Ballard Maturational Assessment
Medical diagnostic method
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The Ballard maturational assessment, Ballard score, or Ballard scale, is a gestational age assessment technique. It was devised by Dr. Jeanne L. Ballard, professor emeritus of the Department of Pediatrics, Obstetrics, and Gynecology at the University of Cincinnati College of Medicine. It was developed in 1979.[1]
| Ballard maturational assessment | |
|---|---|
| Synonyms | Ballard score, Ballard scale |
| Purpose | Gestational age assessment |
The assessment scores various criteria, the sum of which is then extrapolated to the gestational age of the fetus. These criteria are divided into physical and neuromuscular criteria, which 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 preterm babies, i.e., up to 20 weeks.
The scoring relies on the intrauterine changes the fetus undergoes during maturation. Whereas the neuromuscular criteria depend mainly upon muscle tone, the physical scale relies on anatomical changes. Neonate fetuses (less than 37 weeks of age) are in a state of physiological hypotonia, and since muscle tone increases throughout the fetal growth period, it can be used to identify fetal maturation.
Neuromuscular criteria
- Posture – score the infant's posture from flexed to extended
- Square window – assess the flexibility of the wrist [2]
- Arm recoil – measure the angle of recoil after extending arm
- Popliteal angle – measure the angle formed between knees during flexed extension
- Scarf sign – record the resistance while stretching the infant's arm across the chest
- Heel to ear – note the location of the heel when stretching the infant's leg toward the ear [3]
Physical criteria
| −1 | 0 | 1 | 2 | 3 | 4 | 5 | |
|---|---|---|---|---|---|---|---|
| Skin | sticky, friable, transparent | gelatinous, red, translucent | smooth pink, visible veins | superficial peeling and/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 |
>50 mm, no crease |
faint red marks | anterior transverse crease only | creases over anterior two-thirds of sole | creases over the entire sole | |
| Breast bud | 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 | lids open, pinna flat stays folded |
slightly curved pinna, soft, slow recoil |
well-curved pinna, soft but ready recoil |
formed and 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 and labia flat | prominent clitoris and small labia minora | prominent clitoris and enlarging labia minora | labia majora and minora equally prominent | labia majora large, labia minora small | labia majora cover clitoris and minora |
Scoring system
In the original Ballard score, each of the criteria is scored from 0 to 5. The scores were then ranged 5 to 50, with the corresponding gestational ages being 26 weeks and 44 weeks. A score increase of 5 advances the estimated age by 2 weeks. The new Ballard score allows scores of −1 for the criteria. The possible scores then range from −10 to 50, with the gestational range extending earlier to 20 weeks.
A simple formula to estimate age from the Ballard score is
age = (2 * score + 120) / 5
| Score | Weeks |
|---|---|
| -10 | 20 |
| -5 | 22 |
| 0 | 24 |
| 10 | 28 |
| 15 | 30 |
| 20 | 32 |
| 25 | 34 |
| 30 | 36 |
| 35 | 38 |
| 40 | 40 |
| 45 | 42 |
| 50 | 44 |