Table 1 Recommended management of women in clusters randomised to Growth Assessment Protocol (GAP)

Risk assessment for small for gestational age (SGA) (see Fig. 4) and management as per the GAP protocol

• Women at low risk of SGA will be seen in antenatal clinic, where standardised fundal-height measurements will be performed (2–3 weekly), starting from 26 to 28 weeks

• For women at high risk of SGA, serial ultrasounds will be recommended, every 3 weeks starting from 26 to 28 completed gestational weeks

Customised fundal-height and ultrasound charts will be generated in early pregnancy for all women using the gestation-related optimal weight

• (GROW) software. Both ultrasound generated estimated fetal weights (EFWs) and fundal heights will be plotted on the customised chart

• Any deviation from expected progressive growth of fundal height on these charts will raise a recommendation for fetal ultrasound measurement, as will first plots below the 10th centile line

• Any deviation from expected growth on these charts from ultrasound generated EFW measurements will prompt surveillance according to the Royal College of Obstetricians and Gynaecologists (RCOG) Investigation and Management of the Small-for-Gestational-Age Fetus guidance [25]