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Ballard Maturational Assessment | |
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Synonyms | Ballard Score |
Purpose | gestational age assessment |
The Ballard Maturational Assessment, Ballard Score, or Ballard Scale, is a commonly used technique of gestational age assessment. It was devised by Dr Jeanne L. Ballard, Professor Emeritus of Pediatrics, Obstetrics and Gynecology at the University of Cincinnati College of Medicine.
The assessment assigns a score to various criteria, the sum of all of which is then extrapolated to the gestational age of the fetus. These criteria are divided into physical and neurological criteria. This scoring allows for the estimation of age in the range of 26 weeks to 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 hypotonia. This tone increases throughout the fetal growth period, meaning a more premature baby would have a lesser muscle tone.
It was developed in 1979. [1]
These are:
These are:
−1 | 0 | 1 | 2 | 3 | 4 | 5 | Record Score Below: | |
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Skin | sticky, friable, transparent | gelatinous, red, translucent | smooth pink, visible veins | superficial peeling &/or rash, few veins | cracking, pale areas, rare veins | parchment, deep cracking, no vessels | leathery, cracked, wrinkled | |
Lanugo | None | Sparse | Abundant | Thinning | Bald areas | Mostly bald | Sparse | |
Plantar surface | Heel–toe 40–50 mm: −1 <40 mm: −2 | >50 mm no crease | Faint red marks | Anterior transverse crease only | Creases over anterior 2/3 of sole | Creases over the entire sole | ||
Breast | Imperceptible | Barely perceptible | Flat areola no bud | Stippled areola 1–2 mm bud | Raised areola 3–4 mm bud | Full areola 5–10 mm bud | ||
Eye and 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 cartilage ear stiff | ||
Genitals (Male) | Scrotum flat, smooth | Scrotum empty, faint rugae | Testes in upper canal, rare rugae | Testes descending, few rugae | Testes down, good rugae | Testes pendulous, deep rugae | ||
Genitals (Female) | Clitoris prominent & labia flat | Prominent clitoris & small labia minora | Prominent clitoris & enlarging minora | Majora & minora equally prominent | Majora large, minora small | Majora cover clitoris & minora |
Each of the above criteria is scored from 0 through 5, in the original Ballard Score. The scores were then ranged from 5 to 50, with the corresponding gestational ages being 26 weeks and 44 weeks. An increase in the score by 5 increases the age by 2 weeks. The New Ballard Score allows scores of −1 for the criteria, hence making negative scores possible. The possible scores then range from −10 to 50, the gestational range extending up to 20 weeks. (A simple formula to come directly to the age from the Ballard Score is Age=((2*score)+120)) / 5.
Maturity Rating:
Score/weeks: (−10/20), (−5/22), (0/24), (5/26), (10/28), (15/30), (20/32), (25/34), (30/36), (35/38), (40/40), (45/42), (50/44).
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