Ballard Maturational Assessment

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The Ballard Maturational Assessment, Ballard Score, or Ballard Scale is a commonly used technique of gestational age assessment. It assigns a score to various criteria, the sum of all of which is then extrapolated to the gestational age of the baby. These criteria are divided into Physical and Neurological criteria. This scoring allows for the estimation of age in the range of 26 weeks-44 weeks. The New Ballard Score is an extension of the above to include extremely pre-term babies i.e. up to 20 weeks. The scoring relies on the intra-uterine changes that the fetus undergoes during its maturation. Whereas the neurological criteria depend mainly upon muscle tone, the physical ones rely on anatomical changes. The neonate (less than 37 weeks of age) is in a state of physiological hypertonia. This tone increases throughout the fetal growth period, meaning a more premature baby would have lesser muscle tone.

Physical Maturity of the Ballard Maturational Assessment of Gestational Age

[2]

-1

Record Score Below:

Skin

smooth gelatinous, sticky, friable, pink, red, visible transparent translucent veins

cracking, superficial pale peeling &/or areas, rash, few rare veins veins Bald areas

parchment, leathery, deep cracked, cracking, wrinkled no vessels

Lanugo None

Sparse

Abundant Thinning

Mostly bald Sparse

Heel-toe Plantar >50 mm 40-50 mm: -1 surface no crease <40 mm: -2

Faint red marks

Creases Anterior over Creases transverse anterior over entire crease only 2/3 of sole sole Raised Stippled areola areola 3-4 mm 1-2 mm bud bud

Breast

Flat Barely areola Imperceptable perceptable no bud

Full areola 5-10 mm bud

Eye and Lids fused Ear Loosely: -1

Lids open pinna flat

Sl. curved Well-curved Formed pinna pinna & firm soft; slow soft but instant

Thick cartilage

Tightly: -2

stays folded recoil

ready recoil recoil Testes down, good rugae Majora large, minora small

ear stiff

Genitals Scrotum flat, (Male) smooth

Scrotum empty, faint rugae

Testes in Testes upper descending, canal, few rugae rare rugae Prominent clitoris & enlarging minora Majora & minora equally prominent

Testes pendulous, deep rugae

Clitoris Genitals prominent & (Female) labia flat

Prominent clitoris & small labia minora

Majora cover clitoris & minora

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