Pregnancy can be terrifying especially for a first-time mother. There are things that could go wrong and affect the pregnancy progression. This is why health screening is important to evaluate a mother’s general health. A healthy pregnancy can help a mother to feel confident and relax during delivery. Delivering a baby is indeed a painful moment for mother yet a beautiful one and marks the end of pregnancy. A healthy baby is usually what is expected from both pregnancy and delivery. In this article, we will be learning more about Apgar score.
Apgar score describes the condition of the newborn immediately after birth. It is a tool used to assess the transition of the baby from inside of the womb into the environment we all lived in. In 1952, Dr. Virginia Apgar, an anesthesiologist at Columbia University, developed the Apgar score. This explains the name why it is known as Apgar score.
Apgar score has become a standardised tool used by healthcare professionals during childbirth. It is worth noting that Apgar score does not predict individual mortality or adverse neurologic outcome. This is because most infants, even those with very low 1-minute scores, will have normal scores by 5 minutes. However, based on studies, Apgar score less than 5 at 5 minutes and 10 minutes indicates increased risk for cerebral palsy and abnormality correlates to the risk of cerebral palsy. A low Apgar score does not mean an infant will definitely develop cerebral palsy. Although, lower scores over time increases the risk for poor neurologic outcomes.
Apgar score is used to check newborn babies at 1 minute and 5 minutes after birth. Apgar score is a simple assessment used by healthcare professionals to understand general conditions based on observation in the first moments of life. Apgar score often is used to know if a baby needs extra immediate medical care. There are 5 parts of Apgar scoring:
- Skin colour/ oxygenation
- Heart rate
- Reflexes and responsiveness
- Muscle tone
- Breathing
A score of 0, 1 or 2 is assigned to each of the 5 parts:
- Skin colour/ oxygenation – 2 points = pink body, 1 point = pink body but blue extremities (hands and legs), 0 point = complete pale blue body
- Heart rate – 2 points = heartbeat equal to or more than 100 beats/min, 1 point = heartbeat less than 100 beats/min, 0 point = absent of heartbeat
- Reflexes and responsiveness- 2 points = cry, cough or sneeze, 1 point= grimace or feeble cry when stimulated, 0 point = silence or no response to stimulation
- Muscle tone – 2 points = good flexion/ action motion, 1 point = some flexion, 0 point = none or limp
- Breathing effort – 2 points= regular breathing or strong cry, 1 point= irregular, weak, slow breathing or gasping, 0 point= absent of breathing
The maximum score is 10. Scores ranging from 7-10 are considered normal. Apgar scores of 7-10 usually only require post-delivery care. If the 5-minute Apgar score is abnormal which means lower than 7, appropriate measures should be taken. Apgar score should be assigned every 5 minutes until the infant is stabilised. Apgar score below 4 means a newborn in poor condition and in need of immediate medical attention. Apgar score is recommended to be used continuously at 5-minute intervals up to 20 minutes. Apgar score that remains at 0 after 10 minutes may indicate termination of resuscitation efforts as very few infants survive with good neurologic outcomes if no heart rate has been detected for over 10 minutes.
Apgar score may be performed by physician, midwife or nurse. Babies with low Apgar scores often need oxygen or physical stimulation. A low Apgar score in most cases is caused by difficult birth, following Caesarean section or fluid in the baby’s airway. When a newborn has Apgar score of 5 or less at 5 minutes, umbilical artery blood gas from a clamped section of umbilical cord should be obtained by a healthcare professional. This procedure is also known as cord blood gas analysis. It can give information if the baby experienced acidosis and has experienced a low state of oxygen during delivery (hypoxic-ischemic event). Knowing this information can help determine if the baby has developed brain damage known as hypoxic-ischemic encephalopathy. This is a serious birth complication and can lead to early death in babies.
In essence, Apgar score is a tool used by healthcare professionals to assess newborn. Apgar score is only one piece of information used to assess a baby shortly after birth. Baby with a low Apgar score will need immediate medical attention such as respiratory assistance. Apgar score is not a significant indicator of any potential neurological issues. However, persistent low Apgar scores may be a risk for poor neurological outcomes. Again, an Apgar score does not mean anything more than to evaluate how the babies are doing in the first few minutes of life. Ask your healthcare provider for more information regarding Apgar score or anything concerning the baby.
