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NۊTO/NOBg?< NxTO/NOBg?<NfTO/NON^NuPMMalegenFormResetNVH0x DfNb` Dg/-NOOJ@XOg?/-NO\$H/ NO!&H6+ CO fN ` Cf?<?< NTO/NO\O`JCf?<?< NڸTO/NO\O`v Cf?<?< NښTO/NO\O`X Cf?<?< N|TO/NO\O`: Cf?<?< N^TO/NO\O` Cf?<?<N@TO/NO\O/ NO"<?/-NO^O L N^NuPMMalegenFormInitNV/?< NTO/NOS@XOfv`?< NTO/NOS@XOfv`j?< NپTO/NOS@XOfv`P?< N٤TO/NOS@XOfv`6?< NيTO/NOS@XOfv`?<NpTO/NOS@XOfv`v n1C&N^NuPMMalegenFormSaveNVBg?<mN,TO/NOBg?<nNTO/NOBg?<oNTO/NOBg?<pNTO/NOBg?<qNTO/NOBg?<rNTO/NON^NuPMFemalegenFormResetNVH0x DfNb` Dg/-NOOJ@XOg?/-NO\$H/ NO!&H6+ CO fN ` Cf?<?<mNBTO/NO\O`JCf?<?<nN$TO/NO\O`v Cf?<?<oNTO/NO\O`X Cf?<?<pNTO/NO\O`: Cf?<?<qNTO/NO\O` Cf?<?<rN׬TO/NO\O/ NO"<?/-NO^O L N^NuPMFemalegenFormInitNV/?<mN\TO/NOS@XOfv`?<nN@TO/NOS@XOfv`j?<oN&TO/NOS@XOfv`P?<pN TO/NOS@XOfv`6?<qNTO/NOS@XOfv`?<rNTO/NOS@XOfv`v n1C&N^NuPMFemalegenFormSave2L  2F\z2Nj*Rz Ballard Gestational ExamMPhysical Maturity (PM):N #SkinO 2LanugoP APlantar CreasesQ PBreastR _Eye & EarS nMale GenitalsT }Female GenitalsU( NMVn- ComputeWP# AssignXP2 AssignYPA AssignZPP Assign[P_ Assign\Pn Assign]P} Assign^x#( P_x2( P`xA( PaxP( Pbx_( Pcxn( Pdx}( Pe ResetfF PM2  6Rl.Jf.VpBallard Gestational ExamNeuromuscular Maturity (NM): #Posture 2Square Window AArm Recoil# PPopliteal Angle _Scarf Sign# nHeel to EarP# AssignP2 AssignPA AssignPP AssignP_ AssignPn Assignx#( Px2( PxA( PxP( Px_( Pxn( P Reset( NMF PM2 `P *`LNM: Scarf Sign a( Next b Prev c PM dd NM e  Elbow near opp. shoulder f(  Elbow crosses opp. ant. axillary line g<  Elbow reaches opp. ant. axillary line hPc  Elbow at midline id  Elbow does not reach midline jx  Elbow does not cross prox. axillary line(i<̀P1dx2O  ":b(PX`hpxNM: Popliteal Angle( Next  Prev  PM d NM U<L  < 90 deg. (I  160 deg. <I  140 deg. PI  120 deg. UI  100 deg. U(D  90 deg. I  180 deg.<̀P0dd(d<\(h2N T>FNV^NM: Arm Recoil( Next  Prev  PMd NMd{  Full flexion, <90 deg.  Ext. 180 deg., random movements(  Min. flexion, 140-180 deg.<  Small flexion, 110-140 deg.P  Mod. flexion, 90-100 deg.(g<ˀP/dDubowitz/Ballard Exam for Gestational Age: Gestational age is computed based on neuromuscular and physical maturity. 1. Neuromuscular maturity (NM) includes posture, square window, arm recoil, popliteal angle, scarf sign, and heel to ear. 2. Physical maturity (PM) includes skin, lanugo, plantar creases, breast, eye & ear, genitals-male, genitals-female. Results from the individual NM and PM scores for the 12 categories are added up and an estimated gestational age is then computed. Note that for Physical Maturity, either "Male Genitals" or "Female Genitals" needs to be set, not both. 2ЀL "`&.6>FNM: Posture  Arms & legs extended(  Slight flexion of hips & knees<  Strong flexion of hips & kneesP  Legs flexed & abducted, arms flexedd  Full flexion of arms & legs( Next  PMd NM(e<ɀP-d2lS J.PM: Female Genitalsm Clitoris prominent,labia flatn# Clitoris prominent,small labia minorao2 Clitoris prominent,enlarging minorapA Majora and minara equally prominentqP Majora large,minora smallr_ Majora cover clitoris & minoras PMtd NMu Resetv Prev  *b*PM: Skin Sticky,friable,transparent# Gelatinous red,translucent2y Smooth pink,visible veinsA Superficial peeling,rash,few veinsP Cracking,pale areas,rare veins_ Parchment,deep cracks,no vesselsn Leathery,cracked,wrinkled PMd NM( Next 2R 6h(PM: Male Genitals i Scrotum flat,smooth # Scrotum empty,faint rugae 2 Testes in upper canal,rare rugae A Testes descending,rare rugae Pw Testes down,good rugae_ Testes pendulous,deep rugae PMd NM( Next  Prev  Reset24M ,Rv&.NM: Square Window5( Next 6 Prev 7 PM8d NM9H  > 90 deg.:(@  90 deg.;<@  60 deg.<U(@  30 deg.=U@  45 deg.>U<;  0 deg.