Assessment of

Gestational Age

Learning Objectives
Classify the newborn according to GA.
Demonstrate Ballard Dubowitz scale
(rating).
Apply assessment of GA for newborn.

Classification of newborn by
weight and gestational age
Help in predict potential problems

LBW: <2500gm
VLBW: <1500gm
ELBW: <1000gm.
Term :completed 37 weeks gestation
till 42 week
Premature; less than 37 weeks
gestation
Post term: after 42 weeks.

Terms:

Perinatal
Intra
natal

Neonatal
newborn

Prenatal

Assessment of Gestational
Age

An accurate assessment incorporates size

and maturity.
Assessment methods include:
Mothers menstrual history
Prenatal ultrasonography
Evaluation of obstetric parameters
Postnatal maturational examinations
Dubowitz Assessment of Gestational Age
Lubchenco Scale
New Ballard Score

Infant Classification and

Growth Assessment
After assessing gestational age, the
nurse plots the infants length, weight
and occipital-frontal head
circumference (OFC) on intrauterine
growth charts.
Growth curves show measures of
intrauterine growth in percentiles for
each week of gestation.

Infant Classification and

Growth Assessment (Continued)
Term

Percentile

Large for
gestational age
(LGA)

Above the 90th

percentile

Appropriate for
gestational age
(AGA)

Between the tenth

and 90th percentiles

Small for
gestational age

Below the tenth

percentile

Ballard Dubowitz

Tool to assess gestational age.

Optimal accuracy within 12 hours.
Most accurate 28 wks and under 43 wks.
Physical more accurate than neurological.
GA effected by PIH, DM, meds.

Examination precaution

Hand washing
Thermal environment
Light and noise
Less than 5minutes examination time

GESTATIONAL AGE
ASSESSMENT
Two parts
External physical characteristics
Neurological characteristics
Maternal conditions, such as pre eclampsia,
diabetes, and maternal analgesics and
anesthesia may impact certain
components of gestational assessment

Neuromuscular Maturity

Resting Posture
Square window
Arm recoil
Poplitteal angle
Scarf sign
Heel to ear

1. Posture

Clinical assessment

First steps and appearance

Start by congratulating the
mother on the arrival of her new
baby and ask if she has any
concerns. The mother is usually
the first person to notice any
problems.
Ask about feeding and the
passage of urine and stools.
The infant should pass
meconium (the first black, tarry
stools) within 24 hours of birth.
General observation: inspect
colour, breathing, alertness and
spontaneous activity.
Well infants have a flexed,
posture. Partially flexed posture
is found in hypotonia or
prematurity

Well term infant showing typical well flexed

posture

Note the abduction of the hips in this

partially flexed preterm infant (froglike
posture)

Well term infant showing typical

well flexed posture

Note the abduction of the hips

in this partially flexed preterm
infant (froglike posture)

3. Arm recoil

4.Poplitteal angle

Assessment of Gestational Age: The

Dubowitz and Ballard Exams

2. Physical Characteristic
Skin
Lanugo
Plantar creases
Areola
Ear
Genitalia

Physical Maturity,
with maturity
Skin: thicker , less translucent, dry, peeling.
Lanugo:
fine non pigmented hair all over 27-28 wks
disappears gradually

Plantar surface: presence or absence of

creases

Physical Maturity,
with maturity (cont;)

Breast: areola development

Ear cartilage
Eyelid opening
External genitalia
Rugation, desend
Prominent labia majora

Intrauterine Growth Rate

After gestational age is determined, it is
compared to birth weight to determine if
intrauterine growth is appropriate
AGA: Appropriate for Gestational Age
80% of all births

SGA: Small for Gestational Age

10% of all births

LGA: Large for Gestational Age

10% of all births

Plotting Gestational Age

Upper 90% LGA,
From 10-90 AGA.
Bottom 10% SGA,

Thank You

Application Time