The height of the fundus of the uterus (VDM) and its dynamics by weeks of pregnancy. What is the height of the fundus of the uterus? What does vdm and obesity mean during pregnancy

In pregnant women, the height of the fundus of the uterus (VDM) by week and its value are important diagnostic indicators. To perform measurements, the gynecologist does not need complex equipment, the whole procedure is quick and at the same time gives information about the size of the fetus, its condition, and the presence of some complications.

Nothing in the body of the expectant mother undergoes as many changes as the uterus. Its walls protect the child, provide oxygen and various useful compounds necessary for development. The size of this organ is constantly increasing up to 37 weeks.

It is possible to find out how much the BMR has become larger during pregnancy without finger probing through the vagina no earlier than 3 months of gestation. Until that time, the growing organ, together with the fetus, is covered by the pubic bone.

At each scheduled appointment, the gynecologist takes measurements: the volume of the abdomen, the width of the pelvis and the height of the fundus of the uterus. Information is regularly recorded in order to be able to assess the dynamics of the growth of WDM. This is no less important than single static indicators.

To measure the height of the bottom of the uterus, a woman needs to lie on her back. Carefully probing the abdomen along its vertical line, you can find the upper border of the organ: the elastic surface will be replaced by the soft one. One end of the measuring tape is applied to the pubic bone, the other to the found fundus of the uterus.

Features of changes in the uterus during pregnancy

The height of the standing of the fundus of the uterus increases weekly throughout almost all 9 months of pregnancy. At first, it is located behind the pelvic bone and is shaped like a pear. In size, it can be compared with a chicken () and goose () egg. By the end of 2 months, the uterus is enlarged by about three and becomes round. From the 2nd trimester, it is centered in the pelvis, acquires symmetry. Gradually, the genital organ begins to emerge from under the pubic bone and be felt.

By the 3rd trimester, the uterus becomes similar in shape to an egg: it stretches along, the lower side is narrower than the upper one. By the end of pregnancy, its cavity is 500 times larger than it was at the beginning, and the weight increases from 50 grams to 1000. Not only the size of the uterus changes, but also the structure: muscle fibers lengthen, thicken, and a powerful vascular network develops.

Normal indicators of WDM

The height of the standing of the fundus of the uterus by week of pregnancy is indicated in the table below . But it is worth remembering that this indicator is physiological. It may be 2-3 cm larger or smaller than the standard one.

It is important not only the value of WDM measurement indicators during pregnancy, but also their dynamics - an increase relative to the previous measurement. From 24-30 weeks of pregnancy, the height of the fundus of the uterus most often coincides with the timing (weeks = cm).

Term	WDM norm	Notes (edit)
16 weeks	Not less than 6 and not more than 8 cm	It is difficult to independently determine where the fundus of the uterus is located
20 weeks	Not less than 11 and not more than 12 cm	The bottom is palpable with normal and small subcutaneous fat
24 weeks	Not less than 22 and not more than 24 cm	The bottom can be determined in the navel area
28 weeks	Not less than 27 and not more than 29 cm	The uterus is well defined by palpation
32 weeks	Not less than 31 and not more than 33 cm	Feeling the bottom of the uterus, parts of the fetus
36 weeks	Not less than 35 and up to 37 cm
40 weeks	Not less than 32 and up to 35 cm	The fundus of the uterus, parts of the body of the fetus are well defined

What do the BMR indices indicate below the norm?

When the BMR during pregnancy is less than it should be in the current week, additional examination is required to identify the causes.

The doctor's guess is based on the gestational age:

Until 12-13 weeks, when the uterus is still completely behind the pubic bone, its reduced size often indicates that the ovum is fixed in the fallopian tube.
At a later date, a decrease in the rate of growth of the uterus may be a sign of (growth retardation).
The height of the bottom is less than the norm is observed when it develops due to hypertension, infectious and inflammatory diseases of the mother, disturbances in the functioning of the excretory organs of the fetus,.
Reduced BMR indicators during pregnancy are observed with.

Why WDM indicators can be more than normal?

