-term, it is actively growing, and the mother's body is preparing for childbirth. At the moment of lowering the child into the pelvis, childbirth begins.
If the IRR is below the norm corresponding to the gestational age, then this is a sign:
- Low water.
- Wide pelvis in a woman.
- Errors in determining the duration of pregnancy.
- Delays in fetal development.
If the IRR is higher than the norm corresponding to the gestational age, this is a sign of:
- Narrow pelvis of a pregnant woman.
- Large size fruit.
- Polyhydramnios.
- Multiple pregnancy.
- Incorrect position of the fetus.
In parallel with the determination of the IRR, an important diagnostic value is the calculation of the amount of amniotic fluid, which indicates the development of the fetus. This value depends on the individual anatomical structure of the woman and the total thickness of the subcutaneous adipose tissue. And at the end of pregnancy, these two indicators calculate the weight of the fetus.
Now, knowing that the size of the height of the uterine fundus is one of the important diagnostic features pathology of the course of pregnancy, you will no longer wonder why the obstetrician-gynecologist feels and measures your stomach at each visit.
At each visit of a pregnant woman to the doctor leading her pregnancy, the height of the uterine fundus is measured. In the exchange card, the doctor designates this parameter as VDM or VSM. What is such a measurement, why is it carried out and how does this height change throughout the entire period of the intrauterine life of the baby, this article will tell.
What it is?
The female reproductive organ, which becomes a safe haven for a growing child throughout pregnancy, resembles a bag. Its lower part is like the knotted part of this bag, it is the narrowest. This is the cervix, which is a round muscle. The widest part of the uterus, domed, is called the fundus of the uterus. The word “bottom” should not be embarrassing, because for a growing baby who will leave the womb during childbirth, this domed part will really be the bottom. The inlet to the outlet inside the reproductive organ is one - this is the cervical canal inside the cervix, and it is located below.
The height of the bottom of the uterus is a special size that reflects the height to which the bottom has risen relative to the pubis. Until the end of the first trimester, the parameters of the uterus are small (by the eighth week - no more than a goose egg), and it fits perfectly in the space of the small pelvis.
But the genital organ grows rapidly, the number of muscle fibers increases, and by the start of the second trimester, the uterus ceases to fit in the small pelvis and goes beyond it, into the abdominal cavity, gradually rising up and propping up the diaphragm. It is for these good reasons that the belly grows, its visual increase in a woman who is preparing for imminent motherhood.
Fundal height shows how much its growth corresponds to the gestational age, and to a certain extent this size indicates that is everything in order with the lady “in position” and her child. That is why, at each visit to the consultation during all months of pregnancy, starting from 12–14 weeks, the doctor measures the VMD (VSD) and the circumference (girth) of the belly of the expectant mother along the navel line. By the ratio of these two values, using obstetric formulas, it is even possible to calculate the estimated weight of the fetus. Until a certain time, while ultrasound did not exist, this was the only way to find out whether a woman was to give birth to a large, normal or miniature baby.
Today, experts pay less attention to VSM than before, because there are much more diagnostic tools at the disposal of the obstetrician, and their accuracy is much higher. But this parameter was not completely removed from the protocols of the Ministry of Health and obstetric practice in pregnant women.
The definition of VDM can be carried out both independently and with the help of an obstetrician-gynecologist. It is not difficult.
Measurement technique
The actual term interesting position According to the state of the uterus, doctors establish earlier, before the reproductive organ rises from the small pelvis. In the first trimester of pregnancy, palpation is used for this purpose - a bimanual method of gynecological examination (one hand is inserted into the genital tract, and the other is pressed on the lower abdomen to determine the boundaries of the organ). You can't feel anything outside. This method does not provide very accurate information, but an experienced obstetrician can establish pregnancy with a two-handed method with an accuracy of up to a week.
To measure how much the bottom of the uterus has risen, you can use a centimeter tape, a tazomer, as well as the width of the fingers located transversely. It is acceptable to determine the VSDM by anatomical landmarks.
