Today we will list and briefly characterize the signs of a full-term newborn. In addition, we will focus on the issues of postmaturity or prematurity. How can this be determined by the child and how do children differ? What threatens this newborn?

For this reason, it is necessary to know not only the signs of full-term and maturity of the newborn, but also be able to correctly diagnose and be aware of possible problems. If we consider the child as an object of childbirth, then this must be done based on the size of the head, since this is the most voluminous part of the fetal body, which experiences the greatest difficulties during movement through the birth canal. Now we propose to talk in more detail about the signs of a full-term newborn.

full-term baby

What is fetal maturity? This is a certain state of the child, which characterizes the readiness of the internal organs to ensure the life of the baby outside the womb. After the birth of a child, a neonatologist must necessarily examine.

The doctor needs to evaluate three things:

• determination of the term of a newborn child, the signs of which we will consider in this section;
• assess the degree of physical development;
• morphological and functional maturity.

Which baby is considered full term? These signs include:

• birth date - from thirty-eight to forty-two weeks;
• body weight must be more than two and a half kilograms;
• body length - from forty-six centimeters or more.

It is very important to note that there are a number of other signs of a full-term newborn. We are talking about morphological and functional maturity. We will talk about this in detail later. Summing up everything said in this section, we can highlight the main signs of a full-term newborn:

• gestational age;
• body mass;
• body length.

External signs

Let's start with the main features that are visible to the naked eye. The first item on this list is to highlight a loud and demanding voice. Second - the skin should be pink and velvety. Be sure to pay attention to the fact that the skin of the newborn should be clean, and the fat layer should be uniform. The third is the presence of an open large fontanel. However, according to statistics, in fifteen percent of cases, a small one is also open. The fourth external sign is the formation of the auricle, all arcs must be clearly expressed. The fifth sign - the navel is located in the center of the abdomen, the nail plates should completely cover the nail phalanges. The sixth sign is that girls have a closed genital slit, and boys have testicles lowered into the scrotum.

Functional features

In this section, we list the functional signs of a full-term newborn. These include the following:

• the limbs of the baby should be bent at the joints;
• movements are chaotic and quite active;
• children are characterized by increased muscle tone;
• body temperature is stable, deviations within the normal range up to six tenths of degrees Celsius are possible;
• the breathing of the newborn is also stable - from forty to sixty breaths per minute;
• the heartbeat is heard well, rhythmic (the norm is from one hundred twenty to one hundred and forty beats per minute);
• in a full-term baby, all reflexes are symmetrical, it is possible to cause specific ones.

Specific reflexes of newborns:

• sucking;
• search;
• prehensile;
• trunk and others.

prematurity

Now let's turn to the issue of criteria for prematurity, postmaturity of the baby. A premature baby is born before the end of intrauterine development, that is, before the thirty-seventh week of pregnancy. Such babies have a small body weight, weight less than two and a half kilograms, and their height does not reach forty-five centimeters. Newborns have problems with thermoregulation and lack of response to external stimuli. It is important to note the statistical information: such babies are born in about 10% of cases.

It is worth knowing that there is a term "extreme prematurity" if the baby is born for up to twenty-two weeks. This condition is the line between a miscarriage and a premature baby. Body weight in this case is a decisive factor: if it reaches half a kilogram, then this is a premature baby, and just one gram less is a miscarriage.

Prematurity is usually classified according to the body weight of the newborn.

Prematurity problems can be both in mom or dad, and in the child. They are briefly listed in the table below.

Manifestation of prematurity

The signs of full-term, prematurity and postmaturity of a newborn considered by us in the article are reflected in the behavior and development of the baby. We invite you to talk about how prematurity in newborns manifests itself. Now we will give a general clinical picture. Firstly, the newborn has a disproportion of the body (a very large head). In addition, the sutures of the skull are open, so the bones are malleable. Secondly, the auricles are soft. Thirdly, the child is in the frog position, as muscle hypotension is noted. The fourth sign is that the testicles of the boys have not yet descended into the scrotum, and the large labia of the girls have not yet fully developed. Fifth, specific reflexes are extremely weakly expressed. Sixth - shallow and weak breathing (up to 54), low blood pressure (about 55-65). Seventh - frequent urination and regurgitation.