Indicators of the height of the fundus of the uterus above normal are typical for the following situations:

The presence of chorionepithelioma - a tumor that develops from tissue and is a collection of vesicles. This pathology leads to the death of the fetus and poses a danger to the health of the mother.
The height of the fundus of the uterus for weeks is higher than normal for twins or triplets. accompanied by a high risk of complications.
... This complication develops with, mother and fetus, acute and chronic foci of infection.
... This feature can be either a variant of the norm (a genetic feature) or a consequence of diabetes mellitus in a pregnant woman. Childbirth with a large fetus is more likely to be complicated.

The height of the standing of the bottom of the uterus by week is an important diagnostic indicator during pregnancy. A deviation from the norm of WDM in one direction or another is a sign of pathology or complications requiring treatment. The speed and convenience of this examination make it possible to use it at every scheduled visit to the gynecologist.

During pregnancy, a woman should visit an obstetrician-gynecologist at least 7 times. At each examination, a specialist conducts routine examinations that help determine how the child is being carried. These include the measurement of blood pressure and the size of the pelvis, listening to heart sounds and palpation of the fetus, diagnostics of concomitant somatic diseases.

One of the most important methods of examining a pregnant woman is to measure the circumference of the abdomen and the height of the fundus of the uterus. The figures obtained are compared with the norms for a given gestational age, which allows one to judge about abnormalities in the size of the fetus or other pathologies.

Increased abdominal volume during pregnancy

Usually, a sharp increase in the volume of the abdomen occurs at the 16th obstetric week, it is from this period that the abdominal circumference is measured during pregnancy. An earlier examination does not make sense, since before this time the enlarged uterus does not push the anterior abdominal wall forward.

On average, the abdominal circumference during pregnancy increases by 2-3 centimeters every 2 weeks of gestation, respectively, by 1-1.5 centimeters in 7 days. Normally, in the absence of excessively developed subcutaneous fat, when examined for a period of 16 weeks, the girth of the abdomen is 70-75 centimeters. From this it follows that the abdominal circumference at 27 weeks of gestation should be 81-86 centimeters.

It is impossible to ignore the planned measurements of the volume of the abdomen and the height of the fundus of the uterus, since changes in one direction or the other make it possible to suspect pathology in time and prescribe additional examinations.

In normosthenic women, the abdominal circumference at 32 weeks of gestation should approach 90 centimeters, and reach 95-100 centimeters by the time of delivery. However, the results of this measurement are quite subjective and depend on the figure and physique before the conception of the child. Therefore, it is considered more correct to monitor the dynamics of an increase in the volume of the abdomen, which should grow evenly throughout the pregnancy.

Functions for measuring the girth of the abdomen

The abdominal circumference during pregnancy is an important method of examining the expectant mother. This measurement makes it possible to judge the intrauterine growth of the unborn child, to suspect multiple pregnancy or pathology. Usually, a study of the size of the abdominal circumference is carried out simultaneously with the determination of the height of the uterine fundus, which gradually and naturally increases in accordance with the gestational period.

In addition, the measurements listed above help to indirectly determine the weight of the fetus using the formula:

ОЖ * ВСДМ = fetal weight.

where OJ is the abdominal circumference, and VVDM is the height of the uterine fundus.

Abdominal circumference

Reasons for deviation from the norm

If the abdominal circumference does not correspond to the gestational age, the likelihood of the presence of fetal pathology or pregnancy complications increases. Decreased abdominal girth occurs:

With a decrease in the amount of amniotic fluid. This pathology occurs in post-term pregnancy, early rupture of amniotic fluid and concomitant fetal diseases.
With fetal malnutrition. Lagging behind in the growth and development of the unborn child.
With an excessively wide pelvis, when the fetus "falls" into its cavity. Due to insufficient nutrition of the mother.

An increase in the size of the abdominal circumference can cause:

An increase in the amount of amniotic fluid. This is due to the presence of diabetes mellitus in the mother, or due to infection or fetal malformations.
Large size of the child. It can be observed normally. A large fetus almost always accompanies a post-term pregnancy; very rarely, an increase in the weight of an unborn child is caused by pathological reasons.
Multiple pregnancy. It is quite natural that 2 or more babies in the womb will cause an excessive increase in her abdomen.
Fetal position. When the baby is perpendicular to the axis of the uterus, the size of the abdominal girth can be increased.
Narrow pelvis. With this anatomical feature, the child takes a higher and forward position.
Vesicular drift and chorineepithelioma. Rare diseases in which tumor tissue grows in the uterine cavity.
Diet inaccuracies. Sometimes the reason for the increase in the abdomen in the expectant mother is not her unborn child, but the excessive consumption of high-calorie foods.

