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Gestational Age Assessment, Normal Growth and Centile Charts

Gestational Age. Based upon the number of completed weeks of pregnancyBased on the expected date of birth.Scan dating is more accurate than menstrual dating. Physical assessment of gestation. Need to be aware of embryological developmentSome development do not indicate specific gestational age fo

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Gestational Age Assessment, Normal Growth and Centile Charts

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    1. Gestational Age Assessment, Normal Growth and Centile Charts Kate Quarrell

    2. Gestational Age Based upon the number of completed weeks of pregnancy Based on the expected date of birth. Scan dating is more accurate than menstrual dating

    3. Physical assessment of gestation Need to be aware of embryological development Some development do not indicate specific gestational age for example size of fontanelles/ suture lines External Assessment Neurolgical Assessment No actual gold standard for physical assessment.

    4. Dubowitz at al & Ballard Scores for assessing Gestational age Developed a scoring system based on physical & neurological characteristics. Scoring must take place within a few hours of birth Inaccurate by 2 weeks Some insults in-utero distort the scores such as asphyxia, IUGR Affects the neurological score

    5. Criticisms of assessment Score modified by Ballard overestimates gestational age by 2-4 days for babies less than 37 weeks gestation Recent evidence shows that below 28 weeks the assessment might be out by 1- 3 weeks

    6. Neuromuscular Posture - flexion Wrist – square window Arm recoil Popliteal angle Scarf sign Heal to ear

    7. Physical Maturity Skin – texture, colour & opacity Lanugo Plantar surface Breast tissue Eyes – examination of the lens Ears Genitalia

    8. By 20 Weeks Most organs capable of functioning Neurons formed between 10-18 weeks Skin covered with vernix and lanugo Brown fat deposited Limbs are at mature proportions Meconium present in gut

    9. 24 Weeks Skin – thin, wrinkled, translucent & dark red Lungs terminal sac phase (surfactant started to be produced 22weeks, increases significantly after 30weeks) Sensory organs develop, fetus responds to noise Length 32 cm Weight 700g Periods of sleep & activity

    10. 28 Weeks Survival possible Eyelids open Length 37cm Weight 1200g Head circumference 26cm Girl – small labia majora Boy – scrotum – few rugae

    11. 32 Weeks Lanugo disappears from face Ear cartilage soft Lengths 43cm Weight 2000g Accumulation of fat

    12. 36 Weeks Head circumference > abdominal circumference Plantar creases visible Head hair lengthens Nails reach the tips of fingers Lanugo vanishes from shoulder Breast tissue nodule present 1-2 mm Skin pale Length 49cm Head circumference 33cm Weight 2900g

    13. Normal Growth as defined by WHO Weight and assessment of growth Low birth weight,2.5kg Very low birth weight,1.5kg Extremely low birth weight 1.0kg

    14. Centile Charts Correlate parameters such as weight against gestation Look at population and work out normal range. 50th Centile average Normal range 10-90th Centlies

    15. Centile Charts

    16. Small For Gestation Age Growth of fetus less than expected for the population. Weight below 10th centile for gestation Roberton(1999) states that 50% of babies that are SGA there is no known cause. These babies are proportionally small in all the parameters. Babies are well & healthy.

    17. Intrauterine Growth Restriction 1/3 of all low birth weight, majority> 37 weeks Head appears large in relation to body Skin dry, thin layer of subcutaneous fat Baby looks anxious Neurological assessment usually corresponds to gestation

    18. Asymmetrical Growth Restriction Normally in 3 trimester Associated with insult such as pregnancy induced hypertension Head circumference & length normal but weight is low in proportion to those parameters Growth restriction as a result of malnutrition

    19. Symmetrical Growth Restriction Earlier in pregnancy: Intrauterine infections Substance abuse Head circumference is in proportion to weight & length

    20. Large for Gestational Age Babies > the 90th centile Associated with maternal conditions such as diabetes

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