Postmaturity

What are the features of a post-term newborn baby? Signs of postmaturity in the mother should be diagnosed by a doctor with the help of CTG and ultrasound. These symptoms include:

• lack of labor activity;
• reduction in abdominal circumference;
• rather large fruit;
• compaction of the child's skull;
• meconium in amniotic fluid;
• reduced concentration of glucose in the amniotic fluid;
• urinalysis shows low levels of estriol.

It is worth noting that there are two types of post-term pregnancy:

With true postmaturity, the child is in serious danger, because hypoxia develops.

What are the causes of postmaturity and how do they affect the child?

How does a post-term pregnancy affect the baby? The baby has the following symptoms:

• thin body;
• dry and wrinkled skin;
• peeling on the skin;
• lack of fetal lubrication;
• long nails and hair;
• open eyes;
• increased activity.

Pay attention to the fact that the skin of postterm newborns acquires a yellowish tint. To prevent a post-term pregnancy, it is very important to undergo a CTG procedure three times a week (after 40 weeks). The baby's heartbeat and movements will help determine exactly how the baby is feeling.

The causes of this phenomenon are unknown, but doctors distinguish two large groups:

Note that there is also a psychological factor. If the expectant mother is afraid of childbirth and is not psychologically ready for them, then the pregnancy may be delayed. In this case, you need the support of loved ones or a consultation with a psychologist.

Differences between a full-term and premature baby

A full-term baby is distinguished by a number of features. He is ready for life outside the womb, has certain reflexes, the skin is able to maintain a certain temperature regime, the heart rate is stable, normal breathing and activity. A premature baby is the exact opposite: he is not ready for life outside the womb, he is not able to maintain a temperature regime, the heart rate and breathing are unstable, low blood pressure, and the reflexes of newborns are poorly developed.

Fertilization occurs in the ampullary section of the tube after the processes of capacitation of spermatozoa - the loss of surface glycoprotein antigens of the spermatozoon head and its activation. Capacitation occurs in the vagina, uterus, tubes as sperm advance.

A necessary condition for fertilization is the synchrony of gametogenesis and ovulation. The time between ovulation and fertilization in women ranges from 12-24 hours. Of the 100 ovulated eggs, 15 are not fertilized (physiological prezygous elimination).

Statistical analysis of childbirth in the countries of the USA, Western Europe and Australia showed that there are characteristic fertility curves with a wide peak in the winter months, a slight rise in summer and a decrease in spring and autumn. And conception often occurs in spring and autumn, in winter and summer anovulatory and hypoluteal cycles are more often observed. Seasonal variation in the frequency of certain types of congenital pathology in humans is explained by the desynchronization of ovulation and the process of maturation of the oocyte during the transition from anovulatory cycles to ovulatory cycles during the change of seasons of the year (Nikitin A.I. Aging of gametes and congenital pathology // Obstetrics and Gynecology. - 1981. - Nos. 3, 6-9).

The rhythm of gametogenesis and ovulation is determined by the duration of light stimulation. In Arkhangelsk, the minimum daylight hours are 3 hours 51 minutes (December 22), the maximum is 21 hours 21 minutes (June 22). The mediated action of light through the pineal gland causes 80-85% of the appearance of menarche in the first quarter of the year.

And pregnancy proceeds most favorably at conception with increasing daylight hours from 7 to 14 hours (February 10 - April 15) or decreasing daylight hours from 2 to 7 hours (August 15 - November 15). At the same time, for primiparous women under the age of 24, the optimal period of conception is the first peak of fertility, which corresponds to the menarche according to the season - the cumulation of fertility. For women over 28 years of age, the second seasonal peak of fertility is more optimal.

When conceived during favorable periods of fertility, the frequency of pregnancy complications such as miscarriage, early and late toxicosis decreases by 2-2.5 times.