Do not forget that the abdominal circumference during pregnancy may not correspond to the norms due to incorrect measurements, therefore it is better to undergo routine examinations with one qualified doctor.

Measuring the circumference of the abdomen at home

The study will be more reliable if the circumference of the abdomen is measured by another person. Self-measurement has a large error, you should not trust him one hundred percent.

A pregnant woman should take a lying position on a fairly firm surface with her stomach up, her arms should be extended along the torso. The tape should be passed from the back through the strongest arch of the spine, and from the front through the navel. The expectant mother should first empty the bladder and not strain the abdominal muscles.

An important diagnostic indicator in the management of pregnancy is the height of the fundus of the uterus. The discrepancy between the height of the uterine fundus (UFM) and the gestational age may indicate the development of pathology and requires additional diagnostic measures.

What is VCDM? Where is the uterine fundus in women who have not given birth? What are the normal sizes of the uterus during pregnancy? Should a pregnant woman worry if the height indicator does not correspond to the table?

How does the uterus work?

The main function of the uterus is childbearing. The organ is made up of tight muscle joints, thanks to which it can stretch to the desired size as the fetus grows and contract to its natural size in the postpartum period.

During pregnancy, this small sac of elastic muscle grows almost 500 times larger. The weight of the uterus before pregnancy is only 50 g, and at the 40th week this figure reaches 1–1.5 kg.

Where is the uterine fundus located before pregnancy?

Many women are interested in where the uterine fundus is. This is the highest point that protrudes above the pubic joint. In a woman who has not given birth, the length of the uterus is approximately 7 cm. As soon as a fertilized egg is introduced into its mucous membrane, its size begins to gradually increase. In the early stages, the bottom is located slightly below the navel and rises as the organ grows with the child inside. The determination is made in two stages:

external manual examination of the uterus;
measurement of the abdominal circumference and VDM by means of a centimeter tape.

External palpation of the fundus of the uterus becomes possible only from the 16th week of pregnancy (for more details, see the article: the size of the uterus at 16 weeks of gestation). Until this time, WDM can only be determined by vaginal examination.

How does the uterus change during pregnancy?

The change in the size and shape of the uterus is due to the growth of the baby in it. Since the baby weighs more and more every week, the uterus, accordingly, also stretches more. Roughly until the 3rd month, the uterus is at the level of the womb. In size and shape, it resembles a chicken egg, and a little later a goose egg. At this time, the tummy is not yet growing, so nothing can betray the woman's condition.

Until the third trimester of pregnancy, the uterus becomes ovoid. After 32–34 weeks, the baby inside the uterus should take its natural prenatal position - head down.

The structure of the tissues of the uterus also undergoes changes. The walls during this period become thicker and a powerful vascular network forms on them.

How and why is the height of the fundus of the uterus determined?

Data on the height of the uterus must be entered into the patient's exchange card after each planned and unscheduled visit. Before the appointment, the expectant mother needs to prepare for the examination, for example, to empty the intestines in a timely manner. An overflowing bladder can also distort the actual WDM readings. In addition, a pregnant patient should carefully consider the outfit. The expectant mother should choose comfortable and free things. It is better for patients to refuse clothing that squeezes the abdomen or is difficult to remove. Each routine inspection usually follows the following pattern:

acceptance by a woman of a horizontal position;
palpation of the uterus;
determining the length from the pubic bone to the upper part of the uterus using a tape meter.

Despite the fact that the procedure takes less than 1 minute, it is very informative. Usually, after fixing the height of the fundus of the uterus, the obstetrician measures the circumference of the abdomen in order to determine the estimated volume of amniotic fluid. These measurements are less accurate than WDM, since they depend on the thickness of the fatty layer on the abdominal wall and the individual characteristics of the woman's physique. In accordance with the gestational age, the gynecologist draws conclusions about the development, position of the fetus and the amount of amniotic fluid.

