Correspondence 1349
Volume 162 Number 5
Table I. Predictive value of symphysial-fundal height in diagnosis of IUGR
Year
1978 (Selec~d
Positive predictive value fixed prevalence 10%
No.
Prevalence (%)
Sensitivity (%)
Specificity (%)
139
31.6
86.4
89.5
79.2
93.4
48.9
93
48.4
66.7
93.8
90.1
75.0
54.4
841
8.1
26.5
88.2
16.5
93.2
20.0
population)
1983 (Case-control) 1988 (Overall population)
Negative predictive value %
Positive predictive value %
simple and routine measurements. The measurements are inappropriately performed and interpretation of them (in this case plotting values on a graph) is not done. In the similar setting of patients and physicians the predictive value of this method decreases significantly with time. We conclude that when carefully used this simple low-cost method is a useful tool for the diagnosis of IUGR, and that physicians must give relevance to the performance and interpretation of clinical measurements such as this and others obtained in daily practice. Jose M. Beliuin, MD, PhD Jose Villar, MD, MPH Juan C. Nardin, MD Centro Rosarino de Estudios Perinatales Br. Orono 500 2000 Rosario, Argentina
REFERENCES 1. Westin B. Gravidogram and fetal growth. Acta Obstet Gynecol Scand 1977;56:273. 2. Belizan JM, Villar J, Nardin JC, Malamud J, Sainz de Vicuna L. Diagnosis of intrauterine growth retardation by a simple clinical method: measurement of uterine height. AM J OBSTET GYNECOL 1978;131:643. 3. Quaranta P, Currell R, Redman DWG, Robinson ]S. Prediction of small-for-dates infants by measurement of symphysial-fundal-height. Br J Obstet Gynaecol 1981; 89:12. 4. Calvert], Crean EE, Newcombe RG, Pearson JF. Antenatal screening by measurement of symphysis-fund usheight. Br Med J 1982;285:846. 5. Cnattingius S, Axelsson 0, Lindmark G. Symphysisfundus measurements and intrauterine growth retardation. Acta Obstet Gynecol Scand 1984;63:335. 6. Pearce ]M, Campbell S. A comparison of symphysisfundal height and ultrasound as screening tests for lightfor-gestational-age infants. Br] Obstet GynaecoI1987;94: 100. 7. Mathei M, ]airaj P, Muthurathnam S. Screening for lightfor-gestational-age infants: a comparsion of the three simple measurements. Br J Obstet Gynaecol 1987;94:-217. 8. Fescina RH, Martell M, Martinez G, Lastra L, Schwarcz R. Small for dates: evaluation of different diagnostic methods. Acta Obstet Gynecol Scand 1987;66:221. 9. Azziz R, Smith S, Fabro S. The development and use of a standard symphysial-fundal height growth curve in the prediction of small-for-gestational-age neonates. Int] Gynaecol Obstet 1988;26:81.
10. Rosenberg K, Grant ]M, Tweedie I, Aitchison T, Gallagher F. Measurement of fundal height as a screening test for fetal growth retardation. Br ] Obstet Gynaecol 1980;89:78.
Hyperemesis gravidarum and fetal growth retardation To the Editors: Gross et al. pointed out in their article (Gross S, Librach C, Cecutti A. Maternal weight loss associated with hyperemesis gravidarum: A predictor of fetal outcome. AM J OBSTET GYNECOL 1989;160:906-9) that patients with hyperemesis who lost more than 5% of their body weight on admission to the hospital were at greater risk of carrying fetuses with growth retardation. However, the assessment of the amount of weight loss at times relies entirely on the patient's recall of previous body weight and may be erroneous. In our population, data of the prepregnant weights of patients with hyperemesis are often lacking. We therefore define our group of patients with "severe" hyperemesis by different criteria. The vomiting is classified as severe if one or more of the following are present: heavy ketonuria (3 + on Ketostix reagent strips), increase in blood urea and creatinine concentrations, serum electrolyte disturbance, or increase in hematocrit (>0.43%). Our results showed that the mean birth weight (adjusted for gestation) of the babies of the "severe" hyperemesis group is significantly smaller than that of both the "mild" hyperemesis group and the general hospital population. I Although different criteria were used, the two studies agreed on the fact that the babies of patients with severe hyperemesis are at greater risk of growth retardation and these pregnancies should therefore be closely monitored. R. K. H. Chin, MRCOG Department of Obstetrics and Gynaecology Caritas Medical Centre III Wing Hong St. Shamshuipo, Kowloon, Hong Kong REFERENCE 1. Chin RKH, Lao TT. Low birth weight and hyperemesis gravidarum. Eur] Obstet Gynecol 1988;28: 179-83.
