Introduction

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

Score
0
1
2
Activity
(muscle tone)
Absent
Arms and legs flexed
Active movement
Pulse
Absent
Below 100 bpm
Above 100 bpm
Grimace
(reflex irritability)
Flaccid
Some flexion of extremities
Active motion (sneeze, cough, pull away)
Appearance
(skin colour)
Blue, pale
Body pink, extremities blue
Completely pink
Respiration
Absent
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

Results

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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