APGAR Birth Prognosis Score
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Virginia Apgar
Virginia Apgar

APGAR stands for:

  • Activity
  • Pulse
  • Grimace
  • Appearance
  • Respiration

Co-incidentally this is also the exact last name of the anaesthetist who developed the score in the 1950s – Virginia Apgar.

The score is assessed immediately after birth in the delivery room and is a screening tool to assess for the need for any emergency medical intervention.

It is a predictor of the need for urgent immediate care, but is not a predictor of any long term health defects.

APGAR birth prognosis score

(muscle tone)
Arms and legs flexed
Active movement
Below 100 bpm
Above 100 bpm
(reflex irritability)
Some flexion of extremities
Active motion (sneeze, cough, pull away)
(skin colour)
Blue, pale
Body pink, extremities blue
Completely pink
Slow, irregular
Vigorous cry
The test is performed at one and five minutes after birth.

Flow Chart

APGAR Flow Chart
APGAR Flow Chart. Image from wikimedia commons. Author: Madhero88


Scores 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally normal.
A low score does not necessarily mean that there is something critically wrong with the newborn – but it prompts further medical assessment and intervention. For example – a low APGAR score may be the result of residual fluid in the airway, and a simple suction of the airways may be enough to restore the score to the ‘normal’ range.
Typically lower scores are seen in:
  • Premature deliveries – typically lower muscle tone and less developed lung function
  • High-risk pregnancies
  • Caesarean section
  • Complicated deliveries

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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