Volume 162 Number 5
Table I. Predictive value of symphysial-fundal height in diagnosis of IUGR
Year
1978 (Selec~d
Positive predictive value fixed prevalence 10%
No.
Prevalence (%)
Sensitivity (%)
Specificity (%)
139
31.6
86.4
89.5
79.2
93.4
48.9
93
48.4
66.7
93.8
90.1
75.0
54.4
841
8.1
26.5
88.2
16.5
93.2
20.0
population)
1983 (Case-control) 1988 (Overall population)
Negative predictive value %
Positive predictive value %
simple and routine measurements. The measurements are inappropriately performed and interpretation of them (in this case plotting values on a graph) is not done. In the similar setting of patients and physicians the predictive value of this method decreases significantly with time. We conclude that when carefully used this simple low-cost method is a useful tool for the diagnosis of IUGR, and that physicians must give relevance to the performance and interpretation of clinical measurements such as this and others obtained in daily practice. Jose M. Beliuin, MD, PhD Jose Villar, MD, MPH Juan C. Nardin, MD Centro Rosarino de Estudios Perinatales Br. Orono 500 2000 Rosario, Argentina
REFERENCES 1. Westin B. Gravidogram and fetal growth. Acta Obstet Gynecol Scand 1977;56:273. 2. Belizan JM, Villar J, Nardin JC, Malamud J, Sainz de Vicuna L. Diagnosis of intrauterine growth retardation by a simple clinical method: measurement of uterine height. AM J OBSTET GYNECOL 1978;131:643. 3. Quaranta P, Currell R, Redman DWG, Robinson ]S. Prediction of small-for-dates infants by measurement of symphysial-fundal-height. Br J Obstet Gynaecol 1981; 89:12. 4. Calvert], Crean EE, Newcombe RG, Pearson JF. Antenatal screening by measurement of symphysis-fund usheight. Br Med J 1982;285:846. 5. Cnattingius S, Axelsson 0, Lindmark G. Symphysisfundus measurements and intrauterine growth retardation. Acta Obstet Gynecol Scand 1984;63:335. 6. Pearce ]M, Campbell S. A comparison of symphysisfundal height and ultrasound as screening tests for lightfor-gestational-age infants. Br] Obstet GynaecoI1987;94: 100. 7. Mathei M, ]airaj P, Muthurathnam S. Screening for lightfor-gestational-age infants: a comparsion of the three simple measurements. Br J Obstet Gynaecol 1987;94:-217. 8. Fescina RH, Martell M, Martinez G, Lastra L, Schwarcz R. Small for dates: evaluation of different diagnostic methods. Acta Obstet Gynecol Scand 1987;66:221. 9. Azziz R, Smith S, Fabro S. The development and use of a standard symphysial-fundal height growth curve in the prediction of small-for-gestational-age neonates. Int] Gynaecol Obstet 1988;26:81.
10. Rosenberg K, Grant ]M, Tweedie I, Aitchison T, Gallagher F. Measurement of fundal height as a screening test for fetal growth retardation. Br ] Obstet Gynaecol 1980;89:78.
Hyperemesis gravidarum and fetal growth retardation To the Editors: Gross et al. pointed out in their article (Gross S, Librach C, Cecutti A. Maternal weight loss associated with hyperemesis gravidarum: A predictor of fetal outcome. AM J OBSTET GYNECOL 1989;160:906-9) that patients with hyperemesis who lost more than 5% of their body weight on admission to the hospital were at greater risk of carrying fetuses with growth retardation. However, the assessment of the amount of weight loss at times relies entirely on the patient's recall of previous body weight and may be erroneous. In our population, data of the prepregnant weights of patients with hyperemesis are often lacking. We therefore define our group of patients with "severe" hyperemesis by different criteria. The vomiting is classified as severe if one or more of the following are present: heavy ketonuria (3 + on Ketostix reagent strips), increase in blood urea and creatinine concentrations, serum electrolyte disturbance, or increase in hematocrit (>0.43%). Our results showed that the mean birth weight (adjusted for gestation) of the babies of the "severe" hyperemesis group is significantly smaller than that of both the "mild" hyperemesis group and the general hospital population. I Although different criteria were used, the two studies agreed on the fact that the babies of patients with severe hyperemesis are at greater risk of growth retardation and these pregnancies should therefore be closely monitored. R. K. H. Chin, MRCOG Department of Obstetrics and Gynaecology Caritas Medical Centre III Wing Hong St. Shamshuipo, Kowloon, Hong Kong REFERENCE 1. Chin RKH, Lao TT. Low birth weight and hyperemesis gravidarum. Eur] Obstet Gynecol 1988;28: 179-83.