Critical periods of pregnancy development

Fertilization (40 hours)	Embryogenesis (up to 9 weeks):	zygote-morula
implantation (1-2 weeks)		blastula
placentation (3-6 - 12-14 weeks)	histoorganogenesis (up to 12-14 weeks)
	fetogenesis:	functional genesis (up to 18-24 weeks)
		intensive fetal growth systemogenesis (up to 37 weeks)
		childbirth

Up to 50% of zygotes die in the early stages of development and about 20% of diagnosed pregnancies end in spontaneous miscarriage, with more than half of them due to lethal chromosome anomalies.

Artificial termination of pregnancy causes a sudden and fundamentally different reaction from spontaneous abortion. Therefore, after an artificial abortion, the frequency of intrauterine death of embryos, mostly male, increases in subsequent pregnancies.

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The processes of implantation, placentation depend on the decidual reaction of the endometrium. The active function of the placenta is formed by 14-16 weeks, by the end of pregnancy the contact area of ​​the placental villi is 8-12 m 3 . The placenta is the functional heart of pregnancy. The total blood flow in the intervillous space is 500-600 ml/min. Blood circulation in the intervillous space occurs slowly at low pressure (10 mm Hg), due to which an effective metabolism is carried out, and venous blood is discharged through the marginal sinus into the uterine veins. The placenta performs the function of external respiration, excretory, nutritional, synthesis of fetal proteins, depositing, intrasecretory (synthesis of chorionic gonadotropin, sex steroid hormones, relaxin, placental lactogen, trophoblastic b 1 -glycoprotein - TBG, a 2 - fertility microglobulin - AMHF, placental - a 1 - microglobulin - PAMG-1).

Alpha fetoprotein (AFP) is an embryo-specific protein in the amniotic fluid, its increase is observed with abnormalities in the development of the neural tube, congenital nephrosis, teratomas, gastrointestinal atresia, Turner, Down, Meckel syndromes, Fallot's tetralogy, etc., as well as intrauterine fetal death.

Trophoblastic beta globulin (TBG) appears from the end of the first week of pregnancy (the possibility of early diagnosis), increases as pregnancy increases. Its decrease is observed in non-developing pregnancy, moderate and severe preeclampsia and miscarriage.

human placental lactogen (PLC) begins to be determined from the 18-20th week of pregnancy. Its level decreases with gestosis, the threat of abortion, intrauterine fetal hypotrophy. Its low content before delivery predicts complications in childbirth and the postpartum period, intranatal fetal asphyxia.

Fertility Alpha-2 Microglobulin (AMHF) is secreted into the amniotic fluid. Specific outside of pregnancy for ovulation with a maximum increase towards the end of the cycle.

Placental alpha-1 microglobulin (PAMG-1) is found in amniotic fluid, decreases as pregnancy progresses. It is related to the processes of regulation of fetal growth. With gestosis, the threat of abortion, hypotrophy, there is a significant increase in the serum concentration of PAMG-1.

The placenta provides immune protection for the embryo and fetus, fixing antibodies and reducing the mother's cellular and tissue immunity, its histagematical barrier regulates the penetration of substances from mother to fetus and vice versa.

The placental permeability index for medicinal substances averages 50%, with wide fluctuations from 10 to 90-100%.

There is also a paraplacental exchange, due to the active function of the decidua, amniotic and chorionic membranes. Amniotic fluid is formed by the epithelium of the amnion, and their average daily exchange is 12-15 liters. The amnion and chorion contain enzymes of nitrogen, carbohydrate and lipid metabolism, RNA, glycogen, mucopolysaccharides, proteins and amino acids. Glucose, urea, potassium, sodium, calcium pass freely through the amnion and chorion.

Indicators of the physical development of the fetus depending on the duration of pregnancy

Pregnancy period, weeks	Fruit weight, g	Fetal growth, cm
12	40	8-9
16	120	16
20	300-320	24-26
24	500-600	28-31
28	1000	35
32	1600-1800	40-42
36	2500-2750	45-48
40	3500	50

For 10 lunar months, there is an increase in the mass of the fetus compared to the mass of the zygote in 6 ´ 10 12 times.

