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Division of Perinatology

Department of Child Health Medical School


University of Sumatera Utara
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Gestational age can be determined:


Date of last menstrual period
Date of first fetal activity (16-18 weeks)
First reported heart sound (10-12 weeks)
USG examination (before 20 weeks)
AAP recommends:
- birth weight
- gestational age
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CLASSIFICATION
Preterm (< 37 weeks)
Term (37-42 weeks)
Postterm (>42 weeks)

CLASSIFICATION
Classification based on a combination of features:
Small for gestational age (SGA)
- 2 standard deviation below the mean weight
for GA
- or below the 10th percentile
- common in mother with hypertention,
preeclampsia, or who smoke
- associated with TORCH, infection,
chromosomal abnormalities, congenital
malformation
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CLASSIFICATION
Appropriate for gestational age (AGA)
Large for gestational age (LGA)
- 2 standard deviation above the mean
weight for GA
- or above 90 percentile
- in infant of diabetic mothers
- Beckwiths syndrome, constitutionally large
infants with large parents, hydrops fetalis
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Rapid delivery room assessment


- creases in the sole of the foot
- size of the breast nodule
- nature of the scalp hair
- cartilaginous development of the ear lobe
- scrotal rugae and testicular descent in
males
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

New Ballard Score


- The score span from 10 (20 weeks
gestation) to 50 (correlating with 44 weeks
gestation)
- Best performed at <12h of age for infant
<26 weeks gestation
- If infant > 26 weeks gestation, no optimal
age of examination up to 96h
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Accuracy
- accurate whether the infant is sick
or well to within 2 weeks of GA
- Overestimates GA by 2-4 days in
infant 32-37 weeks gestation

METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Criteria
- 6 neuromuscular criteria
Passive tone is more useful than
active tone in indicating GA
- 6 physical criteria

METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Procedures
- administered twice by two different
examination
- data are entered on the chart
- two part examination: neuromuscular
and physical maturity
- 12 scores are totaled
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

- maturity rating is expressed in weeks of


gestation
- Part 2 of the form used to plot
gestational assesment againts length,
height, and head circumference to
determine whether the infant is SGA,
AGA, or LGA
Lubchenco charts
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FENTON CHART
FOR PREMATURE

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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Neuromuscular maturity
Posture
- Score 0 if the arms and legs are
extended
- Score 1 if has beginning flexion of the
knees and hips with arm extended
- determined the other score based on the
diagram
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Square window
- Flex the hand on the forearm between
the thumb and index finger of the
examiner.
- Applay sufficient pressure to achieve as
much as flexion as possible
- Visually measure the angle between the
hypothenar eminence and ventral aspect of the
forearm.
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Arm recoil
- flex the forearms for 5 s, then grasp
the hand and fully extend the arm
and release.
- If full flexion score 4

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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Popliteal angle
- Hold the thigh in the knee-chest position
with the left index finger and the thumb
supporting the knee
- Extended the leg by gentle pressure
from the right index finger behind the
ankle
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Scarf Sign
- Take the infants hand and try to put it
around the neck posteriorly as far as
possible over the opposite shoulder

Heel to ear
- Keeping the pelvis flat on the table
- Take foot and try to put it as close to the
head as possible without forcing it
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Physical maturity
Skin
- Extremly premature: sticky, transparent
skin score -1
Lanugo hair
Plantar surface
- measure foot leghth from the tip of the
great toe to the back of the heel
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Breast
- palpate any breast tissue
Eye and ear
- loosely fused eyelids: closed but gentle
traction opens them
- Tightly fused eyelids: inseperable by
gentle traction
Genitalia
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28 weeks gestation :
little cartilago, pliable

36 weeks to term gestation :


firm ear, well-formed margin

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28 weeks gestation :
No breast tissue, areola barely visible

32 weeks gestation :
visible areola, little breast
tissue

36 weeks gestation :
well-defined areola,
breast nodule
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Genitalia - Male
28 weeks gestation :
testis high in scrotum

36 weeks to term gestation :


testis well descended, increased
scrotal pigmentation

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Foot sole
creases
32 weeks gestation :
creases in anterior one
third

36 weeks to term gestation :


creases over the majority of the
sole

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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Direct ophthalmoscopy
- Before 27 weeks: cornea is too opaque to
allow visualization
- After 34 weeks: atrophy of the vessels of
the lens occurs
- Accurate determination: 27-34 weeks only
- Reliable to 2 weeks
- Must be performed within 48 h of birth
before vessels atrophy
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Grading system
Grade 4 (27-28 weeks): vessel cover the
entire anterior surface of the lens or the
vessels meet in the center of the lens
Grade 3 (29-30 weeks): vessels do not
meet in the center but are close, central
portion of the lens is not covered by
vessels
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METHODS OF DETERMINING
POSTNATAL GESTATIONAL AGE

Grade 2 (31-32 weeks): vessels reach only


to the middle-outer part of the lens, the
central clear portion of the lens is larger
Grade 1 (33-34 weeks): vessels are seen
only at the periphery of the lens

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