The aim of this study was to evaluate postnatal examination of the newborn by nurses in a developing country, using a modified Ballard method, scoring for the six external criteria only (Ballard-ext). Applicability of gestational age estimates with the Ballard-ext. was assessed by calculating its agreement with gestational age derived from the last menstrual period (LMP), fundal height and the Dubowitz method. The smallest difference in gestational age and the most narrow limits of agreement were found between the Ballard-ext. and the Dubowitz method. No reliable gestational age could be obtained from LMP or fundal height. At low gestational ages, Ballard-ext. tended to give lower gestational ages compared with the Dubowitz method. At an average gestational age of more than 251 days, Ballard-ext. gave higher values compared with Dubowitz. Both Ballard-ext. and the Dubowitz method identified 48% of low birthweight babies as growth-retarded (gestational age > or = 37 weeks). No significant difference in gestational age assessment of newborns between nurses was observed. The Ballard method, scoring for external criteria alone, compared favourably with the Dubowitz method. The test is simple to perform and can be reliably used routinely by nurses.
PIP: It is important to know gestational age in order to identify high-risk babies, especially in developing countries and malarious areas in which malnutrition and malaria in pregnancy often cause fetal growth retardation and/or pre-term delivery. The risk of low birth weight attributable to malaria in first pregnancies in malarious areas has been estimated to be as high as 40%. While gestational age is usually estimated from the last menstrual period (LMP), that method may yield inaccurate results due to errors in dates due to cycle variation and irregular menses. Manual assessment from uterine height is also inaccurate. A study was conducted to evaluate postnatal clinical assessment of gestational age by nurses in Malawi, a developing country, using a modified Ballard method, scoring for 6 external criteria only. Results were compared with other methods of gestational age assessment. No reliable gestational age could be obtained from LMP or fundal height approaches. However, at low gestational ages, the Ballard external criteria (BE) approach tended to give lower gestational ages than the Dubowitz score method. At an average gestational age of more than 251 days, BE gave higher values than did the Dubowitz method. Both BE and the Dubowitz method identified 48% of low-birth-weight babies as growth-retarded (gestational age of 37 weeks or longer). No significant difference in gestational age assessment of newborns between nurses was observed. The Ballard method, scoring for external criteria alone, compared favorably with the Dubowitz method and can be reliably and routinely used by nurses.