Cumulative signs of fetal maturity

Height 48-50 cm, weight 3200-3500 g.

The chest is convex, the umbilical ring is between the womb and the navel.

The skin is pale pink, smooth, smooth, the subcutaneous layer is pronounced, the remains of a cheese-like lubricant in the skin folds, vellus hair on the shoulders and upper back, the nails go beyond the fingertips, the hair on the head is up to 2 cm.

The ear and nasal cartilages are elastic.

The testicles are in the scrotum, the clitoris and labia minora are covered with large ones.

The movements are active, the eyes are open, the cry is loud, it takes the breast well.

Principles of a systematic approach to the study of the relationship between mother and fetus

The fetal-maternal relationship proceeds in an inseparable unity, while not so much the fetus adapts to its external environment (mother), as the external environment itself is purposefully rebuilt for the optimal implementation of conditions that can ensure the most complete realization of genetic capabilities. The functional system mother-placenta-fetus is formed.

Systemogenesis is the selective development in embryogenesis of structures that are different in function and localization, which, when combined, form functional systems that provide vital manifestations of a developing organism.

The development of a certain organ of the fetus depends on the state of this organ of the mother.

Biophysical profile of the fetus ( A.M. Vintrilers, 1983)

Non-stress test (NST)

Fetal respiratory movements (FRP)

2 b.	-	at least one episode of DDP lasting 60 seconds. and more in 30 min. observations
1 b.	-	at least one episode of DDP from 30 to 60 sec. in 30 min. observations
0 b.	-	DDP less than 30 sec. or their absence in 30 minutes. observations
Fetal activity (YES)
2 b.	-	at least 3 generalized movements in 30 minutes. observations
1 b.	-	1-2 generalized movements in 30 minutes. observations
0 b.	-	absence of generalized movements in 30 minutes. observations
When comparing the mother's feelings about the movement of the fetus with ultrasound data, the coincidence is 80-85%. Fetal movements are more intense in the evening, an increase in their number occurs from 20 to 32 weeks of pregnancy, in the last 2 months of pregnancy, the number of fetal movements decreases. A decrease in the intensity of movements in violation of the condition of the fetus occurs 12-96 hours earlier than changes in the ECG of the fetus.
Fetal tone (TP)
2 b.	-	one episode or more of extension with a return to the flexion position of the spine and limbs in 30 minutes.
1 b.	-	at least one episode of extension with a return to flexion of either the limbs or the spine.
0 b.	-	limbs in flexed position
Volume of amniotic fluid (AMF)
2 b.	-	water is clearly defined in the uterus, the vertical diameter of the free area of ​​water is 2 cm or more
1 b.	-	vertical diameter of the free area of ​​water 1-2 cm
0 b.	-	close arrangement of small parts of the fruit, the vertical diameter of the free area of ​​water is less than 1 cm
The degree of maturity of the placenta (FFP) - according to P.A. Urannum, 1979
2 b.	-	0, I, II maturity of the placenta
1 b.	-	placenta on the posterior wall of the uterus and it is difficult to determine the degree of maturity
0 b.	-	III maturity of the placenta

The last two weeks of pregnancy and two weeks after birth, the newborn fetus has hypobiosis.When the morphological and functional readiness of all the main organs and life support systems is noted on extreme stimuli: decrease in motor activity, decrease in heart rate, decrease in the intensity of metabolic processes, low consumption of O 2 and CO 2 production , dominance of anaerobic glycolysis, acidosis, hypoglycemia, poikilothermia, immunological tolerance.

Hypobiosis is a protective mechanism that ensures the resistance of the organism of the fetus-newborn to adverse environmental influences.

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full-term called a fetus born 40-42 weeks (10 lunar months) after conception or 280 days. To determine full-term, forensic doctors measure the length of the body. In addition, useful information is established by the presence or absence of ossification nuclei (Becklar's nuclei) in the lower parts of the child's femurs. In a child born full-term, the body reaches a length of about 50 cm, head circumference 34-35 cm, chest circumference 32-34 cm. Physiological fluctuations in the duration of pregnancy are significant from 210 to 367 days. In the modern sense, full-term delivery is delivery at a gestational age of 37 to 42 completed weeks (259-293 days). A fetus born between 28 and 37 weeks is considered premature, and a fetus born before 28 weeks is considered a miscarriage. Postterm is considered

pregnancy over 42 weeks.

