Gestational Assessment In-Depth

How is physical maturity assessed?

The physical assessment part of the Dubowitz/Ballard Examination examines physical characteristics that look different at various stages of your baby's gestational maturity. Babies who are physically mature usually have higher scores than premature babies.

Points are given for each area of assessment, with a low of one or two for extreme immaturity to as high as four or five for post-maturity. The following physical characteristics are assessed:

  • skin - ranges from sticky and red to smooth to cracking or peeling

  • lanugo (the soft downy hair on a baby's body) is absent in immature babies, then appears with maturity, and then disappears again with post-maturity

  • plantar creases - these creases on the soles of the feet range from absent to covering the entire foot depending on the maturity

  • breast - the thickness and size of breast tissue and areola (the darkened ring around each nipple) are assessed

  • eyes and ears - eyes fused or open and amount of cartilage and stiffness of the ear tissue

  • genitals, male - presence of testes and appearance of scrotum, from smooth to wrinkled

  • genitals, female - appearance and size of the clitoris and the labia

How is neuromuscular maturity assessed?

Six evaluations of your baby's neuromuscular system are performed. These include:

  • posture - How does your baby hold his arms and legs?
  • square window - How much can your baby's hands be flexed toward the wrist?
  • arm recoil - How much do your baby's arms "spring back" to a flexed position?
  • popliteal angle - How far do your baby's knees extend?
  • scarf sign - How far can the elbows be moved across your baby's chest?
  • heel to ear - How close can your baby's feet be moved to the ear?

A score is assigned to each assessment area. Typically, the more neurologically mature the baby, the higher the score.

When the physical assessment score and the neuromuscular score are added together, the gestational age can be estimated. Scores range from very low for immature babies (less than 26 to 28 weeks) to very high scores for mature and post-mature babies.