Association of Natal and Maternal Risk Factors with Neonatal Apgar Score in Mosul
Asian Journal of Pregnancy and Childbirth,
Page 212-220
Abstract
Background: The Apgar score is a recognized and practical way to report a newborn infant's condition at 1st and 5th minutes after birth and their reaction to resuscitation, if necessary; nonetheless, it has been improperly used to forecast specific negative neurologic outcomes.
Aim of the Study: To identify the most frequent maternal risk factors associated with low Apgar scores among newborns and evaluate the effect of neonatal sex, type of delivery, mothers’ age on Apgar score at Al-Batool Teaching Hospital in Mosul.
Methodology: This study used a cross-sectional Hospital based study design to achieve the study objectives. The data was obtained and collected from 93 maternal and neonatal record files for the mothers who delivered at Al-Batool Teaching Hospital for the period from 1st May 31st June 2023 with a simple random sampling method was used. All maternity data for women and full-term newborns, regardless of the delivery method, meet the inclusion criteria for this study. All maternal files involving home births, premature births, and referrals from other facilities following deliveries were disqualified. The information was gathered and examined by researchers.
Results: The current study involved 93 full term neonates; 58 were males and 35 were females with male: female ratio of 1.65:1. Of them 35 (37.6%) neonates delivered by normal vaginal delivery while the remaining 58 (62.4%) delivered through cesarean section. The mean Apgar score at 1 min was 5.311±2.274 while at 5 min. was 7.462± 1.891 and the mean maternal age was 27.57± as 5.942 years. The commonest risk factors found was obstructed labor with mean Apgar score of 3.381±1.687 at 1 min and 6.142±1.768 at 5 min, followed by previous 2 CS and meconium stained liquor. Neonates with no maternal risks had mean Apgar score of 8.285±0.755 at 1 min and 9.571±0.534 at 5 min. The statistical difference between Apgar score at 1 and 5 min was significant for each of males and females while the difference between males and females was not significant at each of 1 and 5 min. The mean Apgar score at 5 min was significantly higher than that at 1 min for those with maternal risk the difference between those with maternal risk and those with no maternal risk was statistically significant for both at 1 min and 5 min. Furthermore, mean Apgar score at 5 min was significantly higher than that at 1 min for normal vaginal delivery and cesarean section while the difference between Apgar score in normal vaginal delivery and cesarean section at each of 1 and 5 min was not significant. The Apgar scores for at both 1 and 5 min were not significantly correlated with the mothers’ ages.
Conclusions: Mothers who had obstructed labor, had newborns with low Apgar score. At both 1 and 5 minutes, there was a statistically significant difference between the groups with and without maternal risk. The difference in the Apgar score at 1 and 5 minutes for male and female newborns and between those who delivered vaginally normally and via cesarean section was not statistically significant.
Keywords:
- Apgar score
- maternal risk
- neonates
How to Cite
References
2. Drage JS, Kennedy C, Schwarz BK. The Apgar score as an index of neonatal mortality: A report from the Collaborative Study of Cerebral Palsy. Obstet Gynecol. 1964;24:222-230.
3. Iliodromiti S, Mackay DF, Smith GCS, Pell JP, Nelson SM. Apgar score and the risk of cause-specific infant mortality: a population-based cohort study. Lancet. 2014;384:1749-1755.
4. Razaz N, Cnattingius S, Joseph KS. Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden. BMJ. 2019;365:l1656.
5. Kasdorf E, Laptook A, Azzopardi D, Jacobs S, Perlman JM. Improving infant outcome with a 10 min Apgar of 0. Arch Dis Child Fetal Neonatal Ed. 2015 Mar; 100(2):F102-105.
6. American academy of pediatrics and american heart association. Textbook of neonatal resuscitation. 6th edition. Elk Grove Village, IL: American Academy of Pediatrics and American Heart Association; 2011.
7. Lopriore E, vanBurk F, Walther F, Arnout J. Correct use of the Apgar score for resuscitated and intubated newborn babies: questionnaire study. BMJ. 2004; 329:143–144.
8. American college of obstetrics and gynecology, task force on neonatal encephalopathy; American Academy of pediatrics. Neonatal Encephalopathy and Neurologic Outcome, 2nd edition. Washington, DC: American College of Obstetricians and Gynecologists; 2014.
9. Lungameni J, Nghitanwa EM, Uusiku L, Karera A. Maternal factors associated with immediate low Apgar score in newborn babies at an intermediate hospital in Northern Namibia. Journal of Public Health in Africa. 2022;13(3).
