Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
J Matern Fetal Neonatal Med. 2022 Apr;35(7):1344-1351. doi: 10.1080/14767058.2020.1754789. Epub 2020 Apr 16.
Among low-risk pregnancies, we aimed to ascertain the association between 5-minute Apgar score and adverse outcomes of newborn-maternal dyad.
We conducted a retrospective cohort study using the U.S. vital statistics datasets (2012-2016), including live births from low-risk women with non-anomalous singleton gestations who delivered at 37-41 weeks. Apgar score was categorized as low (0-3), moderate (4-6), and normal (7-10). The primary outcome was composite neonatal adverse outcome (any of the following: assisted ventilation > 6 h, neonatal seizure, or neonatal death). The secondary outcomes were infant mortality and composite maternal adverse outcome (any of the following: admission to the intensive care unit, blood transfusion, uterine rupture, or unplanned hysterectomy). Multivariable Poisson regression analyses were used to estimate the association between 5-minute Apgar score and adverse outcomes (using adjusted relative risk [aRR] and 95% confidence intervals [CI]).
Of 19.9 million live births delivered between 2012 and 2016, 11.7 million (58.7%) met inclusion criteria; 98.9% had a normal 5-minute Apgar score, 0.9% had a moderate score, and 0.2% had a low score. The overall composite neonatal adverse outcome was 3.2 per 1,000 live births and the rates were significantly higher among those with a moderate (aRR 20.8; 95% CI 20.2-21.4) or low score (aRR 43.1; 95% CI 41.6-44.5) than normal score. The overall composite maternal adverse outcome was 2.45 per 1,000 live births and it was significantly higher in deliveries with a moderate (aRR 3.1; 95% CI 2.9-3.3) and low (aRR 4.6; 95% CI 4.2-5.0) 5-minute Apgar score than those with a normal score. Infant mortality also showed a similar pattern.
Though approximate 1% of live births had a 5-minute Apgar score below 7 among low-risk pregnancies, a decreased score was associated with a significantly higher risk of neonatal and maternal adverse outcomes, as well as infant mortality.
在低危妊娠中，我们旨在确定新生儿-产妇对子的 5 分钟 Apgar 评分与不良结局之间的关联。
我们使用美国生命统计数据集（2012-2016 年）进行了回顾性队列研究，包括低危、非畸形单胎妊娠、37-41 周分娩的活产儿。Apgar 评分分为低（0-3）、中（4-6）和正常（7-10）。主要结局是新生儿不良复合结局（以下任何一种情况：辅助通气>6 小时、新生儿惊厥或新生儿死亡）。次要结局为婴儿死亡率和复合产妇不良结局（以下任何一种情况：入住重症监护病房、输血、子宫破裂或计划外子宫切除术）。多变量泊松回归分析用于估计 5 分钟 Apgar 评分与不良结局之间的关联（使用调整后的相对风险[aRR]和 95%置信区间[CI]）。
在 2012 年至 2016 年间分娩的 1990 万活产儿中，有 1170 万（58.7%）符合纳入标准；98.9%的新生儿 Apgar 评分正常，0.9%为中度，0.2%为低。总体新生儿不良复合结局发生率为每 1000 例活产儿 3.2 例，中度（aRR 20.8；95%CI 20.2-21.4）或低（aRR 43.1；95%CI 41.6-44.5）评分者显著高于正常评分者。总体产妇不良复合结局发生率为每 1000 例活产儿 2.45 例，中度（aRR 3.1；95%CI 2.9-3.3）和低（aRR 4.6；95%CI 4.2-5.0）Apgar 评分者显著高于正常评分者。婴儿死亡率也呈现出类似的模式。
尽管在低危妊娠中，约有 1%的活产儿 5 分钟 Apgar 评分低于 7，但评分降低与新生儿和产妇不良结局以及婴儿死亡率显著升高相关。
