scholarly journals Apgar Scoring System in Brazil's Live Births Records: Differences between Home and Hospital Births

2018 ◽  
Vol 41 (02) ◽  
pp. 076-083
Author(s):  
Jordana Bessa ◽  
Naieli Bonatto
Keyword(s):  
Apgar Score ◽  
Hospital Setting ◽  
Home Birth ◽  
Informed Choice ◽  
Singleton Pregnancy ◽  
Apgar Scores ◽  
Unified Health System ◽  
Preliminary Study ◽  
Hospital Births ◽  
Birth Records

Objective To promote informed choice for women and to compare home and hospital births in relation to the Apgar score. Methods Mother's profile and Apgar score of naturally born infants (without forceps assistance) in Brazil between 2011 and 2015, in both settings—hospital or home—were collected from live birth records provided by the Informatics Department of the Unified Health System (DATASUS, in the Portuguese acronym). For the analysis, were included only data from low-risk deliveries, including gestational time between 37 and 41 weeks, singleton pregnancy, at least four visits of prenatal care, infants weighing between 2,500 g, and 4,000 g, mother age between 20-40 years old, and absence of congenital anomalies. Results Home birth infants presented significantly higher risk of 0-5 Apgar scores, both in 1 minute (6.4% versus 3%, odds ratio [OR] = 2.2, confidence interval [CI] IC 2–2.4) and in 5 minutes (4.8% versus 0.4%, OR = 11.5, CI 10.5–12.7). Another finding is related to recovery estimates when from an initially bad 1-minute Apgar (< 6) to a subsequently better 5-minute Apgar (> 6). In this scenario, home infants had poorer recovery, Apgar score was persistently < 6 throughout the fifth minute in most cases (71% versus 10.7%, OR 20.4, CI 17–24.6). Conclusion The results show worse Apgar scores for babies born at home, compared with those born at the hospital setting. This is a pioneer and preliminary study that brings attention concerning differences in Apgar score related to home versus hospital place of birth in Brazil.

Justified skepticism about Apgar scoring in out-of-hospital birth settings

2015 ◽  
Vol 43 (4) ◽  
Author(s):  
Amos Grünebaum ◽  
Laurence B. McCullough ◽  
Robert L. Brent ◽  
Birgit Arabin ◽  
Malcolm I. Levene ◽  
...  
Keyword(s):  
Apgar Score ◽  
Birth Certificate ◽  
Home Birth ◽  
Apgar Scores ◽  
Home Births ◽  
Hospital Birth ◽  
Nurse Midwife ◽  
The Usa ◽  
Birthing Center ◽  
At Home

AbstractThe Apgar score is used worldwide to assess the newborn infant shortly after birth. Apgar scores, including mean scores and those with high cut-off scores, have been used to support claims that planned home birth is as safe as hospital birth. The purpose of this study was to determine the distribution of 5 min Apgar scores among different birth settings and providers in the USA.We obtained data from the National Center for Health Statistics of the US Centers for Disease Control birth certificate data for 2007–2010 for all singleton, term births of infants weighing ≥2500 g (n=13,830,531). Patients were then grouped into six categories by birth setting and birth attendant: hospital-based physician, hospital-based midwife, freestanding birth center with either certified nurse midwife and/or other midwife, and home-based delivery with either certified nurse midwife or other midwife. The distribution of each Apgar score from 0 to 10 was assessed for each group.Newborns delivered by other midwives or certified nurse midwives (CNMs) in a birthing center or at home had a significantly higher likelihood of a 5 min maximum Apgar score of 10 than those delivered in a hospital [52.63% in birthing centers, odds ratio (OR) 29.19, 95% confidence interval (CI): 28.29–30.06, and 52.44% at home, OR 28.95, 95% CI: 28.40–29.50; CNMs: 16.43% in birthing centers, OR 5.16, 95% CI: 4.99–5.34, and 36.9% at home births, OR 15.29, 95% CI: 14.85–15.73].Our study shows an inexplicable bias of high 5 min Apgar scores of 10 in home or birthing center deliveries. Midwives delivering at home or in birthing centers assigned a significantly higher proportion of Apgar scores of 10 when compared to midwives or physicians delivering in the hospital. Studies that have claimed the safety of out-of-hospital deliveries by using higher mean or high cut-off 5 min Apgar scores and reviews based on these studies should be treated with skepticism by obstetricians and midwives, by pregnant women, and by policy makers. The continued use of studies using higher mean or high cut-off 5 min Apgar scores, and a bias of high Apgar score, to advocate the safety of home births is inappropriate.

scholarly journals The Association between the Five-Minute Apgar Score and Neurodevelopmental Outcomes among Children Aged 8−66 Months in Australia

