The Whats And The Hows Of Using Apgar Score

Childbirth is one of life’s most precious moments. The act of giving forth to new life is an unforgettable experience for anyone. However, this is also a vulnerable time for both the mother and the child. While modern medicine has drastically reduced childbirth mortality, proper vigilance is still required to minimize any risks.


Doctors and nurses have developed specialized tools and frameworks to help them assess if and when to provide medical intervention. One of these tools is the APGAR score, which is commonly used to determine the condition of newborns quickly. This metric provides a quick but accurate way to know whether additional medical intervention is required. However, the test has limitations, and understanding these beforehand can help you avoid unnecessary anxiety.


What Is “APGAR Score”?


First, what does APGAR mean? Being an acronym, APGAR stands for activity, pulse rate, grimace, appearance, and respiration. A newborn is given a score from zero to two for each of these categories based on predefined criteria. The scores are then summed to get a number from zero to ten, and this range is the APGAR scale. You should note that while the term APGARs is used to refer to this procedure or its subtests, the word is technically incorrect. Hence, you should not use it.


History Of The APGAR Score

Before the APGAR test, people usually relied on apparent signs, such as lack of breathing or complete inactivity, to determine whether something went wrong during childbirth. Because of this, many physicians failed to detect internal conditions that led to death or permanent disability. In 1952, a physician named Dr. Virginia Apgar noticed that a combination of several assessments, all based on easily observed signs, could be used to determine newborn conditions quickly with a fair amount of accuracy. Her surname was used to name this combined test, and succeeding physicians used the name as an acronym to remember the five main observations measured by the APGAR test.


APGAR Test Procedure


The first APGAR score is usually obtained within one minute from being born, with a repeat measurement being obtained five minutes after birth. This two-step process provides a wealth of information. The former measurement is used to determine how the baby fared during the childbirth process, while the latter measurement is used to see how the baby is adjusting to the world outside the womb. If these scores remain relatively low, appropriate medical interventions are taken before another test is conducted to assess whether the interventions are working.


APGAR Scoring Criteria

APGAR testing relies on easily recognizable signs, such as skin color, that can be very subjective. Hence, to increase the objectivity of this test, specific criteria are now used to give the scores per APGAR subtest:



Active movements earn a rating of two. If the newborn is not moving vigorously but shows good muscle tone and flexed limbs, health care providers can give a score of one. If the limbs are flaccid, no points are given.

Pulse Rate

If the heart rate of the baby is more than 100 beats per minute, he or she will earn two points. Likewise, if the heart rate is below that threshold, the baby only gets one point. If beats cannot be detected, no points are given. Pulse rate is arguably the most critical of the subtests, as any deficiencies can signify serious cardiovascular problems that require immediate treatment.


This subtest measures reflexive responses to a strong stimulus, with a standard procedure involving the application of suction on the infant’s nose. If the baby cries, coughs, or sneezes, two points are given. On the other hand, if the baby only grimaces or other similar facial expressions occur, only a single point is provided. If there is no response, no points are given.


Skin tone is primarily used to assess the appearance of the newborn. If the baby shows pink skin throughout the entire body, two points are given. If only the limbs are shaded blue, the baby gets one point. Otherwise, if the baby appears bluish everywhere, no points are given.


Strong and consistent crying, which is how the respiratory system clears out liquids to prepare for breathing, merits a score of two. Irregular cries only get one point, while the lack of any sounds altogether results in a score of zero.


These criteria constitute the APGAR score chart, which every medical professional involved in childbirth should know and understand. Total APGAR scores of seven and above indicate normal conditions, although it is scarce to obtain a perfect score as bluish skin color is present on the extremities of most newborn infants. Obtaining APGAR scores between four and six is usually a signal for increased surveillance and some medical assistance, while scores below four mean that the newborn needs prompt medical intervention.


Limitations Of APGAR Scoring

The APGAR score is undoubtedly very useful in assessing the health of newborns. But, it is essential to recognize that it is not the only determinant of health. The APGAR score is only a heuristic at most, and low scores do not directly translate to low health. In particular, APGAR scoring is a poor predictor of long-term health. Many infants with low scores grow up to be perfectly healthy adults. The APGAR test only serves as a tool to determine if the baby needs special medical intervention. Hence, accepting this limitation will help expectant mothers like you appreciate the wonder of childbirth without the unnecessary stress.

DISCLAIMER (IMPORTANT): This information (including all text, images, audio, or other formats on is not intended to be a substitute for informed professional advice, diagnosis, endorsement or treatment. You should not take any action or avoid taking action without consulting a qualified professional.   Always seek the advice of your physician or other qualified health provider with any questions about medical conditions. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here a

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