To measure correctly, you need the pregnant woman to take a prone position. She is asked to lie on the couch on her back, her legs are asked to be slightly bent at the knees. It is important that before the measurement, the woman visits the toilet and be sure to empty the bladder from its natural contents.
Next, the obstetrician-gynecologist needs to establish in what position the baby is located, where the bottom of the uterus is, and also what part of the body the baby is adjacent to it. The doctor places both palms on the stomach, and directs the fingertips towards each other (Leopold's first obstetric reception). This sets the most distant point of the bottom of the reproductive organ relative to the line of the pubic bone. Then they apply a centimeter tape to this point and simply determine the numerical value, which expresses the height of the uterine fundus.
If the doctor is a big fan of the old obstetric school, then he can use the finger method. He presses his fingers to each other (middle and index), they should be located transversely on the stomach. Height is determined in fingers, and then converted to centimeters (2 transverse fingers = 3–4 centimeters)
Why do you need to define this parameter?
Each obstetrician considers it his duty to measure VDM, not only because the instructions provide for this, but also because this method is one of the most accessible in order to understand whether the course of pregnancy is normal. VSDM, despite the fact that the size is associated with errors, is one of the indicators of the gravidogram (general table of indicators of a pregnant woman). This is a special table that displays the entire course of the gestation period in the form of graphs: there is a weight gain graph, a pressure graph, a graph of the abdominal circumference and a graph of the VSD.
During almost all weeks of gestation, the height of the fundus of the uterus is in accordance with the term in numerical terms, and only before childbirth, when the abdomen drops, the fetus shifts lower and begins to press the head of the internal cervical os of the cervix, helping it to mature and prepare for disclosure in childbirth, VSD decreases. The belly visually also becomes lower, and it becomes somewhat easier for the expectant mother to breathe and move.
According to the VSDM, the doctor can also guess without an ultrasound machine how much the fetus supposedly weighs, whether it is full-term. After childbirth, or rather, after the birth of the placenta, this size helps specialists to establish how well the uterus contracts.
Timing Compliance and Table
If the circumference of a pregnant woman’s abdomen is a rather individual and subjective value (women’s bellies have different sizes even before the onset of an “interesting position”), then VSDM does not depend much on how thin or fluffy the lady is, tall or short. This value is more constant, and therefore we can talk about the average norms of the height of the bottom point of the reproductive organ for different periods of pregnancy.
Term (week) | VSDM, cm | Term (week) | VSDM, cm |
Anatomical landmarks help in clarifying the timing:
- by 16 weeks pregnancy, the upper part of the uterus is located in the middle of the path from the womb to the navel;
- by week 20 pregnancy, the high point of the bottom is located approximately 2 transverse fingers below the navel;
- by 24–25 weeks- the bottom line is compared with the navel location line;
- by 28–29 weeks- 2 transverse fingers above the navel;
- by 31–32 weeks- the bottom of the uterus is located exactly in the middle between the navel and the xiphoid sternal process;
- by 36 weeks- the bottom of the uterus, if it has not yet descended, is located almost at the xiphoid process at the level of the ribs;
- by 40 weeks- the descended uterus is again in the middle between the navel and the xiphoid process.
The minimum height is considered at the end of the first and beginning of the second trimester, and the maximum bottom of the uterus reaches 35–36 weeks.
If the values are not correct
The dome-shaped part of the female reproductive organ grows simultaneously with the baby, increasing in weeks of pregnancy, in fact, that is why WMD is measured so diligently. Until the 27th week of pregnancy, the height increases by about a centimeter or two per week, after 28 weeks, the rate decreases slightly, and the bottom rises by about 1.5 cm per week, and after 36 weeks, the growth rate decreases to a minimum - 0.2–0, 5 cm per week. If for several measurements of the growth of VDM is not observed, or, conversely, the growth is too fast, they speak of a mismatch with the timing.