A woman can independently find out where the fundus of the uterus is located at home. To do this, you need to lie down, apply a measuring tape from the pubic joint to the point at which the abdomen ceases to be firm. This length is VSDM.

Norm and pathology: table of values of VSDM

In the table below, the values of the height of the standing of the uterine fundus are normal and critical indicators. Deviations from the norm by 1–2 cm should not alarm a pregnant woman. If the measurement results are critical, the gynecologist is obliged to send the patient for additional diagnostics - ultrasound, Doppler, cardiotocography.

What does the deviation from the norm mean?

The specialist conducting the pregnancy relies not only on the abdominal circumference parameter and WDM measurements. If you suspect the development of pathology, these indicators allow you to assess the condition of the child and act ahead of the curve. The advantage of the method is its painlessness and speed.

Indicators less than the norm may indicate both problems and the peculiarities of the anatomy of the expectant mother. So, short stature, narrow hips of the expectant mother can affect the results of measuring the BMR.

Deviation from standard indicators may indicate an erroneous determination of the gestational age. If the pregnancy proceeds without complications and complaints of a deterioration in well-being, a low indicator is a sign that the gynecologist has incorrectly calculated the week of pregnancy. Errors in determining the date happen due to irregular periods or in the case when a woman does not exactly remember the date of the last menstruation.

Another reason is the pathology of the growth and development of the fetus. A deviation of VDM from the norm may indicate various violations of the course of pregnancy, for example, oligohydramnios.

In some pregnant women, the BMR indicator, on the contrary, is overestimated. It is less dangerous for a pregnant woman and her baby. Indicators above the norm are a sign:

Large physique of a child. In most cases, the excess of the indicator is due to a hereditary factor. In rare cases, a deviation from the norm is a manifestation of diabetes mellitus in the mother or intrauterine pathologies.
Multiple pregnancies. Several babies develop in the uterus. In rare cases, two fetuses can be positioned so that the first ultrasound only detects one baby.
Physique features of the patient. The height of the standing of the fundus of the uterus in a tall woman with massive hips may slightly exceed the normal value.
Improper intrauterine position of the fetus. This often happens in the third trimester. Since a planned ultrasound scan is performed at 32-34 weeks, and a baby up to 40 weeks old can change its position several times, measuring WDM is the only way to determine its location without ultrasound
Violations of the course of pregnancy. Too high the height of the fundus of the uterus in the later stages is considered a sign of polyhydramnios. An indicator above the norm may also indicate a dangerous pathology - the presence of chorionepithelioma, that is, a tumor in the tissue of the placenta.

The height of the uterine fundus is an indicator by which the gynecologist judges the correct development of the baby and pregnancy in general. Every expectant mother should know what this indicator means, how to measure it and what is considered the norm.

General characteristics of the concept

In the course of pregnancy, a lot changes in a woman's body. Internal changes are often associated with the fact that as the fetus develops, the uterus acquires the appropriate size and the rest of the organs move to give it enough space.

The distance from the pubic bone to the highest point where the uterus is felt is called its height. It turns out that the height of the fundus of the uterus is the size to which the uterus grows during pregnancy.

This is one of the possible indirect indicators by which the level of fetal development can be determined.

Measurement of the height of the standing of the fundus of the uterus: at the doctor and independently

In the first trimester, the enlarged uterus can be felt by the gynecologist through the vagina. You should not do it yourself for a short time. But as the fetus grows, it is easier to do this - at the beginning of the second trimester, the uterus extends beyond the boundaries of the pelvic bones, and it is easy to feel it through the stomach.

During the appointment, the doctor feels the abdomen and measures it with a measuring tape, then records the results. At home, you can try to repeat his actions.

The bladder must be emptied before taking measurements, otherwise the readings may be inaccurate.

To measure the height of the bottom of the uterus, you will need a centimeter tape - the most common one used by seamstresses to take measurements. You will need to lie on your back and straighten your legs. Then gently feel the abdomen with your fingers, starting from the pubic joint upwards. The belly will be quite firm up to a point. It is this point that is the bottom of the uterus. Then you need to measure the distance from the beginning of the path to this point. This indicator is the height of the uterine fundus.