(f<ʀd.d(d< 2jPM: Eye & Ear< Lids fused# Lids open,pinna flat,stays folded1 Slightly curved pinna,soft,slow recoilA Well curved pinna,soft,ready recoilP Formed,firm,instant recoil_t Thick cartilage,ear stiff PMd NM( Next  Prev NM - Scarf Sign Help: With the infant supine, take the infant's hand and draw it across the neck and as far across the opposite shoulder as possible. Assistance to the elbow is permissible by lifting it across the body. Score according to the location of the elbow. -1: elbow reaches or nears level of opposite shoulder 0: elbow crosses opposite anterior axillary line 1: elbow reaches opposite anterior axillary line 2: elbow at midline 3: elbow does not reach midline 4: elbow does not cross proximate axillary line2 (\About Ballard )A$ OK *Ballard Gestational Exam v1.0 +2New York University ,<School of Medicine# -FCopyright 1999. All rights reserved. .ntona01@popmail.med.nyu.edu# /(Academic Computing# 0ZProgrammer: 1Application: 2dAnthony Ton, Class of 2000#܀ DrPM: Plantar CreasesQ Heel-toe 40-50#K Heel-toe > 502S Faint red marksA Anterior transverse crease onlyP} Creases over anterior 2/3_u Creases over entire sole PMd NM( Next  Prev @ <hPM: BreastAK ImperceptibleB#^ Barely perceptibleC2W Flat arola,no budDA Stippled areola,1-2mm budEP{ Raised areola,3-4mm budF_s Full areola,5-10mm budG PMHd NMI( Next J Prev 2 ĀQ  6LbxNM: Heel to Ear (   Prev  PM d NM   <  U  U(  U< (j<΀d2d(d<x 6NfPM: Lanugoy#/ Sparsez2: Abundant{A6 Thinning|P= Bald areas}_C Mostly bald~ PMd NM( Next  Prev ( NoneNM - Arm Recoil Help: With the infant supine, fully flex the arm for 5 seconds. Then fully extend by pulling the hands and release. Score the reaction. 0: remains extended 180 degrees, or random movements 1: minimal flexion, 140-180 degrees 2: small amount of flexion, 110-140 degrees 3: moderate flexion, 90-100 degrees 4: brisk return to full flexion, < 90 degreesNM - Popliteal Angle Help: With the infant supine and the pelvis flat on the examination surface, the leg is flexed on the thigh and the thigh fully flexed with the use of one hand. With the other hand, the leg is then extended and the angle scored. -1: 180 degrees 0: 160 degrees 1: 140 degrees 2: 120 degrees 3: 100 degrees 4: 90 degrees 5: < 90 degreesNM - Square Window Help: Flex the hand at the wrist. Exert pressure sufficient to get as much flexion as possible. The angle between the hypothenar eminence and the anterior aspect of the forearm is measured and scored. -1: > 90 degrees 0: 90 degrees 1: 60 degrees 2: 45 degrees 3: 30 degrees 4: 0 degreesNM - Posture Help: With the infant supine and quiet, score as follows: 0: arms and legs extended 1: slight or moderate flexion of hips and knees 2: moderate to strong flexion of hips and knees 3: legs flexed and abducted, arms slightly flexed 4: full flexion of arms and legs NM - Heel to Ear Help: With the infant supine, hold the infant's foot with one hand and move it as near to the head as possible without forcing it. Keep the pelvis flat on the examining surface. Score as shown in the diagram on previous window.PM - Female Genitals Help: Note the EITHER male genitals or female genitals category needs to be set. To clear a selection, click on the "Reset" button.PM - Male Genitals Help: Note the EITHER male genitals or female genitals category needs to be set. To clear a selection, click on the "Reset" button.    22"pForm IncompleteYou must assign values to each category. For male & female genitals, only one category may be set.OKAbout Ballard: The Info dialog provides information about the application such as the developer and version number.T * JBQOptionAbout Ballard...Ballard Gestational ExamTotal Score is ^1, giving a gestational age of ^2 weeks.^3OKReset Entries?Are you sure you wish to reset the entries?OKCancelROM ErrorApplication incompatible with ROMOKInvalid SelectionPlease select an item.OKf``fCf``fCf``fb``b? a a ?@ @@@PP$H$HDD@@@@ ` `PP$H@@@@ ` `t\@@@@@@bLd||$H@@@@@\tTTTT$H@@0qt0qt `0qt`0qt`0qt` 0qt0 0``0qt"*"7#""""">"*"7""P" """>"*"62 *@&#"">"*"6@23*&"">"*"6cfzb"">"*"6">svs$rs$:r@s$2r@@@@s$2r0`s$2r!((  @@ @@Debug^1:^2:^3OK0 ?<Ballard1.0