Copyright 2007 R. Klimek

Postnatal clinical assessment of fetal maturity

see: Klimek R, Lauterbach R.: Postnatal clinical assessment of fetal maturity in newborn infants. Archives of Perinatal Medicine 7 (3), 19-23, 2001

Key words: Fetal maturity, Neonatal maturation, Childbirth

Introduction
From ethical and medical reasons the progress in neonatology and anesthesiology obscure the iatrogenic labors, which begin at the time improper for individual childbirth, especially due to induction of labor very often instrumental. After reprogramming of ultrasonographic biometry as well as revitalizing of enzymating monitoring of pregnancies, there is a moral imperative to evaluate fetal maturity of newborn infants immediately after their deliveries. Such individual evaluation of each delivery ought to be performed directly in obstetrical ward not only by routine assessment of the adaptation of the newborn in Apgar scale but also of its fetal maturity according to new index introduced by R.Klimek [6,7]. It is particularly important in the case of instrumental deliveries.
The condition of the newborn depends mainly on its gestational environment and thus testifies to its mother’s health. This is what differentiates modern medical thermodynamics from the labor mechanics of the bygone era of the absolute time and space. Medicine which is focused only on pathology does not fulfill the requirements of the modern perinatology, which points to the necessity of using the entire human knowledge and does not allow to change physiological events into pathological ones. Both the prophylaxis of premature labors (which belongs to pathology) and non-interference with natural gestational processes (physiology) through unnecessary labor induction or cesarean section at a time improper for individual pregnancy, are more important than treatment of premature infants.

Fetal maturity index of newborn infants

The maturity level can be evaluated immediately after labor through obligatory assessment of just six of the many possible newborn features: position of the limbs, elbow angle, its mobility, breast nipple, plantar creases and lanugo. For each of those features one can allocate from 0 to 2 points, which maximally gives 12 technical quantum points of maturity.
Scoring system for simplified clinical assessment of Klimek's maturation index (K) in newborn infants encompass: posture, angle forearm (100-180, 90-100, <90); pulling an elbow to the middle line of the body; distribution of lanugo; plantar creases, breast development (areola appearance and bud size less than 3-4 mm or more than 4 mm).
The new method differs from generally known Amiel-Tison's, Dubowitz and Ballard methods in the smaller range of allocated points, and what is more important- the possibility of making the assessment during routine examination of newborn baby immediately after its birth. New index has possibility for the evaluation of the degree of maturity and does not take into account weight and fetal age but refer directly for the full fetal maturity: 9±1.5 points. The new scale encompasses full maturity in the range from 6 to 12 points, while immature newborns have less than 6 points.
The distribution of the mature newborn according to their K index values was found equal to the statistical and auxological conditioned human birth occurrence in 3662 cases. [6,7,8,10]
Figure 1.


Figure 1. The distribution of the mature newborn according to their K index values

Conclusion

A new simple method of postnatal assessment of neonatal maturity was developed. Six basic features are assessed in technical quantum points from 0 to 2 and the index of ≥ 6 points testifies to the reaching of the full fetal maturity. The obtained values of maturity index K indicate a high statistical correlation with the results of both computer-aided method of advanced pregnancy prediction of full fetal maturity [2,3,4] and the actual postnatal method of maturity assessment developed by Ballard [1,5,9].

References:

[1] Ballard JL et al. New Ballard score expanded to include extremely premature infants. J Pediatr 1991;119:417-423.
[2] Klimek M. Prognosis of birth term and newborn state. Cracow : DREAM Publ.Comp.Inc,1994.
[3] Klimek M. Medical prognosis versus statistical prediction of birth term. In: Klimek R et al., editor. A time to be born. Cracow: DREAM Publ. Company Inc,1996.
[4] Klimek M.(1996) Pregnancy monitoring and prognosis of birth as the time-spacial event ( Polish with English summary). Jagiellonian University, Cracow: DREAM Publ. Comp. Inc.
[5] Klimek M., Tomaszczyk B., Rzepecka-Węglarz B., Klimek M., Lauterbach R., Frączek A. (1995) Ocena dojrzałości noworodka i wieku ciążowego wg skali Ballard-Klimka. (Evaluation of Ballard-Klimek score for assessment of fetal age and maturation), Gin. Pol., 65: 402-408.
[6] Klimek R.(2000) New obstetrical index of newborn maturity. (Prenatal and Neonatal Medicine, Abstracts of the XVI Inter.Congress The Fetus as a Patient, Fiuggi, Italy, 2000, 45) In: E.V.Cosmi (ed) The Fetus As A Patient, Monduzzi Editore S.p.A.: 61-65.
[7] Klimek R., Klimek M., Rzepecka-Węglarz B. (2000) A new score for postnatal clinical assessment of fetal maturity in newborn infants. Int.J.Obst.Gyn., 71: 101-105.
[8] Klimek R., Piechota Z. (1999) Evaluation of new clinical score for assessment of newborn maturity. 2nd Int.Congress on New Technologies in Reproductive Medicine, Neonatology and Gynecology, Sardynia Abstr book.10.
[9] Rzepecka-Węglarz B.(1999) Neonatologic assessment of ultrasonographic and enzymatic estimators of fetal maturity. Doctor’s thesis (Polish). Cracow: Jagiellonian University.
[10] Rzepecka-Węglarz B., Klimek M., Frączek A., Lauterbach R. (2000) Kliniczny sposób oceny dojrzałości noworodka według wskaźnika R.Klimka. (Clinical method of newborn’s maturity evaluation according to R.Klimek’s index), Gin. Pol, 71, 1: 1-7.