Gestational Age assessment

1. GESTATIONAL AGE ASSESSMENT
Ms. NIDHI CHAUHAN
M.sc NURSING BATCH 2017

2. Gestational age is the estimated age
of a fetus expressed in weeks,
calculated from the first day of the
last menstruation period.
Based on gestational age, each
neonate is classified as-
Pre term- <37 weeks
Term- 39 to 41 weeks
Post term- >42 weeks

3. Gestational age can be assessed by three
methods-
1. Menstruation history
2. Prenatal ultrasonography
3. Postnatal maturational examination

4.  Gestational age
 Embryologic age
 Pre term
 Post term
 Neonate
 Hypotonia
 Vernix caseosa
 Flexion
 Extension
 Adduction
 Abduction
 Meconium

5. Assessment of newborn can be
divided into 4 phases:
1. Initial assessment
2. Transitional assessment
3. Gestational age assessment
4. Systematic physical examination

6.  A method to determine the gestational
age is New Ballard Scale(NBS).
 It was proposed by Dr. Jenne L Ballard in
1991.
 NBS assesses 6 external physical and 6
neuromuscular signs of maturity.
 Assessment of gestational age from 20 to
44 weeks
 Scores range from -10 to +50
 Optimal time for assessment if from birth
to 90 hours

9.  Posture
 Square window
 Arm recoil
 Popliteal angle
 Scarf sign
 Heel to ear

10. Observe in the supine position at
rest
Score is assigned based on the
degree of flexion of arms, knees and
hips
Increased flexion and hip adduction
with increased gestational age

12. Infants hand is flexed on the
forearm between the thumb and
index finger of the examiner
Apply enough pressure to get full
flexion without rotating the wrist
Angle between the forearm and the
palm is measured.

14.  This maneuver focuses on passive flexor
tone of the biceps muscle by measuring
the angle of recoil following very brief
extension of the upper extremity.
 Flex the neonates arms for 5 seconds
while in the supine position
 Fully extend the arms by pulling on the
hands and release
 The degree of arm flexion and strength of
recoil are measured. Full term can flex
hand completely up to face.

16.  Place infant in supine position with the
pelvis on the mattress
 Using the thumb and index finger of one
hand, examiner holds the knee adjacent
to the chest and abdomen
 Gently extend the leg with the index
finger
 Look at the angle between the lower leg,
thigh and posterior knee.

18. Place infant in supine position with
head in mid-line position.
Grasp the infants hand and pull the
arm across the chest and around the
neck.
Look at the relationship of elbow to
mid-line of body when arm pulls
across the chest

20. Place the infant supine with pelvis
flat on table.
Grasp one foot with thumb and
index finger and draw foot as near
to head as possible.
Note the distance between the foot
and head as well as degree of knee
extension

22.  Skin
 Lanugo
 Plantar surface
 Breast
 Eye/ear
 Genitalia

23. less transparent and tougher with
increasing gestational age
36-37 weeks loses transparency and
underlying vessels are no longer
visible
Increasing gestational age the veins
become less viable and increasing
subcutaneous tissue

25. Fine downy hair covering fetus from
20-28 weeks
Disappears around face and anterior
trunk ~28 weeks
Term infants may have a few
patches over shoulders

27. 28-30 weeks appear and cover the
anterior portion of the plantar
surface of the foot
 Extend toward the heel as increases
gestational age
After 12 hours sole creases are not
valid indicator of gestational age
due to drying of the skin

29.  Areola is raised by 34 weeks
A 1-2 mm nodule of breast tissue is
palpable by 36 weeks
By 40 weeks the nodule is 10mm

30. SIGN
PHYSICAL MATURITY SCORE SIGN
SCORE-1 0 1 2 3 4 5
Breast
imperce
ptable
barely
percept
able
flat
areola
no bud
stippled
areola
1-2 mm
bud
raised
areola
3-4 mm
bud
full
areola
5-10
mm bud

31.  Lids are open and complete eyelashes
develops at term
 Incurving of the upper pinna begins by 34
weeks gestation and extend entire lobe
by 40 weeks
 Before 34 weeks, pinna has very little
cartilage (Stays folded on itself)
 At 36 weeks, there is some cartilage and
will spring back

32. SIGN
PHYSICAL MATURITY SCORE SIGN
SCORE-1 0 1 2 3 4 5
Eye /
Ear
lids
fused
loosely:
-1
tightly:
-2
lids
open
pinna
flat
stays
folded
sl.
curved
pinna;
soft;
slow
recoil
well-
curved
pinna;
soft but
ready
recoil
formed
& firm
instant
recoil
thick
cartilag
e
ear stiff

33. Testes begin to descend from
abdomen around 28 weeks
At 37 weeks, testes can be palpated
high in scrotum
At 40 weeks, testes are completely
descended and covered with rugae
As gestation progresses, scrotum
becomes more pendulous

34. SIGN
PHYSICAL MATURITY SCORE SIGN
SCORE-1 0 1 2 3 4 5
Genitals
(Male)
scrotum
flat,
smooth
scrotum
empty,
faint
rugae
testes in
upper
canal,
rare
rugae
testes
descendi
ng,
few
rugae
testes
down,
good
rugae
testes
pendulo
us,
deep
rugae

35. Early gestation, clitoris prominent
and widely separated labia
By 40 weeks, fat deposits have
increased in size in labia majora so
labia minora are completely covered

36. SIGN
PHYSICAL MATURITY SCORE SIGN
SCORE-1 0 1 2 3 4 5
Genitals
(Female)
clitoris
promine
nt &
labia flat
promine
nt
clitoris &
small
labia
minora
promine
nt
clitoris &
enlarging
minora
majora
& minora
equally
promine
nt
majora
large,
minora
small
majora
cover
clitoris &
minora