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

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.

• Authors: Eugenia Maria Assunção Salustiano, Juliana Alvares Duarte Bonini Campos, Silvia Maria Ibidi, Rodrigo Ruano, Marcelo Zugaib
• Journal: Revista da Associacao Medica Brasileira (1992) (Rev Assoc Med Bras (1992)) Vol. 58 Issue 5 Pg. 587-93 ( 2012) ISSN: 1806-9282 [Electronic] Brazil
• PMID: 23090231 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

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