Watch a video showing how to correctly measure:

The norms of the standing height of the fundus of the uterus at different periods

the number of hearths;
the size of the child;
intrauterine position of the child;
individual characteristics of a woman's body;
the presence of pathological conditions.

If the child is alone, the size is within the normal range, the location in the womb is correct and the woman does not have features that affect the size of the uterus (for example, there is no polyhydramnios or low water, and her growth is average, and her complexion is normal), then the indicator will be equal to:

6 cm at 16 weeks;
12-14 cm at week 20;
20 cm at 24 weeks;
24-26 cm at 28 weeks;
28-30 cm at 32 weeks;
32-34 cm at 36 weeks;
28-30 cm at 40 weeks.

It is also considered the norm if the indicator is approximately equal to the gestational age in terms of weeks: how many weeks - so much is the indicator in centimeters.

The indicator of the standing height of the fundus of the uterus is constantly increasing. It shrinks by a couple of centimeters just a few days before giving birth.

With multiple pregnancies, the picture changes somewhat. At 16 weeks, the range of the norm is 15 to 28 centimeters. Indicators can exceed the norm from 2 to 12 cm in comparison with a singleton pregnancy.

It is not uncommon for cases when up to 28 and even up to 30 weeks of pregnancy with twins, the indicators barely exceed the norm for pregnant women with one child. Do not panic: babies can lie and develop in different ways, but it is better not to refuse additional examination.

If the deviations exceed 3 cm, our doctors may be puzzled by the search for reasons and send the expectant mother for additional examinations and even prescribe treatment. Often examinations show that everything is in order with the children, but all the same, gynecologists persistently prescribe Actovegin, Curantil and other unnecessary therapy in this situation. Therefore, in civilized countries they do not rely on this indicators and do not measure it at all.

Many accredited obstetricians-gynecologists consider the measurement of the height of the fundus of the uterus to be an ancient teaching of the Soviet medical school, and therefore they rely only on the results of an ultrasound of the fetus.

Possible reasons for indicators below normal

There are cases when, when measuring, the height of the standing of the fundus of the uterus turns out to be less than normal.

Erroneous timing is one of the most common reasons. If a woman first came to the LCD for registration in the second trimester, and not before 12 weeks, as expected, then the doctor does not always succeed in calculating exactly how many weeks the pregnancy has already lasted. Basically, in the situation under consideration, this happens due to the presence of an unstable or long menstrual cycle in a woman, as well as in its absence, for example, if another pregnancy occurred during breastfeeding of the previous baby and there was no menstruation after childbirth. Because of this, actual performance may differ from what it was erroneously assumed to be.

Low water (insufficient amount of amniotic fluid) can also be the reason for the deviation of the indicator to the lower side: there is little water, therefore, the uterus does not increase to the proper extent. May occur with dehydration, the use of nicotine and certain medications (for example, ACE inhibitors). An additional symptom of severe oligohydramnios is pain when the fetus moves. A planned ultrasound scan is enough to detect low water.

A wide pelvis with low levels of the standing height of the bottom of the uterus has a simple explanation: the uterus has enough space between the pelvic bones, so it does not need to rise. It is not a pathology.

In addition to a wide pelvis, there may be other physiological features: a miniature figure, the influence of a genetic factor, and more.

An incorrect (transverse or oblique) position of the fetus can also cause a low rate. The explanation is simple - due to this position of the child, the uterus does not grow up, but to the sides.

Fetal growth retardation is the most unpleasant of possible reasons when the baby does not gain enough weight while in the womb. In addition to physiological reasons (small growth of the mother or father), there may be violations of the development of the placenta or umbilical cord, the presence of infection, bad habits, as well as thickening of the blood and, as a result, insufficient nutrition of the fetus with nutrients and oxygen. There may not be any vivid symptoms, but the doctor will notice on examination that there may be a delay in the development of the fetus and will prescribe an ultrasound scan.

It is believed that the low weight of the expectant mother is the main sign that the child will be born small. Although sometimes this is true, it is still not worth considering this factor as the determining factor. On the contrary, many large women give birth to small babies with low weight.

