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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) 3 .

or who smoke . congenital malformation 4 . chromosomal abnormalities.associated with TORCH.common in mother with hypertention.2 standard deviation below the mean weight for GA .CLASSIFICATION Classification based on a combination of features: Small for gestational age (SGA) . preeclampsia.or below the 10th percentile . infection.

hydrops fetalis 5 .in infant of diabetic mothers .Beckwith’s syndrome. constitutionally large infants with large parents.2 standard deviation above the mean weight for GA .CLASSIFICATION Appropriate for gestational age (AGA) Large for gestational age (LGA) .or above 90 percentile .

METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE Rapid delivery room assessment .creases in the sole of the foot .scrotal rugae and testicular descent in males 6 .size of the breast nodule .cartilaginous development of the ear lobe .nature of the scalp hair .

The score span from 10 (20 weeks gestation) to 50 (correlating with 44 weeks gestation) .If infant > 26 weeks gestation.Best performed at <12h of age for infant <26 weeks gestation .METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE New Ballard Score . no optimal age of examination up to 96h 7 .

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 8 .

METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE Criteria .6 neuromuscular criteria Passive tone is more useful than active tone in indicating GA .6 physical criteria 9 .

METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE Procedures .administered twice by two different examination .two part examination: neuromuscular and physical maturity .data are entered on the chart .12 scores are totaled 10 .

AGA. height. and head circumference to determine whether the infant is SGA.Part 2 of the form used to plot gestational assesment againts length.METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE .maturity rating is expressed in weeks of gestation . or LGA  Lubchenco charts 11 .

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FENTON CHART FOR PREMATURE 13 .

Score 1 if has beginning flexion of the knees and hips with arm extended .METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE Neuromuscular maturity  Posture .Score 0 if the arms and legs are extended .determined the other score based on the diagram 14 .

Visually measure the angle between the hypothenar eminence and ventral aspect of the forearm. 15 .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 . .METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE  Square window .

METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE  Arm recoil .If full flexion  score 4 16 . then grasp the hand and fully extend the arm and release.flex the forearms for 5 s. .

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 17 .METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE  Popliteal angle .

Take the infant’s 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 .METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE   Scarf Sign .Take foot and try to put it as close to the head as possible without forcing it 18 .

Extremly premature: sticky. transparent skin score -1  Lanugo hair  Plantar surface .METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE Physical maturity  Skin .measure foot leghth from the tip of the great toe to the back of the heel 19 .

loosely fused eyelids: closed but gentle traction opens them .METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE    Breast .palpate any breast tissue Eye and ear .Tightly fused eyelids: inseperable by gentle traction Genitalia 20 .

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28 weeks” gestation : little cartilago. well-formed margin 22 . pliable 36 weeks to term gestation : firm ear.

little breast tissue 36 weeks gestation : well-defined areola. breast nodule 23 .28 weeks’ gestation : No breast tissue. areola barely visible 32 weeks’ gestation : visible areola.

Male 28 weeks’ gestation : testis high in scrotum 36 weeks to term gestation : testis well descended.Genitalia . increased scrotal pigmentation 24 .

Foot sole creases 32 weeks’ gestation : creases in anterior one third 36 weeks’ to term gestation : creases over the majority of the sole 25 .

METHODS OF DETERMINING POSTNATAL GESTATIONAL AGE Direct ophthalmoscopy .Reliable to 2 weeks .Before 27 weeks: cornea is too opaque to allow visualization .Accurate determination: 27-34 weeks only .Must be performed within 48 h of birth before vessels atrophy 26 .After 34 weeks: atrophy of the vessels of the lens occurs .

central portion of the lens is not covered by vessels 27 .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.

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 28 .

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