Apgar Score – Safety Check at the Beginning of Life

The first few minutes after birth are some of the most dangerous in a person’s entire life. Consequently, the Apgar score quickly summarizes any potential risks during this vulnerable stage and, most importantly, recognizes any critical lack of oxygen or asphyxia in a newborn child.

The US anesthesiologist Virginia Apgar first presented this simple and standardized method to judge the health of a baby immediately after birth in 1952.

Nowadays, the Apgar score is a global standard in midwifery. It is carried out by midwives, obstetricians and doctors as soon as the baby is born and consists of five criteria: skin color, pulse rate, reflexes, muscle tone and respiratory effort.

The term was originally coined in line with the inventor’s surname, but forms a backronym, APGAR, in several languages, whereby the order of the individual parameters may indeed differ.

A maximum of two points is given to each parameter and the total score then makes up the APGAR score. Generally speaking, this test is done during the first, fifth and tenth minute after birth, in order to determine how the baby adapts to life outside of the mother’s womb. The ideal score is 9 or 10 points, but a newborn with 7 points is also considered to be normal. If the score is less than this, further treatment may become necessary depending on the extent of the so-called adjustment disorder or any sign of depression.

It is mainly the second and third Apgar score which are the most significant concerning the newborn’s condition, as an initial low score usually improves within the first few minutes after birth. If supportive measures need to be administered, these can be assessed by means of subsequent Apgar scores.

Although the Apgar score has been used for more than fifty years, criticisms exist concerning limitations. For instance, the score may be influenced by anomalies, how far developed the child was at the time of leaving the mother’s womb, as well as the mother’s sedation or medication given to the mother during labor. A further disadvantage is the subjective nature of some of the criteria, meaning that only a certain prognostic nature is possible concerning the newborn.

Consequently, this test should not be used on its own to determine the medical condition but always as part of a series of examinations, including PH value for the blood in the umbilical artery and vein.

In spite of these limitations, it still remains, even today, one of the chief assessment tools used in obstetrics, which benefits countless newborns worldwide.

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