2021 ◽  
Vol 18 (12) ◽  
pp. 6450
Author(s):  
Tahir Ahmed Hassen ◽  
Catherine Chojenta ◽  
Nicholas Egan ◽  
Deborah Loxton
Keyword(s):  
Apgar Score ◽  
Generalized Estimating Equations ◽  
Entire Range ◽  
Neurodevelopmental Outcomes ◽  
Apgar Scores ◽  
Neurodevelopmental Delay ◽  
Australian State ◽  
Perinatal Data ◽  
Data Collections ◽  
Minute Apgar Score

This study aimed to evaluate the association of the five-minute Apgar score and neurodevelopmental outcomes in children by taking the entire range of Apgar scores into account. Data from the Australian Longitudinal Study of Women’s Health (ALSWH) and Mothers and their Children’s Health (MatCH) study were linked with Australian state-based Perinatal Data Collections (PDCs) for 809 children aged 8−66 months old. Generalized estimating equations were used to model the association between the five-minute Apgar scores and neurodevelopmental outcomes, using STATA software V.15. Of the 809 children, 614 (75.3%) had a five-minute Apgar score of 9, and 130 (16.1%) had an Apgar score of 10. Approximately 1.9% and 6.2% had Apgar scores of 0−6 and 7−8, respectively. Sixty-nine (8.5%) of children had a neurodevelopmental delay. Children with an Apgar score of 0−6 (AOR = 5.7; 95% CI: 1.2, 27.8) and 7−8 (AOR = 4.1; 95% CI: 1.2, 14.1) had greater odds of gross-motor neurodevelopment delay compared to children with an Apgar score of 10. Further, when continuously modelled, the five-minute Apgar score was inversely associated with neurodevelopmental delay (AOR = 0.75; 95% CI: 0.60, 0.93). Five-minute Apgar score was independently and inversely associated with a neurodevelopmental delay, and the risks were higher even within an Apgar score of 7−8. Hence, the Apgar score may need to be taken into account when evaluating neurodevelopmental outcomes in children.

scholarly journals Influence of Spinal and General Anesthesia on Newborn’s Status

2015 ◽  
Vol 69 (2) ◽  
pp. 65-70
Author(s):  
Emilija Ivanov ◽  
Dafina Karadzova ◽  
Sotir Nikolovski ◽  
Atanas Sivevski ◽  
Kiro Curlinov ◽  
...  
Keyword(s):  
Caesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Base Excess ◽  
Rocuronium Bromide ◽  
Apgar Scores ◽  
Ph Values ◽  
Vital Parameters

AbstractIntroduction. The number of caesarean sections has drastically increased and thus arose the idea to examine the effect of the type of anesthesia on the neonates. The objective was to compare vital parameters in the neonates, born under general and spinal anesthesia.Method. A total of 120 patients with need for caesarean section have been divided in two groups of 60, of which the first was lead in general and the second one in spinal anesthesia. The first one was given propophol (2.0-2.5 mg/kg/tt) and succinil colin (1-1.5 mg/kg/tt). The anesthesia was lead with fentanil 0,005 mg/kg/tt and rocuronium bromide 0.4-0.6 mg/kg/tt. O2:N2O was 3:3 l/min. The second group was lead in spinal anesthesia. 2-3 ml Bupivacain 0.5% was spinally applied between L2-L3. Apgar score was defined in the neonates in the first and fifth minutes. The acido-basic status of the neonate was examined through pH values in the blood and the base excess.Results. In the first minute after birth giving with Apgar, 8 newborns 37(61,67%) were born to the group of patients with SA and 29 (48.33%) to the group of patients with GA. In 11 (18.33%) newborns born to the patients led with SA had Apgar score of 9-10, while only 3 (5%) of the newborns born to the patients led with GA had Apgar score of 9-10. Similar ratio was noted in the fifth minute after birth. Ph of the newborns’ blood as well as the base excess (BE) demonstrated significantly lower values in the group of patients led with SA than in the group of patients led with GA. Ph = 7.33 vs 7.37; BE=-4.57±1.8 vs -2.96±2.3.Conclusion. The newborns from the second group had significantly higher Apgar scores than those in the first group. The newborns’ relative acidose (lower SpO2and BE) did not affect the newborns’ Apgar score in the first and fifth minute.

scholarly journals Notes on home birth: Safety, interventionism and satisfaction

2020 ◽  
Author(s):  
Marc Cruellas ◽  
Fina Martinez Soler ◽  
Avelina Tortosa ◽  
Pepita Gimenez-Bonafe
Keyword(s):  
Practice Guidelines ◽  
Good Practice ◽  
Home Birth ◽  
Developed Countries ◽  
Systematic Research ◽  
Maternal Outcomes ◽  
Controversial Topic ◽  
Hospital Births ◽  
Planned Home Birth ◽  
Unusual Situation

