Obstetrics & Gynecology>>>>>The Puerperium, Lactation, and Immediate Care of the Newborn
Question 26#

A 40-year-old G4P5 at 39 weeks’ gestation has progressed rapidly in labor with a reassuring fetal heart rate pattern. She has had an uncomplicated pregnancy with normal prenatal laboratory tests, including an amniocentesis for advanced maternal age. The patient begins the second stage of labor, and after 15 minutes of pushing, starts to demonstrate recurrent variable heart rate accelerations. You suspect that she may have a fetus with a nuchal cord. You expediently deliver the baby by low-outlet forceps, and hand the baby over to the neonatologists called to attend the delivery. As soon as the baby is handed off to the pediatric team, it lets out a strong spontaneous cry. The infant is pink with slightly blue extremities that are actively moving and kicking. The heart rate is noted to be 110 beats per minute on auscultation.

What Apgar score should the pediatricians assign to this baby at 1 minute of life?

A. 10
B. 9
C. 8
D. 7
E. 6

Correct Answer is B

Comment:

The Apgar scoring system, applied at 1 minute and again at 5 minutes, was developed as an aid to evaluate infants who require resuscitation. Heart rate, respiratory effort, muscle tone, reflex irritability, and color are the five components of the Apgar score. A score of 0, 1, or 2 is given for each of the five components, and the total is added up to give one score. The following table demonstrates the scoring system.

APGAR score:

The baby described here receives an Apgar score of 9. One point is deducted for the baby not being completely pink and having blue extremities.