Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome

Rev Assoc Med Bras (1992). Sep-Oct 2012;58(5):587-93.

Abstract

Objective: To evaluate the association between Apgar scores of less than seven at five minutes (AS5min < 7) and antenatal factors and postnatal outcomes.

Methods: A retrospective cohort and case-control study of 27,252 consecutive term newborns in a low risk obstetrical population between January 2003 and December 2010. Maternal and infant databases were reviewed from all cases with AS5min < 7 (n = 121; 0.4%) and 363 cases with AS5min > 7 at 5 minutes who were randomly selected by a computer program. The main outcomes were neonatal death, newborn respiratory distress, need for orotracheal intubation and neonatal intensive care unit (NICU), and hypoxic-ischemic-encephalopathy.

Results: After multiple regression analysis, repeated late decelerations on cardiotocography (OR: 2.4; 95% CI: 1.4-4.1) and prolonged second stage of labor (OR: 3.3; 95% CI: 1.3-8.3) were associated with AS5min < 7, as well as neonatal respiratory distress (OR: 3.0; 95% CI: 1.3-6.9), orotracheal intubation (OR: 2.5; 95% CI: 1.2-4.8), need for NICU (OR: 9.5; 95% CI: 6.7-16.8), and hypoxic-ischemic-encephalopathy (OR: 14.1; 95% CI: 3.6-54.7). No other antenatal factors were associated with AS5min < 7 (p > 0.05).

Conclusion: Repeated late decelerations and prolonged second stage of labor in the low-risk population are predictors of AS5min < 7, a situation associated with increased risk of neonatal respiratory distress, need for mechanical ventilatory support and NICU, and hypoxic-ischemic-encephalopathy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Apgar Score*
  • Brazil / epidemiology
  • Cerebral Palsy / diagnosis
  • Cerebral Palsy / etiology
  • Female
  • Humans
  • Hypoxia-Ischemia, Brain / diagnosis*
  • Hypoxia-Ischemia, Brain / etiology
  • Infant Mortality
  • Infant, Newborn
  • Labor Stage, Second
  • Maternal Age
  • Pregnancy
  • Respiratory Distress Syndrome, Newborn / diagnosis*
  • Respiratory Distress Syndrome, Newborn / etiology
  • Retrospective Studies
  • Risk Assessment
  • Term Birth / physiology
  • Young Adult