The Apgar score is a simple method of assessing a neonate’s well-being at birth. There are five criteria, each of which is allocated a score between zero and two. The assessment is generally performed at one and five minutes after delivery, and may be repeated later if the score remains low. Scores of 7 and above are considered normal, 4-6 are considered to be fairly low, and 3 and below are regarded as critically low.
It was originally developed in 1952 by an anesthesiologist at Columbia University, Virginia Apgar, to address the need for a standardized way to evaluate infants shortly after birth.
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Virginia Apgar, the creator of the APGAR score
The APGAR acronym
The acronym “APGAR” can be used as an aide memoir for the five criteria:
- Appearance
- Pulse rate
- Grimace
- Activity
- Respiratory effort
The criteria of the Apgar score are as follows:
Score of 0 | Score of 1 | Score of 2 | |
---|---|---|---|
Appearance (skin colour) | Blue or pale all over | Blue at extremities (acrocyanosis) | No cyanosis Body and extremities pink |
Pulse rate | Absent | < 100 per minute | > 100 per minute |
Reflex irritability grimace | No response to stimulation | Grimace on suction or aggressive stimulation | Cry on stimulation |
Activity | None | Some flexion | Flexed arms and legs that resist extension |
Respiratory effort | Absent | Weak, irregular, gasping | Strong, robust cry |
Worked example 1:
You attend the unexpected delivery of a baby in one of the cubicles in the Emergency Department. Your consultant assesses the neonate one minute after delivery and informs you that:
- The extremities are blue, but the body is pink
- The heart rate is 110 per minute
- The baby grimaces with aggressive stimulation
- There is some flexion of the limbs
- The baby has weak, irregular gasping on assessment of respiratory effort
Answer: In this example, the neonate’s APGAR score is 5:
- Appearance: blue extremities – 1
- Pulse rate: 90 – 1
- Baby grimaces with aggressive stimulation – 1
- Activity: some flexion – 1
- Respiratory effort – weak, irregular gasping – 1
Worked example 2:
You repeat the APGAR score at five minutes for your consultant and note the following:
- The body and extremities are both pink
- The heart rate is 110 per minute
- The baby cries with stimulation
- There is some flexion of the limbs
- The baby has a strong, robust cry
Answer: In this example, the neonate’s APGAR score is 9:
- Appearance: pink body and extremities – 2
- Pulse rate: 110 – 2
- Baby cries with stimulation – 2
- Activity: some flexion – 1
- Respiratory effort – strong, robust cry – 2
Thank you to the joint editorial team of www.mrcemexamprep.net for this article.
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Needed this. Thank you!