Possible reasons for indicators above normal

If the indicator of the standing height of the uterine fundus exceeds the norm, then there may also be several reasons for this.

If the fetus overtakes the norms set for a given period in terms of its development, it is logical that the uterus will also be larger than usual. Often this applies to those who had a similar situation in the family in the older generation, and the large size of the fetus is due to genetics.

The second reason is the presence of two, three or more fetuses in the uterus. Each of them needs a place, and each of them grows - therefore, the uterus also grows significantly.

A narrow pelvis in a woman can prevent the uterus from expanding in breadth, and it will take the place it needs from above. Therefore, the height of the bottom will be higher than usual.

Another reason is polyhydramnios, a large amount of amniotic fluid. Determining their volume can be tricky. Symptoms include a gurgling sound, pain and heaviness, a large abdomen at the level of the navel, and shortness of breath due to pressure on the diaphragm. If these symptoms appear against the background of diabetes mellitus, infectious diseases, disturbances in the functioning of the heart and blood vessels, as well as Rh-conflict, it is necessary to undergo an ultrasound scan. Also, polyhydramnios can develop with multiple pregnancies, fetal formation disorders, due to a large fetus, and in later stages due to impaired swallowing function in a child.

By itself, the indicator of the height of the fundus of the uterus carries very scant information. It cannot be used to objectively judge the normal course of pregnancy and the full development of the fetus, and, if necessary, timely identify the pathology and take the necessary measures. For this, there is an ultrasound scan of the fetus.

The biggest changes that occur in a woman's body during pregnancy are probably associated with her uterus. It is here that the fertilized egg is normally attached for its further growth and development. In order to provide the growing fetus with the space necessary for life, the uterus grows in size all the time. As it grows, it rises higher and higher, reaching a maximum at about 37 weeks gestation.

The size of the uterus and the height of its standing are of great diagnostic value. They help to determine the approximate duration of pregnancy and draw conclusions about its course, as well as assess the degree of development and size of the fetus and identify possible deviations in time. That is why the gynecologist will examine and evaluate the size and height of the uterus every time his ward is examined.

In the early stages, the size of the uterus is determined by finger palpation through the vagina. But from the second trimester, after about 13-14 weeks, the uterus goes beyond the pelvic region, rising higher, and it can already be felt through the abdominal wall. Now the gynecologist will measure it every time, or rather, the height of the bottom.

The height of the standing of the fundus of the uterus () is the distance between the top point of the pubic symphysis and the highest point of the uterus, which is its bottom. It is measured in centimeters in the position of a pregnant woman, lying on her back, using a special pelvimeter device or an ordinary measuring tape. The doctor enters all the indicators into yours every time in order to be able to compare them and track the dynamics.

To assess the indicators, a table is used, which shows the norms for the conformity of the WDM to the gestational age:

As you can see, the height of the fundus of the uterus in centimeters approximately corresponds to the gestational age in weeks plus or minus 2-3 cm. This range of fluctuations in WDM values takes into account the individual characteristics of each pregnant woman, in particular, her physiological parameters.

A significant discrepancy in the height of the fundus of the uterus with the norms at a particular stage of pregnancy gives the doctor a reason to suspect that something was wrong. With overestimated indicators, it can be about or too much. The underestimated WDM indices may indicate a low rate of fetal development, its transverse or oblique location.

However, do not rush to panic and draw premature conclusions if your fundus height does not match the deadline. Firstly, the reason for the differences is often an error in determining the gestational age. Secondly, in the case of overestimated indicators, the reason can be doubly pleasant - this is development. Thirdly, the indicators of the height of the fundus of the uterus themselves are uninformative. It is necessary to evaluate the dynamics, and if from week to week or from month to month the uterus rises higher and higher, as it should be, then most likely there is no reason for worry. However, if there is any suspicion of any violation, the doctor will refer you to additional studies (ultrasound, Doppler, CTG and others), and this should not be neglected.

Also take note that 2-4 weeks before labor starts, the baby begins to sink into the pelvis, which we call. In this case, the uterus also slightly decreases and the WDM, respectively, decreases by several centimeters, which can be seen in the table.

Especially for- Elena Kichak