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Apgar score

Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

The Apgar score was developed in 1952 by Virginia Apgar as a means to quickly assess the health of newborn baby, particularly in the context of the effects of obstetric anaesthesia. It comprises evaluation of five criteria on a scale from zero to two, then summing the values, resulting in a score ranging from zero to 10.

The criteria can be remembered with this mnemonic: Appearance Pulse (heart rate) Grimace (response to stimuli) Activity Respiration

Assessments should be performed at 1 and 5 minutes, for the further management of resuscitation (if required) and response to resuscitation. The higher the score, the better the outcome for the baby.

Sign 0 1 2
Heart rate Absent 100bpm >100bpm
Respiratory effort Absent Slow, irregular Good or crying
Muscle tone Limp Some, flexion of limbs Active
Reflex response to stimuli None Minimal grimace Cough or sneeze
Colour Blue, pale Body pink, extremities blue Completely pink
Score is assessed at 1 and 5 minutes. Seek medical aid if total score is <7 'Apgar minus colour' score omits fifth sign. Medical aid should be sort if total score is <6


National Institute for Health and Care Excellence. (2014) Intrapartum care for healthy women and babies. Clinical guideline 190.


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