Prematurity and maturity are not identical concepts. Prematurity determines the time the fetus stays in the womb, and maturity characterizes the degree of development of the fetus.

Under maturity understand the degree of physical development of the fetus, which ensures the possibility of its existence outside the maternal organism (extrauterine life). Maturity is determined by the state of the body parts of the fetus (weight and length of the body, head size, development of the external genital organs, etc.) in a complex. Signs of maturity are body length and weight, circumference, other head sizes, shoulder width and other indicators previously given for full-term newborns. However, in addition to these common features for full-term and maturity, the latter is also characterized by some others that are unique to it:

Elasticity of the skin with a well-developed subcutaneous fat layer;

The presence of vellus hair only in the area of ​​​​the shoulder blades and shoulder girdle;

thick hair on the head 2 - 3 (more than 1) cm long;

dilated pupils without membranes, transparent corneas;

elastic, elastic cartilage of the nose and auricles;

Protrusion of the nails on the fingers beyond their ends and reaching their ends on the toes;

· the testicles lowered into the scrotum in boys, the closure of the small labia in girls with large ones, the closeness of the genital slit;

The nucleus of ossification in the lower epiphysis of the thigh with a diameter of 0.5-0.7 cm;

umbilical cord length 45-60 cm;

The umbilical ring is located in the middle between the womb and the xiphoid process.

A nine-month-old fetus of at least 45 cm and a body weight of at least 2500 g is usually considered mature. With the normal development of pregnancy, a full-term fetus is usually mature.

Viability

Viability in forensic medicine is understood as the ability of the fetus to continue to live outside the mother's body in normal external conditions. If a mature full-term fetus does not have malformations that are incompatible with life, then it is recognized as viable. Premature fetuses that have reached the minimum degree of maturity necessary for life can also be viable. When certain conditions of existence are created, fetuses after 7 months of pregnancy, sometimes even more premature ones, can survive and develop. In forensic medicine, fetuses are recognized as viable after 8 months of maturation in the womb (body length not less than 40 cm, weight not less than 1500-1600 g, head circumference 28 cm).

It should be noted that full-term and fetal maturity are ambiguous concepts.

Prematurity refers to the length of time the fetus stays in the mother's body.

Maturity characterizes the degree of development of the fetus.
Maturity is usually understood as a set of signs (the level of physical development, the development of the skin of soft tissues, the musculoskeletal system), that is, the degree of development of the fetus at which an independent life of the child in the external environment is possible.
Among the signs of maturity of newborns, the leading importance is given to:

Sufficient development of the subcutaneous fat layer;

The length of the hair on the head is at least 2 cm;

The cartilages of the auricles and nose are dense;

The nail plates on the fingers go beyond the ends of the fingers, on the legs - reach the ends of the fingers;

The condition of the external genital organs and other signs.

Accelerated growth and physical development of the fetus can determine the recognition of a newborn child as viable in cases where, according to intrauterine age (less than 8 lunar months), viability in the forensic understanding has not yet been achieved, which significantly changes the legal assessment of the fact of infanticide and responsibility for it.
The above should be taken into account by the investigator when evaluating the expert's conclusions.

Whether a baby is full-term or premature is determined by whether the baby was born on or before term.

The normal duration of pregnancy is 280 days, or 10 lunar months (a lunar month is 28 days). Deviations from this period are possible; in such cases, the infant will be considered premature or postterm.

The full-term baby is characterized by a combination of a number of signs. Its body length is 50 cm, the head circumference is 32 cm, the distance between the shoulders is 12 cm, between the hips is 9.5 cm, and the weight is 3 kg.