A lag of 2 centimeters or more from the standard values \u200b\u200bmay be due to one of the following reasons:
- erroneously established terms of pregnancy, late ovulation;
- a healthy baby, but with a low body weight (genetic inherited constitution);
- IUGR - intrauterine growth retardation;
- a small amount of water;
- transverse or oblique position of the fetus in the uterine cavity;
- wide pelvis of the expectant mother.
Exceeding the VSDM by 2 centimeters or more from the standard values \u200b\u200bmay indicate:
- erroneously determined gestational age;
- incorrect measurement (for example, with a full bladder);
- narrowness of the pelvis of a woman;
- multiple pregnancy;
- healthy baby, but with a large body weight (hereditary factor);
- the presence of diabetes in a woman, including its gestational variety;
- polyhydramnios;
- pelvic presentation of the fetus, in which the legs or buttocks of the crumbs are directed forward.
You should not immediately begin to worry and be nervous - this is generally superfluous in such a situation. In addition, according to medical statistics, the most common cause of deviations from the real indicators of the VVDM is a banal error in determining the gestational age or an incorrect calculation. This is possible with an irregular female cycle, when a woman does not remember the date of the last menstruation, after IVF.
In second place in popularity is such a reason as the weight of the fetus. You need to understand that not always the baby should weigh exactly as much as indicated in the tables with norms. There is a genetic predisposition, and after 10 weeks of pregnancy, all children grow according to their own genetic program, which was laid down by their parents.
One is destined to be large, and the other is destined to be miniature. At the same time, both of them will be perfectly healthy children. Look closely at yourself, at your partner, at your parents and yours. Assess height, weight, physique. Perhaps this is your case.
If developmental delay is suspected, ultrasound with Doppler is prescribed, from 30-31-32 weeks - CTG, this allows you to find out how well the baby's heart beats, whether he receives enough nutrition from the bloodstream. Screening for intrauterine infections. With IUGR, there are a lot of methods of providing assistance, and in most cases, doctors manage to quickly, by eliminating the cause that negatively affects the child, normalize its growth rate.
The width of the pelvis plays an important role. In women with a narrow pelvis, the stomach becomes noticeable much faster, because the uterus leaves the cramped pelvis faster and rises higher than the average values. A wide pelvis is more capacious, and slight deviations of the VDM to a smaller side are possible.
An examination on the occasion of deviations of the WDM from the norms is prescribed in any case, because it is better, as they say, to play it safe. It includes blood donation by a woman for sugar and infections, ultrasound and dopplerography.
But even if the reasons are not found and the genetic characteristics of the child are assumed, then the woman will be observed more closely, it may be necessary to visit the doctor more often, as well as take tests.
How to calculate the weight of a child according to WDM?
To determine the estimated weight of the baby, today they are increasingly resorting to ultrasound diagnostics, since its results are much more accurate. But obstetric formulas, which have already become history, can be applied by women on their own, at least to satisfy their own curiosity. There are several ways.
By Lankowitz
You need to take the last two sizes indicated on the date of the last visit to the antenatal clinic: the circumference of the abdomen of a woman and VDM. You also need to know your height and weight.
The algorithm is the following:(VSDM + coolant + height + weight) x10.
Example: gestational age 30 weeks, OB = 115, VSD = 30, height - 170 cm, weight - 75 kg. (115+30+170+75) X10= 3900. The error of the formula is about half a kilogram, both positive and negative.
By Bublichenko
For this calculation, you need to know exact weight future mother. It is divided by 200 and multiplied by 10. For example, in a pregnant woman who weighs 80 kilograms, the baby will weigh about 4 kilograms. The error is about a kilogram in both directions.
By Yakubova
This method is more accurate than the previous two, but in many ways loses in the accuracy of ultrasound. Formula: ((WDM + coolant) / 4) x100.
If a woman's WMD is 30, and the abdominal circumference is 115, then the estimated weight of the baby in the womb at the current time is 3625 grams. It is important to understand that the formula is applicable only to women with no excess adipose tissue in the abdomen.