Available:https://doi.org/10.4081/jphia.2022.2045
10. Getachew B, Etefa T, Asefa A, Terefe B, Dereje D. Determinants of low fifth minute apgar score among newborn delivered in jimma university medical center, Southwest Ethiopia. International Journal of Pediatrics. 2020.
Available:https://doi.org/10.1155/2020/9896127
11. Tewesa E, Chirwa E, Majamanda MD, et al. Associative factors for birth asphyxia at queen elizabeth central hospital, malawi. Journal of Biosciences and Medicines. 2017; 5.
12. Nayeri F, Shariat M, Dalili H, et al. Perinatal risk factors for neonatal asphyxia in Vali-e-Asr hospital, Tehran-Iran. Iranian Journal of Reproductive Medicine. 2012; 137-140.
13. Straube S, Voigt M, Jorch G, Hallier E, Briese V and Borchardt U. Investigation of the association of Apgar score with maternal socio-economic and biological factors: An analysis of German perinatal statistics. Archives of gynecology and obstetrics. 2010;282(2):135–141.
DOI:https://doi.org/10.1007/s00404-009-1217-7
14. Ibrahim NA, Muhye A, Abdulie S. Prevalence of birth asphyxia and associated factors among neonates delivered in Dilchora referral Hospital, in Dire Dawa Ethiopia. Clinics Mother Child Health. 2017;14:4.
15. Nagy E, Orvos H, Bakki J, Pal A. Sex-differences in Apgar scores for full-term neonates. Acta Pædiatrica/Acta Pædiatrica. 2009;98:897–900.
DOI:10.1111/j.1651-2227.2009.01238.x
16. Lima JC, Mingarelli AM, Segri NJ, Zavala AA, Takano OA. Population-based study on infant mortality. Cien Saude Colet. 2017;22:931–939,
DOI:10.1590/1413-1232017223.12742016.
Available:https://doi.org/10.1590/1413-81232 017 223.12742016
17. Altman M, Sandström A, Petersson G, Frisell T, Cnattingius S, Stephansson O. Prolonged second stage of labor is associated with low Apgar score. European Journal of Epidemiology. 2015; 30(11):1209–1215.
DOI:10.1007/s10654-015-0043-4.
18. Salustiano EMA, Campos JADB, Ibidi SM, Ruano R, Zugaib M. Baixos indices de Apgar no quinto minuto de vida em populaçao de baixo risco: fatores maternos e obstetricos e resultados pos-natais. Revista da Associação Médica Brasileira. 2012;58(5):587–593.
DOI:10.1590/S0104-42302012000500017.
19. Gudayu TW. Proportion and factors associated with low fifth minute Apgar score among singleton newborn babies in Gondar University Referral Hospital; North West Ethiopia. African Health Sciences. 2017;17(1):1–6.
DOI: 10.4314/ ahs.v17i1.2.
20. Sori DA and Belete A Wolde. Meconium stained amniotic fluid: Factors affecting maternal and perinatal outcomes at jimma university specialized teaching hospital, South West Ethiopia. Gynecol Obstet. 2016;394.
21. Wosenu L, Worku AG, Teshome DF, Gelagay AA. Determinants of birth asphyxia among live birth newborns in University of Gondar referral hospital, northwest Ethiopia: A case-control study. PLoS ONE. 2018; 13(9):e0203763.
22. Gane B, Vishnu Bhat B, Rao R, Nandakumar S, Adhisivam B, Joy R, et al. Antenatal and intrapartum risk factors for perinatal asphyxia: A case control study. Curr Pediatr Res. 2013; 17:119–122.
23. Li F, Wu T, Lei X, et al. The Apgar score and Infant mortality. PLoS One. 2013; 8:e69072.
24. Mulugeta T, Sebsibe G, Fenta FA, Sibhat M. Risk factors of perinatal asphyxia among newborns delivered at public hospitals in Addis Ababa, Ethiopia: case–control study. Pediatr Health Med Ther. 2020;11:297.
25. Tasew H, Zemicheal M, Teklay G, Mariye T, Ayele E. Risk factors of birth asphyxia among newborns in public hospitals of Central Zone, Tigray, Ethiopia 2018. BMC Res Notes. 2018; 11(1):1–7.
