To evaluate the specific maternal and perinatal variables associated with a low (≤3) or moderate (4–6) Apgar score, compared to a high (≥7) score.
This was a retrospective, cohort study of 58429 term singleton babies born at the Mater Mother’s Hospital in Brisbane, Australia in 2007–2013. Maternal demographics, socio-economic status using the Australian Socioeconomic Index for Areas (SEIFA) score, obstetric factors, and birth outcomes were compared for neonates grouped into three categories based on their five-minute Apgar: low (≤3), moderate (4–6) and high (≥7). The low- and moderate-score cohorts were individually compared to the high-score cohort using both univariate and multivariate analysis.
Logistic regression analysis confirmed that of the variables analysed, only maternal public insurance status (OR 2.1, 95% CI 1.5–3.1), breech presentation (OR 2.4, 95% CI 1.1–4.6), other non-cephalic presentation (OR 9.5, 95% CI 2.2–25.4), intramuscular narcotic use (OR 2.3, 95% CI 1.5–3.5), and presence of meconium (OR 3.7, 95% CI 2.5–5.4) were significantly associated with low Apgar scores. Variables significantly associated with a moderate score were: SEIFA ≤50th centile (OR 1.6, 95% CI 1.2–2.0) and 61st to 70th centile (OR 1.31, 95% CI 0.9–1.8) categories, maternal public insurance status (OR 2.7, 95% CI 2.2–3.3), nulliparity (OR 2.0, 95% CI 1.7–2.5), emergency caesarean birth (OR 2.6, 95% CI 2.1–3.2), instrumental birth (OR 2.3, 95% CI 1.9–2.9), and presence of meconium (OR 2.6, 95% CI 2.1–3.2).
Factors associated with low and moderate Apgar scores vary in type and degree of influence. Distinctions in the perinatal background can help predict newborn compromise and accelerate delivery of care.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Obstetrics and Gynecology and Reproductive Biology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Low 5-minute Apgar score: a population-based register study of 1 million term births.Am College Obstetr Gynecol. 2001; 98: 65-70
- The continuing value of the apgar score for the assessment of newborn infants.N Engl J Med. 2001; 344: 467-471
- Birth outcomes and academic achievement in childhood: a population record linkage study.J Early Child Res. 2014; 12: 234-250
- Five-minute Apgar score as a marker for developmental vulnerability at 5 years of age.Arch Dis Child Fetal Neonatal Ed. 2015; 0: F1-F7
- Perinatal consequences of a category 1 caesarean section at term.BMJ Open. 2015; 5
- Risk factors associated with low Apgar scores in a low-income population.Paediatr Perinat Epidemiol. 1993; 7: 205-216
- Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome.Revista da Associação Médica Brasileira. 2012; 58: 587-593
Australian Bureau of Statistics. SEIFA –Using and interpreting SEIFA www.abs.gov.au/websitedbs/censushome.nsf/home/seifahelpansuis2013 cited 2016.
- Prevalence of antenatal depression in women enrolled in an outreach program in Canada.J Obst Gynecol Neonatal Nurs: JOGNN/NAACOG. 2006; 35: 491-498
- Impact of a high Edinburgh Postnatal Depression Scale score on obstetric and perinatal outcomes.Sci Rep. 2016; 6: 33544
- How often is a low Apgar score the result of substandard care during labour.BJOG. 2010; 117: 968-978
- The Apgar score revisited: influence of gestational age.J Pediatr. 1986; 109: 865-868
- The relationship of Apgar scores, gestational age, and birthweight to survival of low-birthweight infants.Am J Perinatol. 1987; 4: 121-124
- Risk of low Apgar score and socioeconomic position: a study of Swedish male births.Acta Pædiatrica. 2008; 97: 1275-1280
- Impact of maternal body mass index on intrapartum and neonatal outcomes in brisbane, Australia, 2007 to 2013.Birth. 2016; 43: 358-365
- Obstetrician/gynecologist hospitalists: can we improve safety and outcomes for patients and hospitals and improve lifestyle for physicians?.Am J Obstet Gynecol. 2012; 207: 81-86
- The differential effects of maternal age, race/ethnicity and insurance on neonatal intensive care unit admission rates.BMC Pregnancy Childbirth. 2012; 12: 97
- The effects of increased private health insurance: a review of the evidence.Aust Health Rev. 2004; 28: 119-138
- Association of Apgar scores with death and neurologic disability.Clin Epidemiol. 2009; 1: 45-53
- MRI lesions and infants with neonatal encephalopathy. Is the Apgar score predictive?.Neuropediatrics. 2002; 33: 150-156
- Effects of maternal cigarette smoking on apgar score.Am J Dis Child. 1981; 135: 503-506
- Numbers of deaths related to intrapartum asphyxia and timing of birth in all Wales perinatal survey, 1993-5.BMJ. 1998; 316: 657-660
- A cohort study of low Apgar scores and cognitive outcomes.Arch Dis Child Fetal Neonatal Ed. 2007; 93: F115-F120
- Evaluating the risks of cesarean section: low apgar score in repeat C-Section and vaginal deliveries.Am J Public Health. 1988; 78: 1312-1314
- Immediate maternal and neonatal effects of forceps and vacuum-Assisted deliveries.Am College Obstetr Gynecol. 2004; 103: 512-518
- Gender specific intrapartum and neonatal outcomes for term babies.Eur J Obstetr Gynecol Reprod Biol. 2014; 185: 19-22
- The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses.Am J Obstet Gynecol. 2015; 213: 5-15
- Prediction of intrapartum fetal compromise using the cerebroumbilical ratio: a prospective observational study.Am J Obstet Gynecol. 2013; 208 (124 e1-6)
- Prediction of fetal compromise in labor.Obstet Gynecol. 2014; 123: 1263-1271
- Predicting intrapartum fetal compromise using the fetal Cerebro-Umbilical ratio.Placenta. 2015; 36: 594-598
- Fetal outcome for infants in breech by method of delivery: experiences with a stand-by service system of senior obstetricians and women’s choices of mode of delivery.J Perinat Med. 2011; 39: 385-390
- Breech delivery at term in Denmark, 1982–92: A population-based case-control study.Paediatr Perinat Epidemiol. 1999; 90: 125-130
Published online: January 06, 2017
Accepted: January 4, 2017
Received in revised form: December 23, 2016
Received: June 14, 2016
© 2017 Published by Elsevier Ireland Ltd.