Growth Assessment Protocol (GAP)              

The Perinatal Institute offers GAP as a comprehensive program with a service level agreement which can be viewed here: GAP SLA

Our Terms of Service are set out here.

GAP E-Learning

To access the E-Learning portal please use the following link:   GAP-Elearning

GAP Guidance

The GAP Care Pathway is aligned with the Fetal Growth element of the NHS Saving Babies Lives' Care Bundle v3.
It is available here: GAP Guidance

See also our FAQ pages

GAP is based on the following key elements:

  1. Evidence based care pathway and risk assessment algorithms
  2. Training and accreditation of all staff involved in clinical care
  3. Implementation of customised GROW chart and audit tool
  4. Rolling audit, reporting and benchmarking of performance



GAP uptake:  click here for a list of UK Trusts and Health Boards

GAP training:  dates of forthcoming workshops are listed here.

SFH - Standardised fundal height measurement video. 

GROW 2.0:  Upgrade to electronic chart and recording system


Stillbirth risk and SGA according to Hadlock, Intergrowth-21st, WHO and GROW fetal weight standards:
analysis by maternal ethnicity and BMI.
Am J Obstet Gynecol. 2023 (Pre-proof).
Outcome-based comparative analysis of five fetal growth velocity models to define slow growth
Ultrasound Obset Gynecol. 2023 (Pre-proof)
Evaluating the Growth Assessment Protocol for stillbirth prevention: progress and challenges
J Perinatal Med. 2022;50(6): 737-47.
Reduction of stillbirths in England from 2008 to 2017 according to uptake of the Growth Assessment Protocol:
10‐year population‐based cohort study
Ultrasound Obstet Gynecol. 2021;57:401-8
Prospective risk of stillbirth according to fetal size at term
J Perinatal Med. 2022;50(6): 748-52.
A fetal weight projection model to define growth velocity, and validation against pregnancy outcome in a cohort of serially
scanned pregnancies
Ultrasound Obstet Gynecol. 2022;60(1):86-95.
Customized GROW vs INTERGROWTH-21st birthweight standards to identify small for gestational age associated perinatal
outcomes at term
Am J Obstet Gynecol MFM. 2022;4(2):100545.
Customized growth charts: rationale, validation and clinical benefits
Am J Obstet Gynecol. 2018;218(2S):S609-18.
Fetal growth surveillance – Current guidelines, practices and challenges
Ultrasound. 2018;26(2):69-79.
Customised vs INTERGROWTH-21st birthweight standards to identify small for gestational age associated
perinatal outcomes at term
Am J Obstet Gynecol. 2018;218(2S):S692-9.
Preventing stillbirths through improved antenatal recognition of pregnancies at risk due to fetal growth restriction
Public Health 2014; 128:698-702
Association between reduced stillbirth rates in England and regional uptake of accreditation training in customised fetal
growth assessment
BMJ Open 2013;3:e003942
The Growth Assessment Protocol: a national programme to improve patient safety in maternity care
MIDIRS, 2013; 23:516-23
Tackling Stillbirth: simple and cheap techniques could save hundreds of babies a year
The Times Leading Article 18.12.2013

Effect on ONS stillbirth rates in England

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According to 2020 ONS figures, stillbirth rates in England have fallen consistently for 9 years to 3.80/1000. This represents a 29.0% reduction from the 2000-09 (10 year) average of 5.35, and equates to 1,022 babies saved per year.

The recently published 10 year analysis of unit level ONS data in England showed that:

  • There was an overall decline, associated with better protocols and awareness
  • NHS Trusts that fully implemented the GAP programme achieved a larger reduction
  • Steepest drop was observed in GAP units with best SGA detection rates
  • The study also highlighted that there is much more room for improvement!