A New Use for Apgar’s: Low Apgar Scores and Maternal Health

An Apgar score is the very first test given to a newborn. It is a quick evaluation tool used by a medical practitioner, often an obstetrician or obstetrical nurse, to assess how well the newborn tolerated the delivery and whether or not the neonate requires immediate medical care.

This tool has been employed since 1952 when it was developed by the Anesthesiologist, Dr. Virginia Apgar. Often it’s referred to as an acronym for the following five factors: Appearance (skin colour), Pulse (heart Rate), Grimace (reflex response), Activity (muscle tone), and Respiration (breathing rate and effort). Each of these factors is evaluated and scored on a scale from 0 (none) to 2 (normal) out of a total of 10. The evaluation is usually conducted at one and five minutes after birth. Most newborns score between 7 and 10. A low Apgar score can be an indication for intervention and monitoring. Persistently low Apgar scores can be associated with long-term developmental issues, such as cerebral palsy.

Since the evaluation’s inception its application was limited to identify whether newborns needed urgent medical care or emergency measures. Interestingly, a recent six-year study of over 600,000 Ontario singleton baby health records, has extended the application of this evaluation tool. The study, published in JAMA Pediatrics titled “Association of Newborn Apgar Score With Maternal Admission to the Intensive Care Unit” has identified a link between the newborn’s Apgar score and the mother’s need for critical care. The study shows that the lower the Apgar score the higher the rate of mother’s admission to the ICU. For example, a normal newborn Apgar score resulted in 1.7 maternal ICU admissions per thousand but a low rage Apgar score resulted in an increase to 18.2 maternal ICU admissions per thousand.

A mother’s need for critical care is not always identifiable. Birth is a time of great excitement and young healthy women often have physical reserves that could prevent maternal vital signs from signaling concern after birth. It is likely that this rings true even more so in situations where the newborn has low Apgar scores and must undergo emergency intervention. Thus, the novel application of this universally accepted metric shows far-reaching potential to positively impact maternal health by ensuring practitioners are extra-mindful of the mother’s condition when their newborn presents with abnormal Apgar scores.