Abstract Background: Home birth is still considered an unusual situation on most developed countries, where it accounts between 0.2 and 25 percent of all births depending of the country. However, the safety of the process and whether it should be offered as a choice makes it a controversial topic with strong opinions on both sides. This review aims to describe the situation of home birth in several developed countries and debate its safety and mothers’ satisfaction, by reviewing studies that compare home vs. hospital births.Methods: A systematic research has been done using different search engines to find publications that portray the current situation on this topic. Protocols and historical facts were selected using no filters, while publications reporting maternal and birth outcomes, as well as levels of satisfaction, were selected using filters that limited the search to articles that had been published in the last 10 years. A total of 45 articles were selected and reviewed.Results: Home birth in each country depends on many factors, including historical and cultural. Some countries have either developed good practice guidelines or included home birth on the already existing ones, while some other countries still do not recognize it as a safe option. While most studies do not show significant differences on neonatal mortality APGAR score and intensive care admissions, they do describe slightly better maternal outcomes on home birth due to lower interventionism. Studies also show that between 13 and 29 percent of home births require transferring the woman or the fetus to the hospital. Satisfaction levels also appear to be higher in women who had a planned home birth.Conclusions: Home birth appears to be a safe choice for women with low risk pregnancies, due to a lower rate of interventionism. However, safety depends on many factors, from professional accreditation, to the presence of protocols and good practice guidelines. Satisfaction also appears to be higher on women who had a planned home birth, although it depends on personal considerations and circumstances.

Decision to Incision and Risk for Fetal Acidemia, Low Apgar Scores, and Hypoxic Ischemic Encephalopathy

2020 ◽  
Author(s):  
Sabine Bousleiman ◽  
Dwight J. Rouse ◽  
Cynthia Gyamfi-Bannerman ◽  
Yongmei Huang ◽  
Mary E. D'Alton ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Apgar Score ◽  
Hypoxic Ischemic Encephalopathy ◽  
Apgar Scores ◽  
Fetal Heart Rate Monitoring ◽  
Emergency Cesarean ◽  
Increased Risk ◽  
Secondary Outcomes ◽  
Ischemic Encephalopathy ◽  
Umbilical Cord Ph

Objective This study aimed to assess risk for fetal acidemia, low Apgar scores, and hypoxic ischemic encephalopathy based on decision-to-incision time interval in the setting of emergency cesarean delivery. Study Design This unplanned secondary analysis of the Maternal–Fetal Medicine Units prospective observational cesarean registry dataset evaluated risk for hypoxic ischemic encephalopathy, umbilical cord pH ≤7.0, and Apgar score ≤4 at 5 minutes based on decision-to-incision time for emergency cesarean deliveries. Cesarean occurring for nonreassuring fetal heart rate monitoring, bleeding previa, nonreassuring antepartum testing, placental abruption, or cord prolapse was classified as emergent. Decision-to-incision time was categorized as <10 minutes, 10 to <20 minutes, 20 to <30 minutes, 30 to <50 minutes, or ≥50 minutes. As secondary outcomes umbilical cord pH ≤7.1, umbilical artery pH ≤7.0, and Apgar score ≤5 at 5 minutes were analyzed. Results Of 5,784 women included in the primary analysis, 12.4% had a decision-to-incision interval ≤10 minutes, 20.2% 11 to 20 minutes, 14.9% 21 to 30 minutes, 18.2% 31 to 50 minutes, and 16.5% >50 minutes. Risk for umbilical cord pH ≤7.0 was highest at ≤10 and 11 to 20 minutes (10.2 and 7.9%, respectively), and lowest at 21 to 30 minutes (3.9%), 31 to 50 minutes (3.9%), and >50 minutes (3.5%) (p < 0.01). Risk for Apgar scores ≤4 at 5 minutes was also higher with decision-to-incision intervals ≤10 and 11 to 20 minutes (4.3 and 4.4%, respectively) compared with intervals of 21 to 30 minutes (1.7%), 31 to 50 minutes (2.1%), and >50 minutes (2.0%) (p < 0.01). Hypoxic ischemic encephalopathy occurred in 1.5 and 1.0% of women with decision-to-incision intervals of ≤10 and 11 to 20 minutes compared with 0.3 and 0.5% for women with decision-to-incision intervals of 21 to 30 minutes and 31 to 50 minutes (p = 0.04). Risk for secondary outcomes was also higher with shorter decision-to-incision intervals. Conclusion Shorter decision-to-incision times were associated with increased risk for adverse outcomes in the setting of emergency cesarean. Key Points

