The relationship between the five minute Apgar score, mode of birth and neonatal outcomes

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Abstract
To investigate the relationship between the five-minute Apgar score categories (low, intermediate, and normal), mode of birth and neonatal outcomes. This was a retrospective cross sectional study of term singleton deliveries at Mater Mothers' Hospital in Brisbane, Australia between January 2007 and December 2015. The five minute score was subdivided in to three categories - low (0-3), intermediate (4-6), and normal (≥7). These were correlated with adverse neonatal outcomes and mode of birth. The referent cohort was the normal Apgar group. The study cohort consisted of 39,258 births with a recorded five minute Apgar score. Of these, 38,705 (98.6%) neonates had a normal (≥7) Apgar score, 439 (1.1%) had an intermediate score (4-6) and 114 (0.3%) had a low (0-3) score. Neonatal complications including respiratory distress, feeding problems, hypothermia, and seizures were all significantly associated with both low and intermediate Apgar scores. Emergency operative birth (caesarean and instrumental) conveyed a higher risk of low and intermediate scores and poorer neonatal outcomes. Low and intermediate five minute Apgar scores were strongly associated with mode of birth and poorer neonatal outcomes.

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