Female Assessment using the Ballard Score

To examine the infant female, the hips should be only partially abducted, i.e., to approximately 45° from the horizontal with the infant lying supine. Exaggerated abduction may cause the clitoris and labia minora to appear more prominent, whereas adduction may cause the labia majora to cover over them.

In extreme prematurity, the labia are flat and the clitoris is very prominent and may resemble the male phallus. As maturation progresses, the clitoris becomes less prominent and labia minora become more prominent. Nearing term, both clitoris and labia minora recede and are eventually enveloped by the enlarging labia majora.

Assessment of Fetal Development of the Female

The labia majora contain fat and their size are affected by intrauterine nutrition. Over-nutrition may result in large labia majora earlier in gestation, whereas under-nutrition, as in intrauterine growth retardation or post-maturity, may result in small labia majora with relatively prominent clitoris and labia minora late into gestation. These findings should be reported as observed, since a lower score on this item in the chronically stressed or growth retarded fetus may be counter-balanced by a higher score on certain neuro-muscular items.

Female Assessment Scoring

-1 0 1 2 3 4 5
Genitals (Female) clitoris prominent & labia flat prominent clitoris & small labia minora prominent clitoris & enlarging minora majora & minora equally prominent majora large,
minora small
majora cover clitoris & minora