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Your pregnancy journey can be both an exciting and nerve-wracking experience at the same time. There are a lot of things that you, as an expectant mother, would learn and do during your pregnancy to ensure that everything goes smoothly and according to plan. The goal, of course, is to deliver a healthy and happy baby into this world. One way that your medical team will use to determine the health of the baby would be to use the Apgar test. 

Apgar test checks the baby’s heart rate, breathing, muscle tone, and other vital signs to determine if there are any urgent issues that would require any further medical care. 

The test is usually given 1 minute and 5 minutes after birth. If necessary, the test can be repeated a third time, at the 15-minute mark.

Apgar test

What is an Apgar test?

The Apgar test was developed in 1952 by Virginia Apgar, an anaesthesiologist with the New York-Presbyterian Hospital in order to be able to quickly and accurately assess babies for any issues after obstetrical anesthesia. The name Apgar is, of course, inherited from Dr. Apgar, but is coincidentally also an acronym for the five signs that are assessed during the test:

  • Appearance
  • Pulse (heart rate)
  • Grimace (reflexes)
  • Activity (muscle tone)
  • Respiration (breathing effort)

Normal Apgar score

The test is usually performed by a healthcare professional from the delivery team and could be done by either the nurse, physician, or midwife. 

The baby is assessed in each category and is assigned a score of 0, 1, 2 for each of the five parts of the test. The total score possible then is 10. However, very few babies get a perfect Apgar to score a 10 after birth as most would still have blue limbs until they are warm enough, thereby preventing them from scoring high in the appearance category. 

The normal Apgar score is considered to be between 7 and 10, with the average Apgar score at birth being 7.

How Is The Apgar Score Calculated?

The newborn Apgar score is calculated by testing the baby against each category and giving them a score from 0 to 2, with two being the best score possible. This simple but very effective and robust test is quick and easy to do for a trained professional. Your healthcare team will use the below guide to assign a score:

  • Appearance
    Pale blue: score of 0
    Blue, pink extremities: score of 1
    Pink body and extremities: score of 2
  • Pulse (heart rate)
    Heartbeat not detected: score of  0
    Heart rate less than 100 bpm: score of 1
    Heart rate more than 100 bpm: score of 2

  • Grimace (reflexes)
    This measures the reflexive response to irritability of the baby:
    No response: score of 0
    Grimacing: score of 1
    Grimacing with a physiological response (coughing, sneezing, crying): score of 2

  • Activity (muscle tone)
    This part will measure the activity level of the baby:
    – Lose, non-resistive body muscles: score of 0
    – Some resistance and flexion: score of 1
    – Arms and legs resist extensions, offer resistance: score of 2

  • Respiration (breathing effort)
    – No breathing: score of 0
    – Slow, irregular breathing: score of 1
    – Regular normal breathing, strong cry: score of 2 

Apgar test in the long term

While the Apgar test is a tested and proven method of assessing the baby early on after birth, it does not paint the whole picture of the baby’s health later in life. In fact, many babies go on to be completely healthy having scored fairly low on their Apgar tests. However, the test is still necessary for the assessment and identification of early issues that might actually cause difficulties in life. 

One of the major issues with the Apgar test is in fact, that different medical professional may assess the very subjective categories of the test differently. The baby might appear completely blue to some, while others may see a different skin tone. Thus, the test should be administered with caution and with consideration that the early diagnosis based on the test may not be reflective of the whole situation. In fact, in recent years, a few studies have shown that the Apgar test isn’t as predictive of asphyxiation or a baby’s neurological state during later life, rather an at-the-moment assessment and the point of care to identify immediate urgent issues.

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