26. Kebapcilar L, Kebapcilar AG, Ilhan TT, et al. Is the mean platelet volume a predictive marker of a low apgar score and insulin resistance in Gestational Diabetes Mellitus? A retrospective case- control study. Journal of Clinical and Diagnostic Research. 2016;10:OC06-OC10.
27. Adebami OJ. Maternal and Foetal determinants of mortality in babies with birth asphyxia at Osogbo, Southwestern Nigeria. Global Advanced Research Journal of Medicine and Medical Science. 2015;270-276.
28. Santos NCP, Vogt ES, Duarte DE, et al. Factors associated with low Apgar in newborns in birth center. Rev Bras Enferm. 2019;72:297-304.
29. Tewesa E, Chirwa E, Majamanda MD, et al. A. Associative Factors for Birth Asphyxia at Queen Elizabeth Central Hospital, Malawi. Journal of Biosciences and Medicines. 2017; 5.
30. Sahanak S. Comparison of Apgar score in Neonates: spinal versus General Anaesthesia for Elective Caesarean section. Journal of Evolution Medical and Dental Sciences. 2014;539-544.
31. Bakhsha F, Yousefi Z, Aryai M, et al. Comparison of Apgar score in newborn by vaginal delivery and spinal anesthesia and its relationship with contributing factors. J Bas Res Med Sci. 2015;10-15.
32. Rahmanian K, Jahromi AS, Rahmanian V, Ghasvari M and Abari PF. Association of APGAR score with delivery mode in the non-distress newborns. Online journal of biological sciences. 2014; 14(1):21-25.
DOI:https://doi.org/10.3844/ojbssp.2014.21.25
33. Gudayu TW. Proportion and factors associated with low fifth minute Apgar score among singleton newborn babies in Gondar University referral hospital, North West Ethiopia. Afr Health Sci. 2017; 17(1):1–6.
DOI:10.4314/ahs.v17i1.2.
34. Linder N, Linder I, Fridman E, Kouadio F, Lubin D, Merlob P, et al. Birth trauma – risk factors and short-term neonatal outcome. J Matern Fetal Neonatal Med. 2013; 26(15):1491–1495. DOI:10.3109/14767058.2013.78 9850.
35. Duarte G, da Cunha SP, Shimazaki WS, Marcolino AC, Nogueira AA, Berezowski AT, et al. Tocotraumatismo com repercussäo neonatal. Rev Bras Ginecol Obstet. 1997;19(1):7–11.
36. Paudyal L. Comparison of APGAR scores of newborns with mode of delivery and its associated factors. Int. J. Soc. Sc. Manage. 2020;7(3):176-182.
DOI: 10.3126/ijssm.v7i3.29961
37. Tavares VB, Affonso G, Da Rocha ES, Garcia Rodrigues LF, Moraes C, Coelho S, Araújo SS & Gomes C. Factors associated with 5-min APGAR score, death and survival in neonatal intensive care: A case-control study. BMC Pediatrics. 2022; 22.
Available:https://doi.org/10.1186/s12887-022-03592-9
38. Lai S, Flatley C, Kumar S. Perinatal risk factors for low and moderate five-minute Apgar scores at term. Eur J Obstet Gynecol Reprod Biol. 2017;210:251‐256.
DOI:https://doi.org/10.1016/j.ejogrb.2017.01.008
39. Khalid MA, Ghani R, Khalid MF, Malik MS, Waqas A. Association of delivery procedure with APGAR scores among neonates born to healthy Pakistani mothers: a pilot study. F1000Research. 2018;7(346):346.
DOI:https://doi.org/10.12688/f1000research.13784.1
40. Kilsztajn S, Lopes EDS, Carmo MSND, Reyes AMDA. APGAR score associated with mode of delivery in Sao Paulo State, Brazil. Cad.Saude Publica. 2007;23:1886-1892. PMID: 17653406.
41. Fajar JK, Andalas M, Harapan H. Comparison of Apgar scores in breech presentations between vaginal and cesarean delivery. Ci ji yi xue za zhi = Tzu-chi medical journal. 2017; 29(1):24–29.
DOI:https://doi.org/10.4103/tcmj.tcmj_5_17
42. Burt, Richard, Vaughan T, Daling J. Evaluating the risks of cesarean section: Low Apgar score in repeat C-section and vaginal deliveries. American journal of public health. 1988;78: 1312-1314.
DOI:https://doi.org/10.2105/AJPH.78.10.1312
-
Abstract View: 0 times
PDF Download: 0 times
