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Apgar Score

The Apgar Score, developed in 1952 by an anaesthesiologist called Victoria Apgar, is a quick check designed to determine the physical condition of a newborn baby immediately after birth.

The test is carried out by a doctor, midwife or nurse in the delivery room, usually on two occasions: one minute after birth and then again five minutes after birth.

Sometimes, if there are concerns about the baby's condition or the score at five minutes is low, the test may be taken for a third time 10 minutes after birth.

It is called the Apgar Score because it checks for:

  • Appearance (skin colouration)
  • Pulse
  • Grimace (responsiveness)
  • Activity (muscle tone)
  • Respiration (breathing rate and effort)

How are Apgar Score tests carried out?

Each of the criteria is given a score of 0, 1 or 2 and then added together to generate a total score out of 10, which gives an idea of the overall health of the baby.

The scoring system works as follows:


  • Normal colour all over (hands and feet are pink) = 2 points
  • Normal colour (but hands and feet are blue-ish) = 1 point
  • Blueish-grey or pale all over = 0 points


  • Normal (above 100 beats per minute) = 2 points
  • Below 100 beats per minute = 1 point
  • Absent (no pulse) = 0 points

Grimace (responsiveness or reflex irritability)

  • Pulls away, sneezes, coughs or cries with stimulation = 2 points
  • Facial movement only (grimace) with stimulation = 1 point
  • Absent (no response to stimulation) = 0 points


  • Active, spontaneous movement = 2 points
  • Arms and legs flexed with little movement = 1 point
  • No movement/floppy muscle tone = 0 points


  • Normal rate and effort, strong cry = 2 points
  • Slow or irregular breathing, weak cry = 1 point
  • Absent (no breathing) = 0 points

What is the meaning of the Apgar Score?

The majority of newborns are scored between seven and 10, meaning they do not require any immediate treatment. Scores of 10 are unusual, because most newborns will lose a point for having blue hands and feet, which is typical after birth.

Scores lower than 7 suggest the baby needs medical attention, and if the score remains low after multiple tests, then there is a risk that the child will suffer longer-term neurological damage.

What are the common causes of a low Apgar Score?

If the baby has a low Apgar score, it is usually caused by a difficult birth, a C-section or fluid in the baby’s airway. If this occurs, then the baby might need his or her airways cleared, to be given oxygen, and/or to receive physical stimulation to help get the heart beating at a healthy rate.

Unfortunately, if these problems persist, then the baby might sustain a brain injury, which causes the child to develop a serious neurological condition such as cerebral palsy.

How can I find more information on birth injuries?

If you are looking for additional information and support on birth injuries and other causes of low Apgar scores, there are a number of organisations and resources that may be useful to you:

If you or a loved one has been the victim of medical negligence that has resulted in a birth injury or cerebral palsy diagnosis, the expert solicitors at Potter Rees Dolan may be able to help. Visit our birth injury claims page or our cerebral palsy claims page to find out more, or give us a call on 0800 027 2557.


What are the common causes of a low Apgar Score?

If the baby has a low Apgar score, it is usually cased by a difficult birth, a C-section or fluid in the baby's airway.

If this occurs then the baby would receive oxygen and have its airways cleared to help the baby breathe, or receive physical stimulation to get the heart beating at a healthy rate.

Unfortunately, if these problems arise, then the baby may have sustained a serious injury, such as Cerebral Palsy or Erb's Palsy.

Further reading

Useful Information

Emergency Caesarean Section

This procedure is usually carried out when a normal vaginal delivery would put the mother or the baby at risk.

However, an emergency caesarean is performed when circumstances before or during labour call for an unplanned procedure.

A caesarean section is usually carried out under an epidural or a spinal anaesthetic causing the lower part of the body to be numbed. The procedure usually takes 40-45 minutes but, during an emergency, can be performed quicker.

The risks to the mother in a caesarean section can include an infection of the wound or the womb lining, a blood clot (thrombosis) in the legs or excess bleeding.

Doctors now give the mother a dose of antibiotics before the operation to reduce the likelihood of any infections.

Risks to the baby during a caesarean, according to the NHS, are no greater than a normal vaginal delivery but the most common problem of babies delivered by caesarean is difficulty breathing, although this usually affects babies born prematurely.


This is a condition where tissue which behaves like the lining of the womb (endometrium) is found outside the womb. This is a common condition which is said to affect around 2 million women in the UK. [source]

The symptoms of endometriosis varies from woman to woman but the most common include; painful or heavy periods, pain in the lower abdomen, pelvis or lower back, pain during and after sex, bleeding between periods and difficulty getting pregnant.

The exact cause of endometriosis is unclear and there are many different theories. One theory is that endometriosis is hereditary where it has been passed down through the genes.

Another theory is that it is caused by retrograde menstruation which is when the womb lining flows backwards through the fallopian tubes into the abdomen instead of leaving the body as a period. The tissue then embeds itself into the pelvic organs and grows.

There is no cure for endometriosis but treatments are available to help ease the symptoms including; pain relief and hormone injections. Alternatively, surgery may be performed to remove the endometriosis tissue through laparoscopy or even hysterectomy.

Endometriosis can sometimes cause fertility problems through damaging the ovaries or fallopian tubes but it is said that up to 70% of women with mild-mid endometriosis have no problems getting pregnant after treatment.

Erb's Palsy

This condition is usually caused by a traumatic childbirth where the baby's arm is paralysed when the upper group of the arm's main nerves is injured.

Erb's Palsy, or otherwise known as brachial plexus paralysis, can occur if the infant's head and neck are pulled toward the side at the same time as the shoulders pass through the birth canal.

The condition can also be caused by excessive pulling on the shoulders during a cephalic presentation (head first delivery), or by pressure on the raised arms during a breech (feet first) delivery.

Other causes can include a raised BMI of the mother at time of baby's birth, a high weight at birth and a long second stage of labour.

The child is usually unable to abduct the arm from the shoulder, rotate the arm externally from the shoulder or supinate the forearm giving them a 'waiter's tip' appearance.

Hand grasp in children with Erb's Palsy is usually normal unless the lower part of the plexus is also damaged.

Some babies recover on their own but some need specialist treatment.

Gestational Diabetes

Diabetes is condition where there is too much glucose in the blood which is controlled by a hormone called insulin.

The illness is caused by either insufficient insulin being produced or the body is becoming resistant to insulin.

Gestational diabetes is when, during pregnancy, the woman's body produces a number of hormones which make her body insulin-resistant. The purpose of this hormonal effect is to allow the extra glucose and nutrients in your blood to pass to the foetus so it can grow.

Her body should produce more insulin in order to cope with the increased amount of glucose in the blood. However, some women cannot produce enough insulin in pregnancy to transport the glucose to the cells or their body is becoming more resistant to insulin.

Pregnant women may be more likely to have gestational diabetes if her body mass index is high, if they have previously had a baby weighing more than 10lbs at birth or if they have a family history of diabetes.

Some women may need medication to control their glucose levels but most can control the gestational diabetes through diet and exercise.

Gestational diabetes is usually developed after 28 weeks and usually disappears after the baby is born. However, women who develop gestational diabetes are more likely to develop type 2 diabetes later in life.

If the gestational diabetes is not detected it can cause problems during and after birth.

These include; a risk of the child becoming obese or have diabetes later in life, trauma during birth and placental abruption whereby the placenta starts to come away from the wall of the womb which can cause vaginal bleeding and abdominal pain.

Other complications which can occur include; needing to induce labour, premature labour and even perinatal death, where the baby dies around the time of the birth.

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