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Assessment of Gestational Age

Term infant

Preterm infant

Skin – parchment like, cracking, veins rarely visible.

 is friable, red transparent to translucent with visible veins.

Hair – silky & black in aappearance

Brownish black fuzzy or wooly appearance

Lanugo- very little lanugo

Abundant lanugo hair

Sole creases –present over the entire sole

Single deep crease over ant 1/3rd of sole or no deep crease ; sole may be full of superficial creases

Breast nodule – of 5 – 10 mm is present

Is <5 mm or imperceptible

Ear cartilage – shows instant recoil

Ear cartilage defecient so poor recoil


I. Males – testes are descended with deep rugae on scrotum

Testes at or above ext inguinal ring with few rugae on scrotum

Ii. Females – labia majora cover clitoris and minora

Labia majora is widely separated exposing the minora and clitoris hypertrophied

  1. IUGR





Common varity

i. Insult - later part of gestation

ii. HC& Brain Weight-N

iii. Ponderal index* <2

iv. No increase in cong anomalies

v. Reduction in cell size

vi. Prognosis relatively better

i. Less common varity

ii. Insult- early part of gest

iii. Less

iv. >2

v. Increased

vi. Reduction in cell numbers

vii Prognosis relatively poor


Ponderal index – weight (gm) x 100/length (cm)3 Q


Normal >2.5


Symmetrical IUGR 2-2.5


Asymmetrical IUGR <2

  1. Large for gest age:
    1. Constitutional
    2. Infants of diabetic mothers (classes A, B, C)-It is commonest cause of LGA. Utilization of large quantities of transplacentally transmitted glucose appears to be the basic mechanism producing islet hyperplasia and overgrowth of the fetus. Q
    3. Post maturity
    4. Transpositions of great vessels- Arterialized blood containing more glucose and oxygen is shunted towards the viscera thus leading to hyperplasia of islet -cells.
    5. Erythroblastosis fetalisQ
    6. Beckwith-Wiedemann syndromeQ
    7. Marshall-Smith syndrome -broad forehead with hypertelorism large ears, long filtrum, hypertoniaQ
    8. Cerebral gigantism (Sotos syndrome)-large hands and feet and disproportionate lag in maturationQ.
    9. Parabiotic syndrome (twin)

S. No.





Intra uterine hypoxia




Respiratory difficulties




a) Birth asphyxia




b) Aspiration ill utero




c) HMD




d) Apneic attack




Symptomatic Hypoglycemia
















Susceptibility to infection




Congenital malformation








a) Intraventricular




b) Pulmonary




Feeding difficulties




Table: Causes of preterm birth.

  1. Maternal factors
    1. Medical diseases of the mother during pregnancy.
    2. Complecations of pregnancy e.g., preeclamptic toxemia, placentaprevia and antepartum hemorrhage.
    3. Incompetency of cervix.
    4. Maternal anemia (important in India).
  2. Fetal factors
    1. Multiple Pregnancy
    2. Congenital malformations.
  3. Medical factors
    1. Uncontrolled diabetes mellitus in the mother.
    2. Sever cardiac illness in the mother.
    3. Placental dysfunction.
    4. Fetal hypoxia and fetal distress.
    5. Sever rhesus isoimmunization in the mother or hydrops fetalis.
  4. Iatrogenic
    Improper diagnosis of maturity in elective deliveries.


Table: Causes of SGA babies

  1. Environmental
    1. Ethnic, racial and geographic.
    2. Social and economic status.
    3. Nutritional.
  2. Maternal
    1. Short stature of mother
    2. Prime or grand multipara.
    3. Young mother – below 20 years.
    4. Low pregnancy weight.
    5. Smoking, alcohol, drug abuse.
    6. Maternal illness – anemia, heart disease.
    7. Complications of pregnancy, e.g., pre – eclampsia, hypertension.
  3. Placental factors
    In disorders of implantation of placenta, abruptio placenta, extensive placental infarcts and structural or functional abnormalities of placenta, the fetal growth is compromised. Single umbilical artery and vascular thrombosis also predispose to birth of small babies.
  4. Fetal factor
    1. First born babies are generally smaller
    2. Genetic or chromosomal aberration or congenital anomalies.
    3. Twinning and multiple pregnancies.
    4. Intrauterine infections

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