8th Term pregnancy in uterus didelphys: a rare case report

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Banu Öndeş
Keyword(s):  
Case Report ◽  
Fallopian Tube ◽  
Apgar Score ◽  
Home Birth ◽  
Breech Presentation ◽  
Fetal Distress ◽  
Obstetric Complications ◽  
Close Monitoring ◽  
Uterus Didelphys ◽  
Emergency Cesarean

Abstract Introduction Uterus didelphys is a rarely observed Müllerian duct fusion defect. Two separately developing Müllerian ducts create two hemi uteri with separate fallopian tube, ovary and cervix which may cause obstetric complications. This case report presents a case reaching term for the 8th time, with eight live births discussed in view of the literature. Presentation of case A 38-year-old, gravid 9 para 7 abortion 1, pregnant woman applied to the hospital with breech presentation after unsuccessful home birth attempt. As a result of the indications of acute fetal distress, meconium in amniotic fluid and breech presentation emergency cesarean section was performed. A 2800 g, 49 cm long with 33 cm head circumference female infant was born with 1st min Apgar score of 6 and 5th min Apgar score of 8. During the operation it was observed that the patient had uterus didelphys with each hemi uterus having its own fallopian tube and ovary. After the operation vaginal speculum examination identified two cervices. The patient’s other seven births were homebirth and seven children were healthy and alive. Discussion It is rare for pregnancies in uterus didelphys cases to reach term. Due to the frequency of obstetric complications and negative pregnancy results, close monitoring is required before and during pregnancy.

scholarly journals Association between Acid-Base Balance and Asphyxia in Newborn Infants

2018 ◽  
Vol 34 (1-2) ◽  
pp. 38-43
Author(s):  
Sari Leyli Harahap ◽  
Chairul Adillah Harahap ◽  
Sri Sulastri ◽  
Chairul Yoel ◽  
Noersida Raid
Keyword(s):  
Apgar Score ◽  
Newborn Infants ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Acid Base ◽  
Apgar Scores ◽  
Arterial Blood ◽  
Base Balance

We performed a prospective study on the association between acid-base balance and asphyxta based on Apgar scores in 45 newborn babies admitted to the Division of Perinatology, Pirngadi Hospital, Medan, from January 1 to February 28, 1993. Blood gas analysis was done on blood obtained from umbilical artery. Based on 1st and 5th minutes Apgar scores, 40 (88.9%) and 21 babies (46.7%}, respectively, had asphyxia. Relation to acid-base balance was determined with the sensitivity of the 5th minute Apgar score in predicting acidotic states. It was found that Apgar score had sensitivity of 57.7% and specificity of 68.4% in predicting the acidotic states. Apgar score of > 7 was unable to. exclude the possible acidosis in 45% of cases (negative predictive value 54.1%). Gestational age had no influence on Apgar Scores. Apgar score was more sensitive to eliminate suspected acidosis in term neonates than in preterms. We recommend to perform umbilical arterial blood gas analysis to determine acidotic state in high risk newborn infants.

scholarly journals Expansion of the Surgical Apgar Score across All Surgical Subspecialties as a Means to Predict Postoperative Mortality

2011 ◽  
Vol 114 (6) ◽  
pp. 1305-1312 ◽  
Author(s):  
Paul Q. Reynolds ◽  
Neal W. Sanders ◽  
Jonathan S. Schildcrout ◽  
Nathaniel D. Mercaldo ◽  
Paul J. St. Jacques
Keyword(s):  
Apgar Score ◽  
Scoring System ◽  
Postoperative Mortality ◽  
Predictive Ability ◽  
Apgar Scores ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Surgical Apgar Score

Background A surgical scoring system, akin to the obstetrician's Apgar score, has been developed to assess postoperative risk. To date, evaluation of this scoring system has been limited to general and vascular services. The authors attempt to externally validate and expand the Surgical Apgar Score across a wide breadth of surgical subspecialties. Methods Intraoperative data for 123,864 procedures including all surgical subspecialties were collected and associated with Surgical Apgar Scores (created by the summation of point values associated with the lowest mean arterial pressure, lowest heart rate, and estimated blood loss). Patients' death records were matched to the corresponding score, and logistic regression models were created in which mortality within 7, 30, and 90 days was regressed on the Apgar score. Results Lower Surgical Apgar Scores were associated with an increased risk of death. The magnitude of this association varied by subspecialty. Some subspecialties exhibited higher odds ratios, suggesting that the score is not as useful for them. For most of the subspecialties the association between the Apgar score and mortality decreased as the time since surgery increased, suggesting that predictive ability ceases to be helpful over time. After adjusting for the patient's American Society of Anesthesiologists classification, Apgar scores remained associated with death among most of the subspecialties. Conclusion A previously published methodology for calculating risk among general and vascular surgical patients can be applied across many surgical services to provide an objective means of predicting and communicating patient outcomes in surgery as well as planning potential interventions.

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