Fetal Growth Assessment Form
Please complete the following assessment to record fetal growth parameters. Ensure all measurements are accurate and up to date.
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gestational Age (weeks)
*
Indication for Assessment
*
Routine screening
Suspected growth restriction
Large for gestational age
Follow-up assessment
Other
Estimated Fetal Weight (grams)
*
Key Biometric Measurements
*
Rows
Measurement (mm)
Head Circumference
Abdominal Circumference
Femur Length
Fetal Growth Percentile
*
Please Select
<10th percentile
10th–25th percentile
26th–50th percentile
51st–75th percentile
76th–90th percentile
>90th percentile
Amniotic Fluid Volume
*
Normal
Oligohydramnios
Polyhydramnios
Umbilical Artery Doppler
*
Normal
Elevated resistance
Absent/reversed end diastolic flow
Not assessed
Growth Trend Compared to Previous Assessment
*
Consistent with expected growth
Slowed growth
Accelerated growth
No previous assessment
Additional Comments or Observations
Submit Assessment
Should be Empty: