Historical Context of the Apgar Score

Apgar introduced her system for scoring the condition of the newborn in 1953, noting that when mothers receive an excessive amount of depressant drugs during labor, it is common for an infant to breathe once, but then become apneic for many minutes.  “A satisfactory cry is sometimes not established even when the infant leaves the delivery room.”

Five years later, Apgar (and her colleagues) wrote that scoring at one minute was done because this represented the time of most severe depression: "In the Sloane Hospital the cord has been cut by this time, and the infant is in the hands of an individual other than the obstetrician.  In many hospitals, such is not the case.  Those obstetricians who practice slow delivery and delayed clamping of the cord until pulsations of the umbilical artery cease still have the infant in the sterile field.  However, if the obstetrician is reminded of the passage of time by another observer, he may assign a score even though the cord is still attached," Apgar et al. (1958) JAMA  168:1985.

"Slow delivery" was Apgar's term for the traditional practice of waiting for pulsations in the umbilical cord to cease.  This tradition was replaced by an increasing trend during the 1930s and 1940s to clamp the umbilical cord as soon as possible after birth.  Pulsations are from the infant heart and, by nature's plan, continue until transition from placental to pulmonary respiration is complete (with closing of fetal shunts in the heart).

Apgar et al. (1958) stated, "All infants with a score of 8, 9, or 10 are vigorous and have breathed within seconds of delivery."  This became widely viewed as normal, and that the transition from fetal to neonatal respiration should take place within seconds of delivery.

Many research papers are now advocating "delayed clamping" of the cord, against the teaching of recent textbooks.  Studies going back over 130 years provide evidence for the importance of postnatal placental circulation, and should be cited in ongoing research on neonatal status.   More at http://www.placentalrespiration.net/.

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Abstract

Poster 1

FNPS 2006