Increasing trends in a low 5-minute Apgar score among (near) term
singletons: a Dutch nationwide cohort study
Abstract
Objective: To investigate trends in low 5-minute Apgar
scores in (near) term singletons. Design: Nationwide
cohort study. Setting: The Netherlands.
Population: A cohort of 1,583,188 singletons liveborn
between 35 +0 and 42 +6 weeks of
gestation in the period 2010-2019 from the Dutch Perinatal Registry.
Methods: We studied trends using Cochrane-Armitage trend
tests. Risk factors were studied by logistic regression analysis and
Population Attributable Risk (PAR) calculation. Main
outcome measures: Low 5-minute Apgar score (<7 and
<4) as primary outcome. Results: The
proportion of infants with low 5-minute Apgar score <7 and
<4 increased significantly between 2010 and 2019 (1.04-1.42%
(p<0.001), 0.17-0.19% (p=0.009), respectively). While
neonatal mortality remained unchanged, NICU admissions and low umbilical
artery pH’s increased significantly. Many perinatal characteristics
showed a significant association with low Apgar scores. The highest
risks were found for nulliparity, epidural analgesia, emergency
caesarean section, instrumental vaginal delivery, prolonged second stage
of labour, male sex and delivery in secondary care. The obstetric
interventions induction of labour, epidural analgesia and planned
caesarean section showed an increasing trend. Instrumental vaginal
delivery and emergency caesarean section were performed less frequently
over time, however within these obstetric intervention subgroups the
highest increase in low Apgar scores was observed.
Conclusions In the Netherlands, the risk of a low
5-minute Apgar score increased significantly over the last decade, with
the highest increase being observed in the obstetric intervention
subgroups of instrumental vaginal delivery and emergency caesarean
section. Neonatal mortality remained stable over the study period.