The score assessed in the Test is intended to guide whether to perform neonatal resuscitation maneuvers, following this guidance:
Apgar from 0 to 3: marked difficulties in adapting to extrauterine life; intensely depressed newborn.
Apgar from 4 to 6: moderate difficulties, moderately depressed newborn.
Apgar from 7 to 10: absence of difficulties, satisfactory state.
When newborns obtain a good assessment at five minutes (typically already with a score of 9-10), observation is continued as a surveillance measure, which is an attitude that should always be maintained in the first hours of life, but the Apgar test score of 10 is assumed at 10 minutes of life.
The performance of the Apgar test at 10 minutes is usually only scored in newborns who, after the first five minutes of life, continue to need resuscitation maneuvers and observation of their adaptation.
In the vast majority of births, regardless of the form of birth, ectopic, instrumental or cesarean delivery, the Apgar test should be performed with the newborn in skin-to-skin contact on the mother’s abdomen. We have already commented that it is a scale that is scored through observation and that does not require the application of any particular apparatus or technique, so the benefits of scoring the newborn should be prioritized while making early contact with his mother and mother. Only separate those who require resuscitation measures. Midwives are used to performing the Test with the newborn on top of the mother in skin-to-skin contact.
Despite the time elapsed since its implantation, it is still in force and is very useful in clinical practice. In a doctoral thesis one from 2017, where the relationship between intrapartum cardiotocography records, umbilical artery pH, and the Apgar test was compared, it is concluded that the relationship between the RCTG and the Apgar test at one minute of life is “significant, in pregnant women with a normal RCTG, an Apgar test showing the absence of neonatal depression is 8.6 times more frequent than in pregnant women with pathological RCTG. Likewise, the relationship between the umbilical artery pH and the Apgar test at one minute of life was demonstrated, with the mean umbilical artery pH being higher in neonates who did not present neonatal depression than in those who presented moderate depression, and this, in turn, it was higher than in those who had severe depression”.
What is the Apgar Test for?
Immediately after delivery, the midwife or gynecologist will have to verify the correct adaptation to the baby’s world that has just arrived. In the first minute of life, her vitality and general health are evaluated by employing this quick and straightforward pediatric Test. Then it can be repeated after about 5 minutes. This is especially important in cesarean deliveries since, in these cases, babies tend to show less vitality at the first “check-up.”
What does it consist of?
In the Apgar test, five parameters of the baby are evaluated: heart rate, respiration, muscle tone, reflexes, and skin tone.
And it is that the word Apgar refers to “Appearance, Pulse, Irritability (from English Grimace), Activity and Breathing.”
These factors are easily verifiable and confirm that the heart, lungs, blood circulation, and nervous system adapt to life outside the womb. Your baby no longer needs the placenta, he is an autonomous being, and the Apgar test confirms if he is capable of it. For this, the following is reviewed:
– Heart rate: pulsations are measured. The maximum score is given if they are 100 per minute or more and if they are regular.
– Breathing: It is assessed if the breathing is vigorous and strong or if it is softer, complex, or irregular, or if, on the contrary, it is not breathing.
-Reflections: It is seen if the child responds to a series of stimuli, and it is evaluated based on how he responds to them (with crying, coughing, light sobbing, with delay or without response).
Muscle tone: It is observed if the newborn is moving, active, or has few movements or no muscle tone.
-Appearance of the skin: For a baby to be in perfect condition, her skin must be pink. If not, it may present a cyanotic bluish color, only in the extremities or throughout the body.
Each of these parameters mentioned is given a score from 0 to 2 depending on how the baby responds to the Test. In the end, the five are added, and the total obtained is called the Apgar index.
When a child scores less than 7 points on the first Test, it is repeated after a few minutes. In this second exam, the score usually increases. Usually, the first Test measures the effects of birth on the baby: the second, her adaptation to the environment.
Parents need to know that it is not an invasive or painful test, so you don’t have to worry about causing your newborn to suffer.
Also, bear in mind that the objective of this Test is not to predict the future health of the child or other factors such as behavior or intellectual level. It only measures its adaptability to the environment and its state at this time.
Apgar Test Results
– Between 7 and 10, the baby is in optimal conditions.
– Between 4 and 6, the baby does not have good physiological conditions and will require observation and recovery. This score often is motivated by complications in delivery or the weeks of pregnancy, so it usually resolves without significant problems. In this case, the newborn may require help to adjust, although stimulation such as vigorous baby drying is usually sufficient. Sometimes it may also be necessary to give you oxygen or clear your airway.
– Between 0 and 3, you will need urgent medical attention and possibly resuscitation. In this case, you have to be quick since it implies the danger of neonatal death and can be caused by a congenital disease or malformation.