The skin of a full-term baby is pink, elastic, covered with a delicate fluff in the shoulder area. The nails on the hands protrude beyond the ends of the fingers, and on the legs they reach the ends. The cartilages of the nose and auricles are dense and elastic. The mammary glands in boys and girls are slightly swollen. In boys, the testicles are located in the scrotum, in girls, the large labia cover the small ones. In a transverse section of the distal epiphysis of the femur, in the central part of the section, the so-called ossification nucleus is clearly visible in the form of a dark red focus with a largest diameter of 0.5 cm, located against the background of white cartilaginous tissue.

In a premature baby, the body length, other dimensions and weight will be the smaller, the more premature he is. The skin is pale, flabby, wrinkled, everywhere covered with fluff. The face has an old-looking appearance, the cartilages of the nose and auricles are devoid of elasticity. The nails of the hands and feet do not reach the ends of the fingers. In boys, the scrotum is empty due to the location of the testicles in the abdominal cavity. In girls, the large labia do not cover the small ones.

A full-term baby is usually mature.

Maturity should be understood as a certain degree of physical development of the infant. The need to establish maturity during a forensic medical examination of the corpse of a newborn infant is due to the fact that a child who has reached it (in the absence of deformities, developmental anomalies and diseases incompatible with life) is always viable, which is important for resolving a number of procedural issues by law enforcement officers.

"Maturity" is a morphological concept and characterizes the degree of intrauterine development of the fetus, which is delivered for examination, and the concept of "full-term" refers to the stages of pregnancy, the signs of which remain in the mother's body. Therefore, the forensic medical examination of the corpse of a newborn in solving these two issues is limited only to determining its maturity. The definition of a full-term pregnancy cannot be the subject of an examination due to the lack of an object of study.

Signs of fetal maturity

Fetal maturity criteria (1966)

• elasticity of the skin with a well-developed subcutaneous fat layer;
• the presence of vellus hair only in the area of ​​​​the shoulder blades and shoulder girdle;
• thick hair on the head 2-3 (more than 1) cm;
• dilated pupils without a membrane, transparent corneas;
• elastic, elastic cartilage of the nose and auricles;
• the protrusion of the nails on the fingers beyond their ends and reaching their ends on the toes;
• testicles descended into the scrotum in boys
• the closure of the small labia in girls with large ones, the closeness of the genital slit.

Kasper-Güntz fetal maturity indicators

Metric indicators of individual bones of term infants.

Criteria for fruit maturity (modern ???)

The skin of a mature newborn is pale grayish in color, subcutaneous fatty tissue is well developed. Blocked sebaceous glands are found on the wings of the nose. The cartilages of the nose and ears are elastic. The length of the hair on the head is 2 cm. The fluff on the trunk and hands usually disappears, the nails on the hands go beyond the ends of the fingers, on the legs they reach the ends of the fingers. In boys, the testicles are located in the scrotum, in girls, the large labia cover the small ones. Subcutaneous adipose tissue is well developed. The mammary glands protrude. An important sign of the maturity of the newborn, according to most authors, is the presence of ossification nuclei (in the sternum (ossification point of Zhuravleva), calcaneus, talus, femur and humerus). So in a mature newborn in the lower epiphyses of the femur, Beklar's nuclei can be detected - ossification islands with a diameter of about 0.5-0.6 cm.

Currently, the signs that make it possible to judge the maturity of a newborn are the length and weight of the body, head size, shoulder width and other anthropometric data.

In some cases, to resolve the issue of maturity according to the detected parts of the fetus, the data of Kasper and Gunz on the sizes of some bones of a mature newborn child can be used: the length along the diagonal of the parietal bone is 7.6 cm; frontal in height - 5.6 cm, in width - 4.5 cm; clavicle length - 3.4 cm; shoulder blades - 3.2 cm; humerus - 7.5 cm; elbow - 7 cm; radial - 6.6 cm; hips - 8.7 cm; tibia - 7.9 cm; small tibia - 7.7 cm.

When conducting a forensic medical examination (examination) of the corpses of newborn infants, the question of their maturity, like other issues, is resolved on the basis of not one, but the entire set of signs, where one of the main ones is the histological examination of internal organs.