NORMAL PEURPERIUM AND THE NEONATE

COURSE CODE: FCMW 305

NAME: SR. MERCY KPIEBAKYENE
ID NUMBER: UGR0502210999
TOPIC: APGAR SCORE

INTRODUCTION
Apgar score was invented by an American physician called Dr. Virginia Apgar in 1952
at Columbia University college of physicians and surgeons. She used her name as the
mnemonic for the five categories. It was a rapid method of assessing the clinical
status of the new born infant at 1minute of age and the need for intervention to
establish breathing. This scoring system provided a standardized assessment for
infants after delivery.
The Apgar score comprises five components:
1) color
2) heart rate
3) reflexes
4) muscle ton
5) respiration
Each of these components is given a score of 0, 1, or 2. Thus, the Apgar score
quantifies the clinical signs of neonatal depression such as cyanosis or pallor,
bradycardia, depressed reflex response to stimulation, hypotonia, and apnea or
gasping respirations. The score is reported at 1 minute and 5 minutes after birth for
all infants, and at 5-minute intervals thereafter until 20 minutes for infants with a
score less than 7.
The Apgar score provides an accepted and convenient method for reporting the
status of the newborn infant immediately after birth and the response to
resuscitation if needed; however, it has been inappropriately used to predict
individual adverse neurologic outcome.
The purpose of this statement is to place the Apgar score in its proper perspective.
Definition
Apgar score is a quick way for doctors and midwives to evaluate the health of all
newborns at 1and 5 minutes after birth and in response to resuscitation. Apgar score
is based on the total score of 1 to 10. A higher score is an indication that the infant
is doing well. For instance, an Apgar of 7,8, or 9 is normal and is a sign that the
newborn is in good health. However, an Apgar below 7 is a sign of poor health and
need immediate intervention.

‘APGAR’ STANDS FOR;

A Appearance
P Pulse
G Grimace
A Activity
R Respiration

How the Test is Performed

The Apgar test is done by a doctor, midwife, or nurse. The provider examines the
baby's:
 Breathing effort
 Heart rate
 Muscle tone
 Reflexes
 Skin color
Each category is scored with 0, 1, or 2, depending on the observed condition.

Breathing effort:
 If the infant is not breathing, the respiratory score is 0.
 If the respirations are slow or irregular, the infant scores 1 for respiratory
effort.
 If the infant cries well, the respiratory score is 2.
 The Heart rate is evaluated by stethoscope. This is the most important
assessment:
 If there is no heartbeat, the infant scores 0 for heart rate.
 If heart rate is less than 100 beats per minute, the infant scores 1 for heart
rate.
 If heart rate is greater than 100 beats per minute, the infant scores 2 for heart
rate.

Muscle tone:
 If muscles are loose and floppy, the infant scores 0 for muscle tone.
 If there is some muscle tone, the infant scores 1.
 If there is active motion, the infant scores 2 for muscle tone.

Grimace response or reflex irritability is a term describing response to

stimulation, such as a mild pinch:
 If there is no reaction, the infant scores 0 for reflex irritability.
 If there is grimacing, the infant scores 1 for reflex irritability.
 If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2
for reflex irritability.

Skin color:
 If the skin color is pale or blue, the infant scores 0 for color.
 If the body is pink and the extremities are blue, the infant scores 1 for color.
 If the entire body is pink, the infant scores 2 for color.

For instance, if after the one minute of assessment, the infant scores 1 for breathing
effort, 2 for heart rate, 1 for muscle tone, 1 for grimace, and 2 for skin color. It means
the infant has scored 7/10 for the first 1minute. Then at 5minutes the infant scores
1 for breathing effort, 2 for heart rate, 2 for muscle tone, 2 for grimace, and 2 for
skin color. This means the infant has scored 9/10 for the 5minute.

Why the Test is Performed

This test is done to determine whether a newborn needs help breathing or is having
heart trouble.
Normal Results
The Apgar score is based on a total score of 1 to 10. The higher the score, the better
the baby is doing after birth.
A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. A
score of 10 is very unusual, since almost all newborns lose 1 point for blue hands
and feet, which is normal for after birth.

What Abnormal Results Mean

Any score lower than 7 is a sign that the baby needs medical attention. The lower
the score, the more help the baby needs to adjust outside the mother's womb.
Most of the time a low Apgar score is caused by:
 Difficult birth
 C-section
 Fluid in the baby's airway
A baby with a low Apgar score may need:
 Oxygen and clearing out the airway to help with breathing
 Physical stimulation to get the heart beating at a healthy rate
Most of the time, a low score at 1 minute is near-normal by 5 minutes.
A lower Apgar score does not mean a child will have serious or long-term health
problems.
The Apgar score was not designed to predict a baby’s long -term health, behavior,
intelligence, personality or outcome. It was designed to help health care providers
tell a newborn over all physical condition so that they could quickly decide whether
the baby needed immediate medical care.
 Apgar scoring system
Indicator 0 point 1 point 2 points

Absent Flexed arms and Active

A Appearance legs
(Muscle tone)

Absent Below 100 bpm Over 100 bpm

P Pulse
(Heart rate)

Floppy Minimal response Prompt response

G Grimace to stimulation to stimulation
(Reflex irritability)
Blue; pale Pink body, blue pink
A Appearance extremities
(Skin colour)

absent Slow and irregular Vigorous cry

R Respiration

Limitations of the Apgar Score

It is important to recognize the limitations of the Apgar score. The Apgar score is an
expression of the infant’s physiologic condition at one point in time, which includes
subjective components.
There are numerous factors that can influence the Apgar score, including
 Maternal sedation or anesthesia,
  Congenital malformations,
 Gestational age,
 Trauma
 Interobserver variability.
 Elements of the score such as tone, color, and reflex irritability can be
subjective, and partially depend on the physiologic maturity of the infant.
 The score also may be affected by variations in normal transition. For
example, lower initial oxygen saturations in the first few minutes need not
prompt immediate supplemental oxygen administration; the Neonatal
Resuscitation Program targets for oxygen saturation are 60–65% at 1 minute
and 80–85% at 5 minutes.
 The healthy preterm infant with no evidence of asphyxia may receive a low
score only because of immaturity. The incidence of low Apgar scores is
inversely related to birth weight and low score can not predict morbidity or
mortality for any individual infant.
There are four Apgar scoring system in the assessment of birth Asphyxia and adverse
Early Neurologic outcomes. They include;
1. Conventional-Apgar scoring system
2. Expanded-Apgar scoring system
3. Specified-Apgar scoring system
4. Combined-Apgar scoring system

REFERENCES
https://www.hopkinsallchildrens.org>
https://medlineplus.gov.article
https://www.ncbi.nim.nih.gov/pmc/article/pmc4374718/
https://straightanursingstudent.com
https://publications.aap.org>article