GAP in Aotearoa New Zealand

The Growth Assessment Protocol (GAP) is an international, award winning program which aims to improve safety in maternity care and outcome of pregnancy, including perinatal mortality and morbidity, with the predominant focus on improving antenatal recognition of pregnancies at risk due to fetal growth restriction.

GAP consists of evidence based guidelines and risk assessment algorithms, education and accreditation of all staff involved in clinical care, and rolling audit and benchmarking of performance. For further information and links to evidence and resources, please see

In Aotearoa New Zealand, GAP is commissioned nationally by the Accident Compensation Commission (ACC). Thanks to a concerted effort by DHBs and clinicians including midwives, obstetricians and sonographers, all expectant mothers are now being cared for with evidence based maternity guidelines, including New Zealand antenatal growth charts which are customised according to each individual pregnancy’s characteristics. The GAP Terms of Service is detailed here: Terms of service. Resources include:

  • GAP Education - dates of forthcoming workshops are listed here.
  • Fundal Height Measurement - click here for video demonstration. (Enter password “measureright”).
  • GAP eLearning - To access eLearning please use the following link -

Recent NZ results have shown a substantial increase in the health service’s ability to detect antenatally if the baby’s growth is unsatisfactory, which allows further investigation and timely delivery if necessary. Significant progress in this regard has been made across ethnic groups in New Zealand.

GAP Team: The service is delivered by the UK Perinatal Institute GAP team led by Emily Butler, in association with the NZ educational leads Joyce Cowan and Clare Senner who have both been central to the national rollout and support to the DHB’s.

In February 2023, Jodie Rofe from Nelson Marlborough and Kate Clayton from Canterbury have joined the NZ GAP Team. Both have navigated their own DHB’s through the implementation of GAP and will act as a support to other champions across the country.

The Perinatal Institute and the ACC are working with various stakeholders which include representation from RANZCOG, NZCOM, RANZCR, Ministry of Health, Te Aka Whai Ora (Māori Health Authority) and Te Whatu Ora (Health New Zealand).

Joyce Cowan & Clare Senner                   Emily Butler

Jodie Rofe                                                   Kate Clayton

Plans for 2023: We are working with ACC, Te Whatu Ora and the NZ GAP Advisory Group on the national roll-out of GROW App 2.0. This is the electronic version of customised charts which provides a number of features that help to further improve fetal growth surveillance. For further information, please see the GROW App 2.0 Page