what is a gravidogram
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gravidogram antenatal chart pregnancy monitoring
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gravidogram definition obstetrics components antenatal care record
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https://www.health.gov.za/wp-content/uploads/2023/05/BANC-Pl…
Here is a thorough explanation of the gravidogram:
Gravidogram
A gravidogram (also called an antenatal graph or antenatal growth chart) is a structured record used in prenatal (antenatal) care to monitor the progress of a pregnancy visit by visit. Rather than recording isolated readings, it plots key maternal and fetal parameters over time as a graph, making it easy to detect abnormal trends at a glance.
It is a core component of the maternity record that the pregnant woman typically carries with her throughout pregnancy, ensuring continuity of care across different healthcare providers and facilities.
What it Tracks
The gravidogram typically includes a chart for the following parameters recorded at each antenatal visit:
| Parameter | Purpose |
|---|---|
| Symphysis-fundal height (SFH) | Measures uterine size in cm (from pubic symphysis to uterine fundus); the key proxy for fetal growth |
| Gestational age (in weeks) | Plotted on the horizontal axis; all measurements are referenced against it |
| Fetal growth centile lines | Pre-drawn reference lines (e.g., 10th, 50th, 90th percentiles); SFH is plotted against these |
| Maternal weight | Monitors appropriate gestational weight gain |
| Blood pressure | Detects hypertensive disorders of pregnancy (gestational hypertension, pre-eclampsia) |
| Fetal heart rate / fetal movements | Confirms fetal wellbeing at each visit |
| Urine dipstick findings | Proteinuria, glucosuria, etc. |
| Oedema | Clinical sign for pre-eclampsia and nutritional status |
| Presentation and engagement | Fetal lie and presenting part as term approaches |
The SFH Growth Chart - the Heart of the Gravidogram
The central visual element is the symphysis-fundal height (SF) growth chart:
- Gestational age in weeks runs along the horizontal axis
- SF measurement in centimetres runs along the vertical axis
- Pre-drawn centile bands act as reference lines
- At each visit, the midwife or doctor measures SFH with a tape measure and plots the value on the chart
This allows immediate visual identification of:
- Slow or static growth - possible intrauterine growth restriction (IUGR/FGR)
- Accelerated growth - possible macrosomia, polyhydramnios
- Normal growth trajectory - reassuring, no intervention needed
Clinical Significance
- Early detection of fetal growth restriction (FGR) - the leading preventable cause of stillbirth
- Tracking maternal hypertension trends - a single BP reading may be misleading; the chart reveals a rising trend
- Monitoring weight gain - excess or insufficient gain prompts dietary counselling
- Communication tool - because the woman carries the card, any provider seeing her for the first time has the full pregnancy history at a glance
- Quality assurance - audits of gravidograms reveal whether recommended measurements are actually being done at each visit
Context and Use
The gravidogram is widely used in low- and middle-income settings (notably in South Africa's Basic Antenatal Care programme, and across sub-Saharan Africa and South Asia) where ultrasound may not be available at every visit. In higher-income settings, many of these parameters are now tracked digitally in electronic maternity records, though the underlying data is the same.
Recent digital health work (such as the SMART Start feasibility study) has been translating the traditional paper gravidogram into smartphone-based digital maternity records, making the data accessible to both patients and clinicians in real time.
In short: the gravidogram is a longitudinal antenatal monitoring chart, with the symphysis-fundal height plotted against gestational age centile references as its centrepiece, surrounded by serial recordings of blood pressure, weight, urinalysis, fetal heart rate, and clinical findings - all in one place for every visit of the pregnancy.
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