By Jordania
The formula is simple: OzhkhVDM, which usually means multiplying one indicator from an exchange card by another. With a WDM of 30 cm and a coolant of 100 cm, the estimated weight of the baby in the womb is 3300 grams.
Important! Of all the formulas, the Jordanian method is considered the most accurate.
Self measurements
Self-measurement of the height of the rise of the domed part of the uterus above the womb is much easier than deciphering the measurements. At home, a woman may well do this without outside help. Knowing how doctors do it (described above), you can similarly use a centimeter tape, and if it is not at hand, then by the method of two folded fingers. It is important to go to the toilet, empty your bladder and take a comfortable horizontal position with your legs slightly bent at the knees.
A bed with a soft mattress is not suitable for measurements - the surface on which the future mom, must be rigid. The self-determination algorithm is quite simple:
- determine the location of the pubic bone, its upper border;
- gently feel the bottom of the reproductive organ, smoothly rising from the edge of the pubic bone to the navel and above (to the touch, the bottom looks like a comb with uneven contours);
- using any of the above methods, measure the distance from the edge of the pubis to the high bottom point.
Do not make mistakes, try to apply the zero mark of the centimeter tape to the edge of the pubic bone. Remember that VDM is measured not in mm, but in cm.
Be sure to take into account the peculiarities of your pregnancy, in particular the position of the fetus (the doctor reports about it at the appointment), the number of children, with twins, the weight of the fetus will be less, and the size of the uterus due to the stretching of the walls will be larger.
Content
From the moment of conception to birth, the size of the fetus gradually increases. The growth of the uterus observed in this case by weeks of pregnancy is a normal physiological process. According to the dynamics of this indicator, an experienced gynecologist monitors the features of changes in the state of the mother and the development of the embryo, can notice the complications or pathologies that have arisen in time and take measures to eliminate them. Measurements are made and recorded by the doctor at regular scheduled examinations; from the second trimester, a woman can perform them on her own, at home.
What is the size of the uterus by week of pregnancy
The size of the uterus in nulliparous women averages from 4.5 to 7 cm in length and from 4.5 to 6.5 cm in width, thickness - 3.5-4 cm. Individual parameters may deviate from the physiological norm by 2-3 see After the onset of pregnancy and implantation of the embryo, an increase in the organ begins (under the influence of the growth of the fetus), which continues until the last prenatal weeks. By childbirth, the size of the uterus reaches 33-40 cm.
By changing the location of the uterus and the parameters of its growth, an experienced specialist can determine the gestational age, the nuances of its course, and the developmental features of the fetus. To track the dynamics of organ enlargement, at each scheduled examination, the gynecologist measures the volume of the abdomen, the width of the pelvis. With the beginning of the second trimester, an indicator of the height of the fundus of the uterus (VSD or VDM) is introduced.
The height of the bottom of the uterus by weeks of pregnancy is the distance between the pubic symphysis and the highest point of the organ, measured with a regular centimeter tape. On average, this indicator corresponds to the period - from 8-9 cm in the eighth to ninth week, to 35-40 cm - in the fortieth. Deviations may indicate a multiple pregnancy (with increased values) or pathologies (wrong position of the fetus, developmental delay, oligohydramnios). The method of such diagnostics is indicative only in dynamics, one-time measurements are not informative.
Features of changes in the uterus during pregnancy
The process of organ enlargement occurs gradually, measuredly, therefore, normally it does not cause discomfort to a woman. Drawing pains, other unpleasant symptoms occur against the background of sprains or the formation of adhesions during polyhydramnios, multiple pregnancies, or due to scars after previous surgical operations. The size of the uterus depends on the trimester and varies as follows:
- First trimester. The uterus is located behind the pelvic bone, the shape resembles a pear. At the sixth week, the size of the organ reaches the volume of a chicken egg, at the eighth - a goose. By the end of the trimester, the uterus takes on a round shape, increases three times from the initial size.
- Second trimester. The organ is centered in the pelvic region, acquires symmetry, begins to be felt through the abdominal wall, as it comes out from behind the pubic bone.
- Third trimester. The organ again takes the form of an egg, stretching to the bottom. The uterine cavity increases 500 times compared to the beginning of pregnancy, the weight of the organ changes on average from 50 g to a kilogram (muscle fibers lengthen, thicken, the vascular network develops).
The height of the uterine fundus by weeks in each trimester increases in parallel with the development of the fetus. It goes through the following main stages:
- 8-9 weeks of obstetric period - the average volume of the organ corresponds to a goose egg, it is not palpable through the abdominal wall.
- 10-13 - the organ rises above the pubic bone; the activity of the functions of the placental system increases, the corpus luteum gradually disappears. The fetus develops the vascular system, it begins to make the first movements. VDM - about 11 cm.
- 14-16 - completion of formation internal organs embryo. The uterus reaches a size of 14-15 cm. At 16 weeks, the position of the bottom height reaches the middle between the navel and the top of the pubic bone.
- 17-19 - the fetus develops the immune system, limbs, cerebellum. The organ increases in size up to 19-20 cm.
- 20 weeks and beyond - the gap between the bottom of the uterus and the pubis reaches 21 cm, then this figure increases by an average of 1 cm per week. The SMD is located about two fingers below the navel.
- 23-24 - the weight of the fetus reaches 0.6 kg or more, it develops muscles and bones, and the respiratory system is formed. VDM - 24 cm.
- 28 - VDM about 28 cm, located 2-3 cm above the navel.
- 29-30 - the size of the organ reaches 31-32 cm.
- 32 - the uterus is located in the center between the navel and the xiphoid process of the sternum, VDM - about 34 cm.
- 38 - the gradual omission of the organ begins, accompanied by strong pressure on the diaphragm and stomach.
- 40 - the size of the uterus is from 32-34 to 40 cm, depending on physiological features the mother's body, the size of the fetus, and a number of other factors.
Uterus Size Chart by Week
Indicators of the standing height of the bottom and the size of the uterus are physiological, therefore, deviations from the fixed norms within 2-3 cm in most cases arise due to the characteristics of the mother's body and individual nuances of the course of pregnancy. The dynamics of changes in the size and position of the body in accordance with different periods is presented in the table:
|
Pregnancy period, weeks |
|
|---|---|
Until about 16 weeks, it is difficult to determine the location of the fundus of the uterus, because the organ is covered by the pubic bone. From the 20th week, the bottom is well palpable through the abdominal wall in the presence of a small layer of fat. From the 24th week, the height of the fundus is located in the navel, further, until the prenatal weeks, including them, the depth of the bottom of the uterus and the organ itself are perfectly palpable through the abdominal wall. In parallel with the growth of the size of the organ itself, there is a slight decrease in the length of its neck.
Deviations from the norm
The location of the uterus by weeks of pregnancy and its size during normal growth and development of the fetus change at approximately the same pace in all women. If the doctor fixes in the dynamics deviations from the average normal indicators (taking into account the physiological individual characteristics of the mother) up or down, he prescribes a number of additional examinations in order to timely prevent the development of dangerous complications.
Indicators below the norm
When changes in the size of the uterus by weeks of pregnancy deviate from the norm downwards, doctors, depending on the timing, prescribe a number of additional diagnostic examinations (for example, ultrasound). Such indicators may indicate an inaccurate determination of the term, a thin physique of the mother. Ultrasound also helps to identify possible pathologies that threaten intrauterine malformations and abnormalities in the development of the fetus:
- Up to 13-14 weeks, the reduced size of the organ may be evidence of an ectopic pregnancy.
- In the second trimester, low rates of organ enlargement may indicate fetal growth retardation (hypotrophy), oligohydramnios, placental insufficiency (against the background of maternal infectious diseases), preeclampsia.
- On later dates reduced WDM indicator accompanies transverse presentation fetus, sometimes this is observed with a wide pelvis of the mother.
